space 1px
submain image
Home > Medical Service > Spine > Surgical Procedure
Select Surgical Procedure

Percutaneous Endoscopic Lumbar Discectomy (PELD)

Percutaneous Endoscopic Lumbar Discectomy (PELD) is not the Conventional excision but a treatment which in between the conservative and open surgery. Therefore, it does not disrupt the normal soft tissue or the vertebral structures. After inserting a thin wire into the skin, the surgeons treat the herniated disc with laser and radio-frequency thermal effect under endoscopic guidance.

Advantages
- Under the local anesthesia, the elderly patients or even the diabetes patients could tolerable the procedure.
- Cosmetic effects since it is minimally invasive spinal surgery.
- It preserves vertebrae and normal nucleus pulposus and removes only the lesional site so that there is no risk of evoking the neural adhesion. Bloodless surgery, no transfusion is required.
- It saves the time and the costs. 75% of the patients discharged on the same.
- Due to rapid recovery, comparing to open surgeries, it is recommendable for the workers or students with the desire of early return-to-work.

Surgical Techniques
- Patient is in prone position under the local anesthesia so as to communicate with the surgeons and nurses. The surgeon inserts the thin wire into the disc. With the 0.6cm (diameter) of endoscope, the surgeon could observe the inside with safety. With the better view under endoscope, minute forceps, radio-frequency, and Holmium-YAG laser, the surgeon could make the disc shrink so as to diminish the pain. This treatment, regarded as the third generation, is more advancing that the previous first, second generation laser therapy with following additional effectiveness.
- Minimized excision effect (with laser, as fine as hair, which could approach into the small and narrow spinal canal)
- Prevent lumbar pain effect (pain nerve that distributed to posterior annulus fibrosis)
- Disc diminishing effect (diminish the extruded disc)
- Disc intensifying effect (remodeling the collagen component of disc material)
- Hemostasis effect (coagulation)

Laser technique under the endoscopic view Radio-frequency technique under the endoscopic view


Indications
This surgical technique is in between the conservative therapy and open surgery. Therefore, either lumber disc herniation or extraforaminal stenosis is an indication, which shows no improvement after conservative therapy.

Prognosis
Successful rate is 93% and 7% showed the recurrence. The 7% recurrence was due to combined spinal canal stenosis.

MRI image of preoperation
A ruptured disc that is dehydrated as black color between 4th and 5th lumbar vertebra is compressing the nerve root.
MRI image 3years after the surgery
The corresponding disc level I is maintaining its original height while the ruptured portion is disappeared.


Caring for a patient after surgery

Post operative 1 week
  • Please take a rest at least three days. It is OK to sit, stand and walk with proper position shortly.
  • Please avoid from twistingor bending your back, lifting heavy materials or sitting longer than one hour.
  • You had better have meals on standing posture.
  • Please keep your back straighten up or extended when you stand.
  • It is OK to walk for 30 minutes with right position. Back exercise is not allowed.
  • It is necessary to sterilize the incision and the dressing would be removed 10 days after the surgery. Doctor consultation is necessary.
  • Please wear the brace while moving. The patient does need to wear the brace while lying down or sleeping.
Post operative 2 week
  • The patient may get back to work or school but avoid twisting or bending their back.
  • The patient may take shower or bath. When washing face and hair, you would better keep your back straighten up under shower machine.
  • The patient may drive by himself for only short distance.
  • Please start back stretching exercise two weeks after the operation.
Post operative 3 to 6 week
  • The patient may perform light works.
  • Sex-life is allowed.
  • On supine position, the patient may do flexion-extension back exercise. Climbing is more recommendable compared to the swimming.
Post operative 6 week
  • The patient does not need to wear the brace longer than 6 weeks. If you still want to protect your back while working or doing exercise, you may wear ASTROBACK (Cushion protector) instead of the brace.
  • Conservative therapy such as intensifying exercise (Medex program, Centaur program) and flexibility exercise (Gyrotonic program) are recommendable.
Post operative 3 months
  • The patient is recommended to take the CT or MRI in order to confirm the disc condition at this time. You had better consult with doctor to check your disc condition on 6 months, 1 year and 2 years after the operation, if possible.
Other
  • It is recommendable to pull back your seat to 135° while seated in a vehicle immediately after the discharge.
  • It is important to intake plenty of vegetable while controlling your calorie in order to avoid constipation.
  • Please reduce fat consumption and avoid overeating.
  • If you are taking medicine due to Diabetes, Hypertension or Cardiac diseases, you should consult with your physician for the medication schedule before and after surgery.