Percutaneous Lumbar Diskectomy

University of Texas Southwestern Medical Center, Dallas.

The development of an approach for percutaneous lumbar diskectomy (PLD) began over 20 years ago. Since then, clinical investigations of manual and automated PLD techniques have recorded an average success rate of 50% to 70%. Currently, the indications for PLD include (1) a major complaint of acute unilateral leg pain localized to a single dermatome associated witha a single-disk herniation; (2) neurologic signs or symptoms appropirate to a single-disk herniation; (3) magnetic resonance imaginng, computed tomographic, or diskographic evidence of a single herniation contained within the annulus of the lumbar disk; and (4) failure of a well-managed course of conservative treatment to relive the pain and symptoms. Conventional laminotomy/laminectomy, with or without the use of a microscope or surgical loupes, remains the usual method of surgical care for symptomatic lumbar disk disease. The role of PLD awaits further prospective randomized controlled studies.