Guidance
3 The procedure
3 The procedure
3.1 Percutaneous endoscopic lumbar discectomy aims to preserve bony structures and cause less damage to paravertebral muscles and ligaments than open discectomy, allowing a shorter hospital stay and faster recovery. An interlaminar approach provides an alternative to the transforaminal approach for treating central or centro-lateral disc extrusions, especially at the L5–S1 level where the transforaminal approach is difficult.
3.2 Percutaneous interlaminar endoscopic lumbar discectomy is usually done with the patient in the prone position using local or general anaesthesia. Under fluoroscopic guidance, a guidewire is inserted into the appropriate interlaminar space. Dilators are used to expose the ligamentum flavum and the ruptured disc is accessed through this ligament. An endoscope and rongeurs are used to remove the herniated disc fragments. A laser may also be used to aid removal of the disc. The patient can usually mobilise within a few hours of the procedure.