Percutaneous transforaminal endoscopic lumbar discectomy for sciatica

3 The procedure

3.1 Percutaneous endoscopic lumbar discectomy procedures aim to preserve bony structures and cause less damage to paravertebral muscles and ligaments than open lumbar discectomy, allowing a shorter hospital stay and faster recovery. Percutaneous transforaminal endoscopic lumbar discectomy is done with the patient in the prone or lateral position using local or general anaesthesia. Under fluoroscopic guidance, a needle is inserted through the skin and the appropriate intervertebral foramen into the disc. A small guidewire is placed through the needle and the needle is exchanged for a series of dilators to create a working channel through the muscles, to the ruptured disc. An endoscope and rongeurs are used for removal of 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.