Operative failure of percutaneous endoscopic lumbar discectomy: A radiologic analysis of 55 cases

Study Design. A retrospective study. Objective. To determine the range of lumbar disc herniation that can be addressed effectively using current endoscopic techniques. Summary of Background Data. The current technical limitation of the procedure in terms of the location and size of the herniation has not been fully documented in previous studies. Methods. The inclusion was an intracanal lower lumbar disc herniation in which subsequent surgery was performed because of the presence of remnant fragments. All 1586 cases, including 55 failed cases, were classified according to the size, location, and extent of migration. Results. In the nonmigrated herniations, the central located high-canal compromised (> 50%) herniations showed the highest rate of failure (15%), and the rate was significantly different from the low and high-canal compromise group (1.9% and 11.1%, respectively, P < 0.001). There was no significant difference in the failure rate between the nonmigrated herniations and low-grade migration group (2.7% and 3.7%, respectively). However, the high-grade migration group (beyond the measured height of the posterior marginal disc space) showed a significantly high-incidence of failure (15.7%, P < 0.001). Conclusions. Based on these results, open surgery may be considered for herniations with high-canal compromise and high-grade migration. On the other hand, percutaneous endoscopic lumbar discectomy can be considered to be a surgical option in the remaining intracanal disc herniations.