Percutaneous endoscopic lumbar discectomy: minimally invasive technique for multiple episodes of lumbar disc herniation

Backgrounds: Although open lumbar discectomy is a gold standard surgical technique for lumbar disc herniation (LDH), surgery-induced tissue injury may actually become a source of postsurgical pain. Percutaneous endoscopic lumbar discectomy (PELD) is introduced as a minimal invasive spinal technique for LDH. The PELD has gained popularity and shown successful results. The authors report the clinical usefulness of the PELD technique in two patients with the serial multilevel LDHs. Case presentations: A 32-year-old man suffered from radicular pain at the L5 dermatome due to the down migrated soft LDH at the L4-5 level. The PELD was performed to remove the ruptured fragments, yielding a complete decompression of the L5 nerve root. Four years later, he visited the clinic because of right leg radiating pain along the S1 dermatome. An MRI scan revealed the LDH at the L5-S1 level. The PELD with foraminoplasty was also performed successfully at the L5-S1 level. Two months after the second PELD, he visited the clinic again because of severe pain along the left L4 dermatome; consequently, the PELD was also performed at the L3-4 level without any complications. A 34-year-old man presented with radiating pain in the back and both legs at the L5 dermatome. The MR images show a disc extrusion at the L4-5. The patient underwent the PELD at the L4-5 via the left approach. After the PELD, the back and leg pain both improved. One year later, the patient suffered from severe pain in the back and the left anterior thigh. The MR images show a left paramedian LDH at the L2-3. After the PELD was performed at the L2-3, the pain was relieved. The final MR images show no signs of any aggravated degeneration of the intervertebral discs or the facet joints at all of the treated levels. Conclusion: When multiple episodes of LDH occur in a patient's life span, PELD could be considered as an alternative good technique to treat LDH in each step by preserving normal anatomic structures.