Automated Percutaneous Lumbar Discectomy for Symptomatic Contained Disc Herniation: An Updated Review

Purpose: The aim of this article is to provide an updated review of the literatures and give a summary of the evidences supporting the technical mechanism, indications, results and influential factors associated with automated percutaneous lumbar discectomy (APLD) for the treatment of symptomatic contained disc herniation. Methods: We searched the databases of PubMed and EMBASE for articles written in English and published from January 1980 to December 2014. The search terms that we used included disc herniation, disc protrusion, disc extrusion, disc prolapse, automated percutaneous lumbar discectomy/diskectomy and mechanical disc decompression. We have analysed all of the systematic reviews, meta-analyses, randomized controlled trials, nonrandomized controlled trials and observational studies in which APLD was involved for the management of contained lumbar disc herniation. Results: There have been 4 RCTs, one comparable trial and multiple observational studies reported for APLD. APLD were widely used since a roughly 75% success rate was reported initially. But its use declined after several randomized controlled trials' low success rate of this technique. Few studies have been performed in recent years and the high-quality of information available about this technique was poor because of the lack of quality controlled, blinded and randomized trials currently. However, it is difficult to conduct a randomized trial, especially placebo controlled in interventional pain management. Conclusion: APLD is a safe procedure with minimal complications, and it may provide appropriate choice for the patients with contained disc herniation. For the patients with recurrent disc herniation after conventional surgical procedures, APLD may be an alternative choice.