Early Experience With Automated Percutaneous Lumbar Discectomy in the Treatment of Lumbar Disc Herniation

Abstract

Seventeen patients with symptomatic lumbar disc herniation were treated with automated percutaneous lumbar discectomy employing local anesthetic in an outpatient setting. Operative technique included (1) intravenous sedation and single-dose antibiotics, (2) prone oblique patient positioning for initial needle placement, and (3) postdiscectomy interspace lavage with bupivacaine hydrochloride. There were no postoperative complications and the procedure was well-tolerated by all patients. Although results have thus far been less successful than previously reported, with improved patient selection by means of routine magnetic resonance imaging (or computed tomographic discography in select cases), success rates (nine of 17 patients) might approach those achieved by chemonucleolysis. The successful response of four patients with so-called midline L4-L5 discs has been particularly encouraging, and it may be that percutaneous lumbar discectomy will be an effective and a reasonable treatment alternative for this particular subgroup of patients.