Skip to main content

Endoscopic spine discectomy: indications and outcomes

International Orthopaedics volume 43, pages 909–916 (2019)Cite this article

Abstract

Purpose

Percutaneous endoscopic discectomy is an effective minimally invasive spine surgery (MISS) for soft disc herniations. The objective of this review was to describe the current indications, surgical techniques, and clinical outcomes of endoscopic spine surgery.

Methods

A narrative review was performed with a focus on surgical indication of percutaneous endoscopic discectomy and the clinical outcomes in lumbar and cervical spine. Percutaneous endoscopic or full-endoscopic discectomy using a working channel endoscope was described.

Results

The basic principles, surgical techniques, and clinical outcomes in lumbar and cervical disc herniations were demonstrated. For the lumbar disc herniation (LDH), transforaminal and interlaminar approaches were reviewed, whereas for the cervical disc herniation (CDH), anterior and posterior approaches were reviewed.

Conclusions

Endoscopic spine surgery for soft disc herniation can be effective with benefits of minimal tissue trauma in properly selected cases. Given the recent technical advancements, the surgical indications for endoscopic spine surgery are still expanding and the clinical results have become more practical and reliable.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Krugluger J, Knahr K (2001) Minimally invasive disc surgery: a review. Int Orthop 24:303–306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Chang X, Chen B, Li HY, Han XB, Zhou Y, Li CQ (2014) The safety and efficacy of minimally invasive discectomy: a meta-analysis of prospective randomized controlled trials. Int Orthop 38:1225–1234. https://doi.org/10.1007/s00264-014-2331-0

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hijikata S (1989) Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop 238:9–23

    Article  Google Scholar 

  4. Kambin P, Sampson S (1986) Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res 207:37–43

    Google Scholar 

  5. Ahn Y (2012) Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices 9:361–366. https://doi.org/10.1586/erd.12.23

    Article  CAS  PubMed  Google Scholar 

  6. Ahn Y (2014) Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices 11:605–616. https://doi.org/10.1586/17434440.2014.940314

    Article  CAS  PubMed  Google Scholar 

  7. Wang K, Hong X, Zhou BY, Bao JP, Xie XH, Wang F, Wu XT (2015) Evaluation of transforaminal endoscopic lumbar discectomy in the treatment of lumbar disc herniation. Int Orthop 39:1599–1604. https://doi.org/10.1007/s00264-015-2747-1

    Article  PubMed  Google Scholar 

  8. Kambin P, O'Brien E, Zhou L, Schaffer JL (1998) Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 347:150–167

    Article  Google Scholar 

  9. Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27:722–731

    Article  Google Scholar 

  10. Onik G, Helms CA, Ginsberg L, Hoaglund FT, Morris J (1985) Percutaneous lumbar diskectomy using a new aspiration probe: porcine and cadaver model. Radiology 155:251–252

    Article  CAS  PubMed  Google Scholar 

  11. Onik G, Maroon J, Helms C et al (1987) Automated percutaneous diskectomy: initial patient experience. Work in progress. Radiology 162:129–132

    Article  CAS  PubMed  Google Scholar 

  12. Maroon JC, Onik G (1987) Percutaneous automated discectomy: a new method for lumbar disc removal. Technical note. J Neurosurg 66:143–146

    Article  CAS  PubMed  Google Scholar 

  13. Krugluger J, Knahr K (2000) Chemonucleolysis and automated percutaneous discectomy—a prospective randomized comparison. Int Orthop 24:167–169

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Hausmann B, Forst R (1983) Nucleoscope . Instrumentarium for endoscopy of the intervertebral disc space. Arch Orthop Trauma Surg 102:57–59

    Article  CAS  PubMed  Google Scholar 

  15. Schreiber A, Suezawa Y (1986) Transdiscoscopic percutaneous nucleotomy in disk herniation. Orthop Rev 15:35–38

    CAS  PubMed  Google Scholar 

  16. Mayer HM, Brock M (1993) Percutaneous endoscopic lumbar discectomy (PELD). Neurosurg Rev 16:115–120

    Article  CAS  PubMed  Google Scholar 

  17. Mathews HH (1996) Transforaminal endoscopic microdiscectomy. Neurosurg Clin N Am 7:59–63

    Article  CAS  PubMed  Google Scholar 

  18. Ditsworth DA (1998) Endoscopic transforaminal lumbar discectomy and reconfiguration: a postero-lateral approach into the spinal canal. Surg Neurol 49:588–597 discussion 597-598

    Article  CAS  PubMed  Google Scholar 

  19. Ruetten S, Komp M, Godolias G (2006) A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg 49:80–87

    Article  CAS  Google Scholar 

  20. Tajima T, Sakamoto H, Yamakawa H (1989) Diskectomy cervical percutanee. Revue Med Orthoped 17:7–10

    Google Scholar 

  21. Courtheoux F, Theron J (1992) Automated percutaneous nucleotomy in the treatment of cervicobrachial neuralgia due to disc herniation. J Neuroradiol 19:211–216

    CAS  PubMed  Google Scholar 

  22. Bonaldi G, Minonzio G, Belloni G et al (1994) Percutaneous cervical diskectomy: preliminary experience. Neuroradiology 36:483–486

    Article  CAS  PubMed  Google Scholar 

  23. Hoogland T, Scheckenbach C (1995) Low-dose chemonucleolysis combined with percutaneous nucleotomy in herniated cervical disks. J Spinal Disord 8:228–232

    Article  CAS  PubMed  Google Scholar 

  24. Knight MT, Goswami A, Patko JT (2001) Cervical percutaneous laser disc decompression: preliminary results of an ongoing prospective outcome study. J Clin Laser Med Surg 19:3–8

    Article  CAS  PubMed  Google Scholar 

  25. Laing RJ, Ng I, Seeley HM, Hutchinson PJ (2001) Prospective study of clinical and radiological outcome after anterior cervical discectomy. Br J Neurosurg 15:319–323

    Article  CAS  PubMed  Google Scholar 

  26. Ahn Y, Lee SH, Lee SC, Shin SW, Chung SE (2004) Factors predicting excellent outcome of percutaneous cervical discectomy: analysis of 111 consecutive cases. Neuroradiology 46:378–384

    Article  CAS  PubMed  Google Scholar 

  27. Chiu JC, Clifford TJ, Greenspan M et al (2000) Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty. Mt Sinai J Med 67:278–282

    CAS  PubMed  Google Scholar 

  28. Ahn Y, Lee SH, Chung SE, Park HS, Shin SW (2005) Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology 47:924–930

    Article  CAS  Google Scholar 

  29. Ahn Y, Lee SH, Shin SW (2005) Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg 23:362–368

    Article  PubMed  Google Scholar 

  30. Grieve JP, Kitchen ND, Moore AJ, Marsh HT (2000) Results of posterior cervical foraminotomy for treatment of cervical spondylitic radiculopathy. Br J Neurosurg 14:40–43

    Article  CAS  PubMed  Google Scholar 

  31. O'Toole JE, Sheikh H, Eichholz KM, Fessler RG, Perez-Cruet MJ (2006) Endoscopic posterior cervical foraminotomy and discectomy. Neurosurg Clin N Am 17:411–422

    Article  PubMed  Google Scholar 

  32. Hilton DL Jr (2007) Minimally invasive tubular access for posterior cervical foraminotomy with three-dimensional microscopic visualization and localization with anterior/posterior imaging. Spine J 7:154–158

    Article  PubMed  Google Scholar 

  33. Coric D, Adamson T (2008) Minimally invasive cervical microendoscopic laminoforaminotomy. Neurosurg Focus 25:E2. https://doi.org/10.3171/FOC/2008/25/8/E2

    Article  PubMed  Google Scholar 

  34. Ruetten S, Komp M, Godolias G (2005) An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine (Phila Pa 1976) 30:2570–2578

    Article  Google Scholar 

  35. Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S (2013) The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician 16:335–344

    PubMed  Google Scholar 

  36. Spiegl U, Hauck S, Merkel P, Bühren V, Gonschorek O (2013) Six-year outcome of thoracoscopic ventral spondylodesis after unstable incomplete cranial burst fractures of the thoracolumbar junction: ventral versus dorso-ventral strategy. Int Orthop 37:1113–1120. https://doi.org/10.1007/s00264-013-1879-4

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ahn Y (2016) Percutaneous endoscopic cervical discectomy using working channel endoscopes. Expert Rev Med Devices 13:601–610. https://doi.org/10.1080/17434440.2016.1180245

    Article  CAS  PubMed  Google Scholar 

  38. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY (2004) Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976) 29:E326

    Article  Google Scholar 

  39. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:940–948. https://doi.org/10.1097/BRS.0b013e31816c8b67

    Article  Google Scholar 

  40. Zdeblick TA, Zou D, Warden KE, McCabe R, Kunz D, Vanderby R (1992) Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am 74:22–27

    Article  CAS  PubMed  Google Scholar 

  41. Mayer HM, Brock M (1993) Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78:216–225

    Article  CAS  PubMed  Google Scholar 

  42. Hermantin FU, Peters T, Quartararo L, Kambin P (1999) A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg Am 81:958–965

    Article  CAS  PubMed  Google Scholar 

  43. Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine 31:E890–E897

    Article  PubMed  Google Scholar 

  44. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7

    Article  Google Scholar 

  45. Nellensteijn J, Ostelo R, Bartels R, Peul W, van Royen B, van Tulder M (2010) Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature. Eur Spine J 19:181–204. https://doi.org/10.1007/s00586-009-1155-x

    Article  PubMed  Google Scholar 

  46. Cong L, Zhu Y, Tu G (2016) A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. Eur Spine J 25:134–143. https://doi.org/10.1007/s00586-015-3776-6

    Article  PubMed  Google Scholar 

  47. Li XC, Zhong CF, Deng GB, Liang RW, Huang CM (2016) Full-endoscopic procedures versus traditional discectomy surgery for discectomy: a systematic review and meta-analysis of current global clinical trials. Pain Physician 19:103–118

    Article  CAS  PubMed  Google Scholar 

  48. Ruan W, Feng F, Liu Z, Xie J, Cai L, Ping A (2016) Comparison of percutaneous endoscopic lumbar discectomy versus open lumbar microdiscectomy for lumbar disc herniation: a meta-analysis. Int J Surg 31:86–92. https://doi.org/10.1016/j.ijsu.2016.05.061

    Article  PubMed  Google Scholar 

  49. Ruetten S, Komp M, Merk H, Godolias G (2009) Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22:122–129. https://doi.org/10.1097/BSD.0b013e318175ddb4

    Article  Google Scholar 

  50. Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 33:1677–1682. https://doi.org/10.1007/s00264-008-0684-y

    Article  PubMed  PubMed Central  Google Scholar 

  51. Song Z, Zhang Z, Hao J, Shen J, Zhou N, Xu S, Ni W, Hu Z (2016) Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review. Int Orthop 40:1335–1343. https://doi.org/10.1007/s00264-016-3193-4

    Article  PubMed  Google Scholar 

  52. Gillard DM, Corenman DS, Dornan GJ (2014) Failed less invasive lumbar spine surgery as a predictor of subsequent fusion outcomes. Int Orthop 38:811–815. https://doi.org/10.1007/s00264-013-2167-z

    Article  PubMed  Google Scholar 

  53. Cheng J, Wang H, Zheng W, Li C, Wang J, Zhang Z, Huang B, Zhou Y (2013) Reoperation after lumbar disc surgery in two hundred and seven patients. Int Orthop 37:1511–1517. https://doi.org/10.1007/s00264-013-1925-2

    Article  PubMed  PubMed Central  Google Scholar 

  54. Fan G, Han R, Gu X, Zhang H, Guan X, Fan Y, Wang T, He S (2017) Navigation improves the learning curve of transforamimal percutaneous endoscopic lumbar discectomy. Int Orthop 41:323–332. https://doi.org/10.1007/s00264-016-3281-5

    Article  PubMed  Google Scholar 

  55. Mazas S, Benzakour A, Castelain JE, Damade C, Ghailane S, Gille O (2018) Cervical disc herniation: which surgery? Int Orthop. https://doi.org/10.1007/s00264-018-4221-3

  56. Du J, Tang X, Jing X, Li N, Wang Y, Zhang X (2016) Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation. Int Orthop 40:1247–1252. https://doi.org/10.1007/s00264-016-3177-4

    Article  PubMed  Google Scholar 

  57. Ahn Y, Jang IT, Kim WK (2016) Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clin Neurol Neurosurg 147:11–17. https://doi.org/10.1016/j.clineuro.2016.05.016

    Article  PubMed  Google Scholar 

  58. Zheng C, Wu F, Cai L (2016) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children. Int Orthop 40:1099–1102. https://doi.org/10.1007/s00264-016-3155-x

    Article  PubMed  Google Scholar 

  59. Wang Y, Yan Y, Yang J, Zhang L, Guo C, Peng Z, Wu H, Zhang D, Kong Q (2018) Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation. Int Orthop. https://doi.org/10.1007/s00264-018-4210-6

  60. Xiaobing Z, Xingchen L, Honggang Z, Xiaoqiang C, Qidong Y, Haijun M, Hejun Y, Bisheng W (2018) "U" route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis. Int Orthop. https://doi.org/10.1007/s00264-018-4145-y

Download references

Acknowledgments

The author would like to thank Jin Ah Kim, Jae Min Son, and Ho Kim for their support and assistance with this study.

Author information

Affiliations

  1. Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea

    Yong Ahn

Authors
  1. Yong Ahn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Ahn.

Ethics declarations

Conflict of interest

The author declares that there is no conflict of interest.

Financial disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ahn, Y. Endoscopic spine discectomy: indications and outcomes. International Orthopaedics (SICOT) 43, 909–916 (2019). https://doi.org/10.1007/s00264-018-04283-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-018-04283-w

Keywords

  • Discectomy
  • Endoscopic
  • Indication
  • Interlaminar
  • Transforaminal