Lumbar discectomy classification

see Percutaneous laser disc decompression

Percutaneous Endoscopic Lumbar Discectomy

a) Standard open lumbar discectomy: 65–85% reported no sciatica one-year post-op compared to 36% for conservative treatment.

Long-term results (> 1 year) were similar. 10% of patients underwent further back surgery during the first year

b) Lumbar microdiscectomy: similar to standard procedure, but a smaller incision is utilized. Advantages may be cosmetic, shortened hospital stay, lower blood loss. It may be more difficult to retrieve some fragments.

Overall efficacy is similar to standard discectomy

c) sequestrectomy: removal of only the herniated portion of the disc without entering the disc space to remove disc material from there.

see Intradiscal surgical procedures.

Minimally invasive surgery (MIS) techniques have emerged as viable and safe alternatives for lumbar disc herniation, including percutaneous lumbar discectomy, percutaneous endoscopic lumbar discectomy, and minimally invasive tubular microdiscectomy.

A meta-analysis revealed that minimally invasive tubular microdiscectomy and percutaneous endoscopic lumbar discectomy, the most commonly employed MIS techniques for discectomy, can be used as safe alternatives for open discectomy depending on the preference of the operating surgeon ¹⁾.

Microsurgery is considered a standard procedure. However, since the herniated fragment was identified as the offending agent, it has always considered necessary to remove fragment only or the entire disc. This dogma is based on the assumption that increased rates of recurrent disc herniations would follow sequestrectomy alone. For the small subgroup of patients with a free fragment compressing the nerve root, Williams was the first to report encouraging results following minimal removal of tissue from the intervertebral disc space ²⁾.

The frequency of herniotomy is gradually increasing in LDH treatment. Herniotomy used to be synonymous with fragmentectomy or sequestrectomy. The term 'herniotomy' is defined as removal of the herniated disc fragment only, and the 'conventional discectomy' as removal of the herniated disc and degenerative nucleus from the intervertebral disc space.

Minimally invasive discectomy (MID) may be inferior in terms of relief of leg pain, LBP and re-hospitalisation; however, differences in pain relief appeared to be small and may not be clinically important. Potential advantages of MID are lower risk of surgical site and other infections. MID may be associated with shorter hospital stay but the evidence was inconsistent. Given these potential advantages, more research is needed to define appropriate indications for MID as an alternative to standard MD/OD.

In the U.S., it has been estimated that the Medicare system spends over $300 million annually on lumbar discectomies.