Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation Using an Endoscopic Staining: A Technical Note

Abstract

Symptomatic lumbar disc herniation (LDH) is widely treated using percutaneous endoscopic lumbar discectomy (PELD). In the present PELD surgery, performing decompression under endoscope still takes a long time to explore the rupture site of annulus fibrosus, resulting in prolonged operation time and over-invasion of the undegenerated annulus fibrosus. A wide range of intraoperative exploration also induces an iatrogenic injury of the normal annulus fibrosus, even aggravating intervertebral disc degeneration, which may lead to early postoperative recurrence in severe case. Hence, it is important to seek a precise decompression in PELD surgery. Under this kind of realization, more spinal surgeons possibly choose a disc staining before performing decompression. However, the classical disc staining technique still has its shortcomings. First of all, an appropriate dose of staining cannot be accurately mastered, even induces unqualified staining effect. Second, the duration of surgery and the times of fluoroscopy will be increased. Finally, what surgeons see under the endoscope is the staining result but not the staining process. Hence, this is accomplished more effectively by designing procedures that perform fully visible disc staining under spinal endoscope. There is no specific research to discuss the technique note of endoscopic staining in PELD surgery. We have come up with a new original technology of endoscopic staining with methylene blue injection in PELD for treatment of LDH.

Efficacy and safety of unilateral biportal endoscopic discectomy and conventional endoscopic discectomy in the treatment of lumbar disc herniation: a systematic review and meta-analysis

“…The UBE is widely indicated and has good efficacy in the treatment of diseases, such as LDH and epidural peptide swelling (30). The UBE technique was used for a long time because of its many advantages, but it was gradually stopped being used following the rapid development of single-channel operations; however, after improvements and innovations by Korean scholars, it has begun to be re-appreciated and promoted by domestic physicians in recent years (31). Since we started using this technique at the end of 2020, we found that there are still many intraoperative difficulties and shortcomings that require attention and improvement.…”

Can the Full-Percutaneous Endoscopic Lumbar Discectomy in Day Surgery Mode Achieve Better Outcomes Following Enhanced Recovery after Surgery Protocol? A Retrospective Comparative Study

“…Patients with the LDH often seek medical attention for discogenic low back pain or radiating pain, most of which are caused by herniated discs pressing on nerves (1,2). Percutaneous endoscopic lumbar discectomy (PELD) has recently become popular in the treatment of LDH due to the smaller skin incision, light tissue damage, shorter operation time, rapid recovery, and earlier return to work (3)(4)(5). At present, most studies show that the average length of stay of PELD as a traditional model is 2 to 5 days (6)(7)(8).…”