Does percutaneous nucleotomy with discoscopy replace conventional discectomy? Eight years of experience and results in treatment of herniated lumbar disc.

Percutaneous nucleotomy was first described in 1975 by Hijikata in Japan. In 1979 the present authors adopted this method for the treatment of lumbar disc herniation and modified Hijikata's original instruments. Since 1982 additional intradiscal optical control has been included by means of an adapted arthroscopic kit for more accurate and effective removal of the nucleus pulposus under direct view. This procedure is called discoscopy. Between 1979 and late 1987, the method was applied to 109 patients with lumbar disc herniation. The indications included lumbar sciatica that (1) was resistant to conservative treatment and (2) in which myelography and/or examination by computed tomography proved a disc protrusion without dislocation in the spinal canal. The level most affected was L4-L5. Major operative complications encountered were one vascular lesion and two cases of secondary spondylodiscitis. Clinical results in patients with other additional causes of sciatica, such as spondylolisthesis or relapse of disc herniation, were nearly as favorable as in isolated first-time disc herniation. The overall success rate was 72.5% (79/109 patients).