Spine update. Percutaneous lumbar disc surgery.

Various techniques of percutaneous lumbar disc surgery have become popular for treating lumbar disc herniations. There is a vast and increasing body of literature on this topic that consists mainly of retrospective, uncontrolled clinical studies, technical articles, and case reports. A literature analysis revealed two different techniques, both termed "percutaneous discectomy." One is the selective removal of nucleus pulposus from the herniation site with various manual and automated instruments under endoscopic control (percutaneous nucleotomy with discoscopy, arthroscopic microdiscectomy, percutaneous endoscopic discectomy); the other is the removal of nucleus pulposus from the center of the disc space with one single automated instrument (automated percutaneous lumbar discectomy) to achieve an intradiscal decompression. Selective percutaneous discectomy with endoscopic control requires a restrictive selection of patients and can achieve clinical results comparable with microdiscectomy under controlled conditions. There is no scientifically proven validity of automated percutaneous lumbar discectomy compared with standard surgical methods and chemonucleolysis. The majority of the articles analyzed did not fulfill the selection criteria of Spine. Additional prospective, randomized and controlled studies are needed to define the eventual role of percutaneous lumbar discectomy on a scientific basis.