PERCUTANEOUS ENDOSCOPIC LUMBAR DISCECTOMY: INDICATIONS AND COMPLICATIONS

Abstract

In the technique of percutaneous endoscopic lumbar discectomy (PELD), access to the
disc is achieved through Kambin's triangle, formed by the exiting nerve root (hypotenuse), the
superior endplate of the caudal vertebra (base), and the superior articular process of the caudal
segment (height).
The PELD procedure involves removing the nucleus pulposus using forceps within the annulus
fibrosus, thus being considered an "inside-out" technique, which complicates the removal of a
migrated disc herniation [1,2,3].
During the PELD technique, foraminoplasty is performed using sequential trephines, followed by
the insertion of an endoscope into the spinal canal to remove herniated material. Thus, PELD is
regarded as an "outside-in" technology, providing significant advantages for treating highly
migrated disc herniations and lumbar spinal stenosis [4,5,6,7].
Regarding the L5/S1 segment, puncture through the foraminal opening can be technically
challenging due to the high iliac crest, large L5 transverse process, and concealed location of the
herniated material. In such cases, the interlaminar approach may be a more preferable option [8,9].