Feasibility and clinic application of percutaneous lateral endoscopic discectomy

Objective:To investigate the anatomic evidence of percutaneous lateral endoscopic discectomy and observe the result of clinical application.Method:28 patients of L4/5 disc herniation on the plane of L4/5 disc in prone position were examined by CT scan.To observe the anatomic structures from the point of percutaneous puncture to the vertebral canal and the pathway puncturing in 90° between lumbar lateral and vertebral canal,the distance between the point of puncture and the skin of posterior median line was measured.66 patients of lumbar disc herniation were treated using percutaneous lateral endoscopic discectomy,the results of treatment and complications were observed.Result:The important structures from outside to inside using lateral puncture were medium structures of lumbodorsal fascia(obliquus externus abdominis,obliquus internus abdominis,transversus abdominis,lumbar quadrate muscle),deep lamella of lumbodorsal fascia,greater psoas muscle,intervertebra foramina and vertebral canal.The distance from puncture point to the posterior median line was 18.08±1.88cm.The distance between the puncture point to the superior articular process anterior border was 13.70±1.69cm.We punctured vertebral canal directly in 27 cases out of 28 patients,and had no any anatomic injury along puncture line.Two cases nerve injuries did not related with puncture action and two cases received secondary open operation.Conclusion:It is feasible to enter vertebral canal through anterior border of superior articular process from lateral side.It is one method to the cases of severe intercanal herniation that does not seat in the same plane of interspace treated with a minimal incision.