THE PERCUTANEOUS TRANSFORAMINAL APPROACH TO THE EPIDURAL SPACE FOR ENDOSCOPIC TREATMANT OF NON-CONTAINED HERNIATED DISCS

The authors report their preliminary experiences with the percutaneous transforaminal approach to the epidural space. 85 patients were treat ed endoscopically for non-contained lumbar herniated discs. Very good and good results of 20 patients (learning curve) were obtained in 65%. However, reoperation rate was 25% versus 3% for the last 65 patients. The first 50 patients were treated under local anaesthesia, the last 35 patients under general anaesthesia. Operative technique is describe d in detail. Laser application in the epidural space is helpful for ti ssue ablation and to obtain hemostasis. No complications were observed . The main advantages of this new minimal invasive technique are, besi des reduced morbidity, less epidural scaring and removal of the seques tered tissue under visual control while retaining disc tissue in the i ntervertebral space. Thus, the disadvantages of open nucleotomy with p ossible instability and abundant scaring may be avoided.