Percutaneous endoscopic laser discectomy

Background: The aim of the present paper was to systematically review the l iterature on percutaneous endoscopic laser discectomy (PELD) with respect t o the safety and efficacy of the procedure. Where possible the procedure wa s compared with open discectomy. Methods: Studies on PELD were identified using MEDLINE (1984 to December 19 99), EMBASE (1974 to December 1999) and Current Contents (1993 to Week 1, 2 000). A number of search terms were used: PELD; PLDD (percutaneous laser di sc decompression); and laser and (spine or lumbar) and (disc* or disk*). Th e Cochrane Library was searched from 1966 to issue 4, 1999, using the searc h term 'discectom' or 'discotom'. Live human studies of patients with lumba r disc prolapses for whom surgery was appropriate were included. Cadaver st udies were also included. A surgeon and reviewer independently assessed the retrieved articles for their inclusion in the review. Results: Only 12 papers were identified that related to PELD. The level of evidence for safety and efficacy was low; there were no controlled, blinded or randomized studies. The highest level of evidence came from time series studies. No quantitative analysis could be undertaken for the present revi ew. Conclusions: Given the extremely low level of evidence available fur this p rocedure it was recommended that the procedure be regarded as experimental until results are available from a controlled clinical trial, ideally with random allocation to an intervention and control group.