[Orthopedic Percutaneous Endoscopic Lumbar Discectomy] Percutaneous Endoscopic Interlaminar Approach for Lumbar Discectomy and Nerve Decompression

Percutaneous endoscopic interlaminar discectomy (PEID) is mainly used for patients with high iliac crests and L5 transverse process hypertrophy. It is also used for L5-S1 disc herniation and extrusion that are difficult to treat with PEID. The surgical steps are as follows: 1. The patient is placed in a prone position with the lower limbs lowered and the hip and knee flexed. (Figure 26) 2. The lesion segment is located using fluoroscopy. The puncture point is marked approximately 1.0 cm lateral to the affected side in the posterior midline, according to the corresponding interlaminar space. (Figure 27) The surgical area is routinely disinfected and draped with sterile towels. 3. Local infiltration anesthesia is performed at the puncture point using 0.5% lidocaine. An 18G needle is used to puncture the interlaminar space medially to the affected side of the facet joint. The position of the needle in the interlaminar space is adjusted appropriately according to the location of the disc herniation. 4. Puncture to the outside of the ligamentum flavum, insert the guidewire, withdraw the puncture needle, make a 7-8 mm skin incision along the puncture point, and dilate the skin step by step with a dilating cannula. After sequential dilation, install the working cannula (Figure 28) and connect it to the endoscope and irrigation system. (Figure 29)

5. The ligamentum flavum is dilated. Under direct vision, a conical working cannula is gently rotated into the spinal canal along the ligamentum flavum fissure, revealing fragmented nucleus pulposus and annulus fibrosus tissue. (Figures 30-35) 6. After identifying the nucleus pulposus tissue, the herniated nucleus pulposus is removed using endoscopic nucleus pulposus forceps (Figures 36-40) until the posterior longitudinal ligament and surrounding adipose tissue are clearly visible. 7. Under direct vision, the remaining nucleus pulposus tissue is ablated and hemostatically stopped using a bipolar radiofrequency ablation electrode, and the annulus fibrosus tear shrinks and reshapes. (Figure 41)

8. A sign of adequate decompression is that the nerve root and dural sac can be seen fluctuating with respiration under endoscopy (Figure 42). After careful exploration to ensure no herniated nucleus pulposus remains, the endoscopic system is withdrawn, and the wound is sutured.