Percutaneous Endoscopic Lumbar Discectomy (PELD) - Minimal Invasive Spine Surgery in india

Percutaneous Endoscopic Lumbar Discectomy (PELD)

PELD or Percutaneous Endoscopic Lumbar Discectomy is an advanced minimally invasive spine surgery done for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. PELD is also a good treatment option in management of spinal tumors and structural deformities also in patients whose pain threshold is low or who are not responding well to conservative treatments like pain killers, anti inflammatory drugs and rehabilitation.

Percutaneous Endoscopic Lumbar Discectomy (PELD) is not the Conventional excision but a treatment which in between the conservative and open surgery. Therefore, it does not disrupt the normal soft tissue or the vertebral structures. After inserting a thin wire into the skin, the surgeons treat the herniated disc with laser and radio-frequency thermal effect under endoscopic guidance.


 

What is Percutaneous Endoscopic Lumbar Discectomy (PELD)?

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a unique approach for the treatment of non-sequestrated disc herniation (disc prolapse). An advanced minimal invasive technique, PELD is performed for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. In addition to decompression surgery, the technique has been found effective in management of spinal tumors and structural deformities.

What does the procedure involve? 

Percutaneous Endoscopic Lumbar Discectomy is a minimal invasive spine surgery. It is an endoscopic surgical procedure which is conducted under local anaesthesia with mild sedation. The patient is made to lie on his/her front and the exact entry point is mapped on patient’s body using image intensifier X-ray system. A small incision of about 8-10 cm is made from the midline on the posterior part of the body.
 

There are two different ways in which the inter-vertebral disc material can be removed:

• Manual procedure also known as Automated Percutaneous Discectomy involves insertion of a long spinal needle from the side of the back, directly into the disc, by-passing other bone and ligaments. Through this needle, guide wire is passed and after making a 5 mm incision, a dilator and working cannula are passed, through which an endoscope is inserted. The prolapsed part of disc is removed with the guidance of the camera and monitor attached to the endoscope.
• The laser surgery, referred to as Percutaneous Laser Discectomy (PLD), uses an external imager called the fluoroscope to direct the probe. The probe delivers laser energy which vaporizes a part of the inter-vertebral disc material and decompresses the nerve root. The most frequently used laser for treatment is Holmium Yttrium-Aluminum-Garnet (YAG) laser.

In either procedure, the wound is closed with single stitch. The patient gets immediate pain relief.

Duration: 60 minutes

Risks

• Improper placement may result in nerve damage
• Inadequate decompression may result in the need for a second operation, using a different technique
  

Benefits

• Surgery is done under local anaesthesia
• No muscle, ligament or normal tissue damage and minimal blood loss
• No prolonged bed rest required after surgery
• Early return to work
• Even prolapsed, migrated, extra-foraminal, recurrent discs can be removed
• Very good technique for old and medically compromised patients