The historical development and status of percutaneous discectomy through 1990 is initially reviewed. Literature since 1990 is reviewed with attention to experimental data, refinements in diagnosis, additional indications for the procedure, results, complications, and technical innovations, including laser discectomy. Despite almost 20 years of experience, no study meeting acceptable standards of comparative clinical science exists comparing percutaneous discectomy with either nonsurgical management or conventional open lumbar discectomy. Based on comparisons with similarly scientifically flawed studies of conventional discectomy, the procedure appears to have a lower success rate. The potential advantages of decreased cost and morbidity have not been subjected to a scientifically sound economic analysis. As expected, significant complications with the procedure are beginning to appear in the literature. In an evidence based health care system, percutaneous discectomy will have difficulty justifying its role without careful comparative clinical studies of high scientific caliber.
- Lumbar disc herniation
- Percutaneous discectomy