Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation Using an Endoscopic Staining: A Technical Note

• Published in: Orthopaedic surgery 2021-06, Vol.13 (4), p.1430-1436
• Main Authors: Tang, Jingjing, Liang, Ziyang, He, Jiahui, Shang, Qi, Zhang, Jiarui, Wu, Zhihua, Jiang, Xiaobing, Liang, De, Ren, Hui, Cui, Jianchao, Zhou, Zelong, Yao, Zhensong
• Format: Article
• Language: English
• Subjects: Back surgery; Decompression; Endoscopic surgery; Endoscopy; Intervertebral disc disease; Staining; Surgeons; Surgical Technique
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.12907

Symptomatic lumbar disc herniation (LDH) is widely treated using percutaneous endoscopic lumbar discectomy (PELD). In the present PELD surgery, performing decompression under endoscope still takes a long time to explore the rupture site of annulus fibrosus, resulting in prolonged operation time and over‐invasion of the undegenerated annulus fibrosus. A wide range of intraoperative exploration also induces an iatrogenic injury of the normal annulus fibrosus, even aggravating intervertebral disc degeneration, which may lead to early postoperative recurrence in severe case. Hence, it is important to seek a precise decompression in PELD surgery. Under this kind of realization, more spinal surgeons possibly choose a disc staining before performing decompression. However, the classical disc staining technique still has its shortcomings. First of all, an appropriate dose of staining cannot be accurately mastered, even induces unqualified staining effect. Second, the duration of surgery and the times of fluoroscopy will be increased. Finally, what surgeons see under the endoscope is the staining result but not the staining process. Hence, this is accomplished more effectively by designing procedures that perform fully visible disc staining under spinal endoscope. There is no specific research to discuss the technique note of endoscopic staining in PELD surgery. We have come up with a new original technology of endoscopic staining with methylene blue injection in PELD for treatment of LDH. This current study is to display a series cases using a new and original endoscopic disc staining. This modified technique can fully observe the process of disc staining. It also minimizes the iatrogenic injury of the intraoperative undegenerated annulus fibrosus. In addition, the learning curve is smooth and it is easy to master this technique for experienced orthopedic and neurosurgical spine specialists.