GUIDELINES: PERCUTANEOUS TRANSFORAMINAL ENDOSCOPIC LUMBAR DISCECTOMY FOR SCIATICA

Evidence-based recommendations on percutaneous transforaminal endoscopic lumbar discectomy for sciatica in adults. This involves removing part of the damaged spinal disc to relieve the symptoms of sciatica.

Recommendations:

  1. Current evidence on the safety and efficacy of percutaneous transforaminal endoscopic lumbar discectomy for sciatica is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.
  2. Percutaneous transforaminal endoscopic lumbar discectomy for sciatica is a procedure that needs particular experience. Surgeons should acquire the necessary expertise through specific training and mentoring. It should only be done by surgeons who do the procedure regularly.

Indications:

Symptomatic lumbar disc herniation - radiculopathy
Lumbar discectomy is considered if there is nerve compression or persistent symptoms that are unresponsive to conservative treatment.
Surgical techniques include open discectomy / microdiscectomy or minimally invasive alternatives using percutaneous endoscopic approaches.

Procedure:

Percutaneous endoscopic lumbar discectomy procedures aim to preserve bony structures and cause less damage to paravertebral muscles and ligaments than open lumbar discectomy, allowing a shorter hospital stay and faster recovery.
Patient in the prone or lateral position using local or general anaesthesia. Under fluoroscopic guidance, a needle is inserted through the skin and the appropriate intervertebral foramen into the disc. A small guidewire is placed through the needle and the needle is exchanged for a series of dilators to create a working channel through the muscles, to the ruptured disc. An endoscope and rongeurs are used for removal of the herniated disc fragments.

NOTE: It remains the responsibility of the health care professional to ensure / prove adequate competence in performing the procedure and to show efficacy, safety and cost-effectiveness.

This is not seen as a mainstream procedure in our spinal community and adequate training is essential before a surgeon attempts this procedure.

(These Guidelines was discussed & approved at the AGM of the South African Spine Society: July 13, 2017, Cape Town)

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