Current concepts in minimally invasive discectomy.

OBJECTIVE: The purpose of this study was to evaluate the various minimally invasive procedures available for the treatment of lumbar disc disease.

METHODS: A review of the literature, as well as my personal experience with minimally invasive approaches to the lumbar discs, was performed. This review included the percutaneous and open surgical approaches currently available and used for the treatment of lumbar disc disease.

RESULTS: The primary minimally invasive procedures for the treatment of lumbar disc disease include the following: 1) chemonucleolysis, introduced by Lyman Smith in 1964; 2) percutaneous manual nucleotomy, introduced by Hijikata in 1975; 3) microdiscectomy, first performed by Yaşargil in 1968; 4) automated percutaneous lumbar discectomy, introduced by Onik in 1984; 5) laser discectomy, first performed by Ascher and Choy in 1987; 6) endoscopic discectomy, first used by Schreiber and Suezawa in 1986 and improved by Mayer, Brock, and Mathews; 7) microendoscopic discectomy, introduced by Smith and Foley in 1995; and 8) intradiscal electrothermy, first reported by Saal and Saal in 2000.

CONCLUSION: Although all percutaneous techniques have been reported to yield high success rates, to date no studies have demonstrated any of these to be superior to microsurgical discectomy, which continues to be regarded as the standard with which all other techniques must be compared.