• Sang-Ho Lee, Kyung-Chul Choi, Oon Ki Baek, Ho Jin Kim, and Seung-Hwa Yoo.
• *Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea †Department of Neurosurgery, Daegu Wooridul Spine Hospital, Daegu, Korea; and ‡Wooridul Institute for Biomedical Science and Technology, Seoul, Korea.
• Spine. 2014 Apr 1;39(7):E473-9.

Study DesignTechnical case report.ObjectiveTo describe the novel technique of percutaneous endoscopic herniotomy using a unilateral intra-annular subligamentous approach for the treatment of large centrally herniated discs.Summary Of Background DataOpen discectomy for large central disc herniations may have poor long-term prognosis due to heavy loss of intervertebral disc tissue, segmental instability, and recurrence of pain.MethodsSix consecutive patients who presented with back and leg pain, and/or weakness due to a large central disc herniation were treated using percutaneous endoscopic herniotomy with a unilateral intra-annular subligamentous approach.ResultsThe patients experienced relief of symptoms and intervertebral disc spaces were well maintained. The annular defects were noted to be in the process of healing and recovery.ConclusionPercutaneous endoscopic unilateral intra-annular subligamentous herniotomy was an effective and affordable minimally invasive procedure for patients with large central disc herniations, allowing preservation of nonpathological intradiscal tissue through a concentric outer-layer annular approach.

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