• Subash C Jha, Ichiro Tonogai, Yoichiro Takata, Toshinori Sakai, Kosaku Higashino, Tetsuya Matsuura, Naoto Suzue, Daisuke Hamada, Tomohiro Goto, Toshihiko Nishisho, Takahiko Tsutsui, Yuichiro Goda, Mitsunobu Abe, Kazuaki Mineta, Tetsuya Kimura, Akihiro Nitta, Shingo Hama, Tadahiro Higuchi, Shoji Fukuta, and Koichi Sairyo.
• Department of Orthopedics, Tokushima University, Tokushima, Japan. 2. Department of Orthopedics and Traumatology, Kathmandu University Hospital, Dhulikhel, Nepal.
• J. Med. Invest. 2015 Jan 1; 62 (1-2): 100-2.

AbstractMicrosurgery for lumbar disc herniation that requires surgical intervention has been well described. The methods vary from traditional open discectomy to minimally invasive techniques. All need adequate preanesthetic preparation of patients as general anesthesia is required for the procedure, and nerve monitoring is necessary to prevent iatrogenic nerve injury. Conventional surgical techniques sometimes require the removal of the corresponding lamina to assess the nerve root and herniated disc, and this may increase the risk for posterior instability of the vertebral body. Should this occur, fusion surgery may be needed, further increasing morbidity and cost. We present here a case of lumbar herniated disc fragments causing acute cauda equina syndrome that were endoscopically resected through a transforaminal approach in an awake patient under local anesthesia. Percutaneous endoscopic discectomy under local anesthesia proved to be a better alternative to open back surgery as it made immediate intervention possible, was associated with fewer perioperative complications and morbidity, minimized soft tissue damage, and allowed early rehabilitation with a better outcome and greater patient satisfaction. In addition to these advantages, percutaneous endoscopic discectomy protects other approaches that may be needed in subsequent surgeries, whether open or minimally invasive.

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