title: Automated percutaneous lumbar discectomy: a prospective multi-institutional study.
abstract: OBJECTIVE
  A prospective study in 10 independent hospitals from 1992 to 1994 evaluated automated percutaneous lumbar discectomy (APLD) with a newly designed percutaneous instrument.
  
  
  METHODS
  One thousand five hundred eighty-two APLD procedures were performed in 1,525 patients with disc herniation or back pain. Mean follow-up after APLD was 18.3 months. Follow-up of at least 1 year was available in 1,474 patients. One thousand two hundred eighty-nine patients had sciatic pain and 185 had back pain only. Eight hundred twenty-two patients had symptoms for less than 2 years, 652 for more than 2 years. One thousand two hundred sixty-two patients were older than 60 years, 212 were younger than 60 years. Nine hundred fifty patients had disc protrusion, and 357 had sequestration. Forty-eight patients had disc or longitudinal ligament calcification. Twenty-two had previous surgical discectomy. All discectomies were done with use of a straight needle with the patient in the lateral decubitus position.
  
  
  RESULTS
  Success rate (measured by Hijikata's criteria) was 83% at 1 year. Success was significantly greater for protrusion versus sequestration (86% vs 72%, P < .001); for back pain alone versus leg and back pain (89% vs 80%, P < .005); for duration of symptoms less than 2 years versus more than 2 years (85% vs 79%, P < .005); and for age younger than 60 years versus older than 60 years (84% vs 76%, P < .01). Among postsurgical patients, success rate was 77% (17 of 22 patients). The only complication was discitis (0.06%, nine patients). Technical success at L5-S1 was 99% (795 of 800).
  
  
  CONCLUSIONS
  APLD with Teng's instrument has excellent results. Indications may include back pain alone. A straight needle can be used at L5-S1 in most patients, with proper positioning.
authors.affiliation: Department of Radiology, Nanjing Railway Medical College, China.
authors.forename: G J
authors.initials: GJ
authors.lastname: Teng
authors.forename: R F
authors.initials: RF
authors.lastname: Jeffery
authors.forename: J H
authors.initials: JH
authors.lastname: Guo
authors.forename: S C
authors.initials: SC
authors.lastname: He
authors.forename: H Z
authors.initials: HZ
authors.lastname: Zhu
authors.forename: X H
authors.initials: XH
authors.lastname: Wang
authors.forename: Y Z
authors.initials: YZ
authors.lastname: Wu
authors.forename: J M
authors.initials: JM
authors.lastname: Lu
authors.forename: X L
authors.initials: XL
authors.lastname: Ling
authors.forename: Y
authors.initials: Y
authors.lastname: Qian
authors.forename: Y M
authors.initials: YM
authors.lastname: Zhang
authors.forename: M J
authors.initials: MJ
authors.lastname: Zhu
authors.forename: L
authors.initials: L
authors.lastname: Guan
authors.forename: X M
authors.initials: XM
authors.lastname: He
mesh_terms: D017587:Diskectomy, Percutaneous / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012447:Sacrum / Q000601:surgery; D013525:Surgical Instruments; D013997:Time Factors