title: Advantages and disadvantages of posterolateral approach for percutaneous endoscopic lumbar discectomy.
abstract: BACKGROUND
  Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments for lumbar disc herniation (LDH), and has 3 different operative approaches. This study focused on the posterolateral approach (PLA) and investigated the appropriate operative indication.
  
  
  METHODS
  PLA was performed in 29 patients with foraminal and extraforaminal LDH. The height and width of the foramen, LDH type, and positional relationship between LDH and the foramen were radiologically evaluated. Foraminoplasty was also performed in 12 cases including those combined with intra-canal LDH or osseous foraminal stenosis. Pre- and postoperative status was evaluated using Numerical Rating Scale (NRS) scores.
  
  
  RESULTS
  Patient mean age was 56.8 years; there was single-level involvement at L3/4 (13 cases) and at L4/5 (13 cases). The mean pre- and postoperative NRS scores were 6.1 and 1.8, respectively. Early recurrence developed in a patient who was found to have local scoliosis at the corresponding vertebral level.
  
  
  CONCLUSIONS
  PLA can be safely used to treat foraminal and extraforaminal LDH with foraminal height ≥13 mm and foraminal width ≥7 mm. The procedure is effective for preserving the facet joint; however, we should carefully consider the indications when local scoliosis and/or instability are present.
authors.affiliation: Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Yokosuka
authors.affiliation: Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan; ; Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takano
authors.affiliation: Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Inanami
authors.affiliation: Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Koga
keywords: Percutaneous endoscopic lumbar discectomy (PELD); foraminoplasty; lumbar disc herniation (LDH); minimally invasive; posterolateral approach