Automated Percutaneous Lumbar Discectomy in the Treatment of Herniated Discs

Abstract

ducing automated percutaneous lumbar discectomy (APLD).1 At that time, there was tremendous resistance to the concept of a minimally invasive treatment for herniated lumbar discs. Chemonucleolysis had rushed onto the scene with great fanfare, only to be destroyed by the occurrence of devastating complications, such as transverse myelitis. At that time there was essentially no field of minimally invasive lumbar spine surgery. The concept of minimally invasive lumbar spine surgery, exemplified by APLD, has stood the test of time. Based on the massive amount of data accumulated on APLD, percutaneous discectomy gained its own CPT code, emerging from the twilight zone of experimental procedures. Those most opposed to the concept of minimally invasive spine surgery, the neurosurgical community, have acknowledged its impact on the treatment of patients with herniated discs.2 Although perhaps not reaching its full potential in the volume of cases performed, APLD has had a significant impact on the evolution of disc therapy; it has been extremely successful in achieving its major goal, that of safety. The original intent of APLD was to have a highly safe, minimally invasive treatment for lumbar disc herniations, with a reasonable success rate. At least 170,000 APLD procedures (probably more, since outside the United States the disposable instrument has been routinely resterilized) have been performed with a mortality rate of zero: there has never been a report of death associated with the procedure. In over 50 published series, there has been no instance of permanent nerve injury or great vessel damage, the only reported complication being discitis at a rate of 0.2%, equivalent to that of discography.3,4 It can now be said unequivocally that APLD is the safest treatment available for herniated lumbar discs. Contrast this with open discectomy, or even microdiscectomy, as reported by Ramirez and 8