Arthroscopic Discectomy of the Lumbar Spine

Although open laminotomy remains an acceptable and, at times, necessary method of treatment for herniated intervertebral discs, spinal stenosis, and various intracanal spinal disorders, arthroscopic disc surgery is emerging as an alternative method of treatment for contained and nonmigrated sequestered herniated discs. Successful performance of arthroscopic disc surgery requires technical skill and a learning curve. Prudent patient selection, adherence to inclusion and exclusion criteria, and avoidance of entry into the spinal canal when possible will reduce the incidence of perineural and intraneural fibrosis and will ensure a satisfactory outcome. Although the incidence of complications has been acceptable, a satisfactory outcome ranging from 75% to 87% has been reported after arthroscopic microdiscectomy. In contrast to nuclear debulking procedures, the objective imaging confirmation of decompression of the nerve root may be shown by immediate postoperative computed tomography or magnetic resonance imaging studies.