A 29-year-old male patient presented with back and radiating pain in both legs. MRI shows large disc herniation at the L4-5 level.
For successful percutaneous endoscopic lumbar discectomy, a working cannula should first be located with herniation. The left side is caudal side, right side is cranial side, 6 o’clock direction
is toward the nucleus pulposus, and 12 o’clock is toward the epidural space. Second, we make a working space with the removal of disc tissue using a side-firing laser and forceps. We then release the annular anchorage with the laser.
Third, we catch a disc fragment and pull the disc fragment by twisting the forceps.
After removal of the disc fragment, we find the torn annulus and check the epidural space. The
torn annulus is shrunk by laser and bipolar coagulator.
After the PELD, the symptoms improved and postoperative MR shows good decompression.