History and current status of percutaneous arthroscopic disc surgery

Study Design. The relevant literature and the author's experience with the management of lumbar disc herniation is reviewed. Objectives. To describe the history of percutaneous arthroscopic discectomy, and to discuss the indications, the procedure's scientific validity, and its outcome. Summary of Background Data. In contrast to nuclear-debulking procedures, arthroscopic microdiscectomy is target-oriented and capable of retrieving the compressive elements in a carefully selected patient population. The insult to myoligamentous stabilizing structures and intracanalicular tissues is minimal. Extraction of herniated fragments not only can be demonstrated under arthroscopic visualization but also via postoperative imaging studies. Methods. Search of the literature and the author's experience with arthroscopic disc surgery. Results. Arthroscopic microdiscectomy has a learning curve. In properly selected patients, a successful outcome similar to macro- or microdiscectomy may be achieved. Conclusions. Proper patient selection is paramount to a successful outcome of arthroscopic disc surgery. Sequestered migrated herniations and large central herniations at L5-S1 in individuals with elevated iliac crests will require open surgery.