Percutaneous Endoscopic Lumbar Discectomy on L5-S1: Comparison of Modified Knee-Chest and Prone Position in Terms of Foraminal Height and Puncture Time

Abstract

All the patients involved met the inclusion criteria: diagnosed with L5-S1 intervertebral disc herniation by preoperative magnetic resonance imaging scan, radiating limb pain, and positive straight leg raise test. The patient rested on the knees and chest with head was turned to one side, arms extended on the bed, and elbows flexed and resting so that they partially bear the patient's weight; the abdomen remained unsupported, though a small pillow might be placed under the chest; with bilateral 45° hip flexion as well as a 30° knee flexion until the “flat-back” of the patient could be seen. PELD is performed under local anesthesia, the tolerance of the patients should be considered during the operation due to aggravated sciatica. Because transforaminal endoscopic discectomy surgery has a steep learning curve which requires many years of training and experience, patients who were treated at the beginning of the learning curve sometimes have bad experience of pain during the procedure. [...]there were more advantages in L5-S1 PELD using MKC position than prone position during the PELD procedure.