Minimally Invasive Techniques for Lumbar Disc Herniation
Summary
Minimally invasive approaches to lumbar disc herniation have transformed the management of radicular pain and neurological deficits by reducing soft-tissue trauma, preserving spinal stability and accelerating postoperative recovery. Core techniques include percutaneous endoscopic lumbar discectomy, microendoscopic discectomy and tubular-retractor assisted microdiscectomy. These methods employ small incisions and muscle-sparing trajectories—either posterolateral (transforaminal) or through the interlaminar window—to visualise and remove herniated nucleus pulposus under endoscopic or microscopic guidance. Advances in imaging, navigation and instrument design have refined access to the disc space via Kambin’s triangle, enabling targeted removal of compressive fragments without disrupting bony facets or ligamentous structures. Biomechanical studies have clarified optimal puncture angles and facet-preservation strategies to maintain segmental stability, while patient-reported outcome measures consistently demonstrate reduced pain, shorter hospital stay and comparable long-term functional gains versus open surgery. Ongoing innovation in high-definition optics, radiofrequency energy delivery and robotic guidance continues to extend indications to complex anatomy, recurrent herniation and high-risk patient cohorts.
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Minimally Invasive Techniques for Lumbar Disc Herniation publication trend
The graph below shows the total number of articles in minimally invasive techniques for lumbar disc herniation across all publications each year (not limited to Nature Index journals).
Technical terms
Percutaneous endoscopic lumbar discectomy (PELD): A muscle-sparing procedure using an endoscope and tubular cannula to remove herniated disc material through a small skin incision.
Transforaminal approach: A posterolateral trajectory entering the disc space via the neural foramen to access and excise herniated fragments.
Interlaminar approach: A midline or slightly lateral pathway between adjacent laminae, often at L5/S1, to visualise and decompress the affected nerve root.
Kambin’s triangle: A safe anatomical zone bounded by the exiting nerve root, superior endplate and facet joint, used as an access corridor for posterolateral discectomy.
Finite element analysis (FEA): A computational modelling method that predicts mechanical behaviour and stress distribution in spinal segments under various surgical modifications.
References
- Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery. Frontiers in Bioengineering and Biotechnology (2024).
- Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field. Bioengineering (2023).
- A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta‐Analysis. BioMed Research International (2018).
- Transforaminal endoscopic discectomy versus conventional microdiscectomy for lumbar discherniation: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research (2018).
- Percutaneous Endoscopic Lumbar Discectomy Assisted by O‐Arm‐Based Navigation Improves the Learning Curve. BioMed Research International (2019).
- Cadaveric Analysis of the Kambin's Triangle. Cureus (2016).
- Effect of Graded Facetectomy on Lumbar Biomechanics. Journal of Healthcare Engineering (2017).
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