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Kitahama et al. Mini-invasive Surg 2017;1:109-14 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.11
www.misjournal.net
Topic: Percutaneous endoscopic system for spinal diseases Open Access

Posterolateral percutaneous endoscopic

discectomy with free-running

electromyography monitoring under

general anesthesia

Yoshihiro Kitahama , Genichiro Matsui , Manabu Minami , Taigo Kawaoka , Kimimichi Otome , Masato Nakamura 2
2
1
2
1
1
1 Center for Spinal Surgery, Omaezaki Municipal Hospital, Omaezaki, Shizuoka 437-1696, Japan.
2 Department of Anesthesiology, Omaezaki Municipal Hospital, Omaezaki, Shizuoka 437-1696, Japan.
Correspondence to: Dr. Yoshihiro Kitahama, Center for Spinal Surgery, Omaezaki Municipal Hospital, 2060 Ikeshinden, Omaezaki, Shizuoka 437-1696,
Japan. E-mail: ykitah@gmail.com
How to cite this article: Kitahama Y, Matsui G, Minami M, Kawaoka T, Otome K, Nakamura M. Posterolateral percutaneous endoscopic discectomy
with free-running electromyography monitoring under general anesthesia. Mini-invasive Surg 2017;1:109-14.
ABSTRACT

Article history: Aim: Posterolateral percutaneous endoscopic discectomy (PLPED) is commonly performed
Received: 13 Mar 2017 under local anesthesia, but patients and surgeons are concerned about intraoperative
Accepted: 17 Jul 2017 uncontrolled pain. The purpose of this study was to evaluate the safety of the PLPED under
Published: 30 Sep 2017 general anesthesia with free-running electromyography (EMG) monitoring. Methods: The
clinical outcomes of consecutive 48 cases of lumbar disc herniation (LDH) were evaluated by
Key words: numeric rating scale (NRS) score and MacNab’s criteria. Hospital stay and time to ambulation
Percutaneous endoscopic lumbar and return to work were also assessed. Results: NRS score for the affected leg significantly
discectomy, improved from 6.4 to 0.9 immediately after the operation. MacNab’s criteria were 91.5% for
electromyography, a follow-up period of 13.5 months. Although no serious complication occurred, 3 patients
lumbar disc herniation, (6.3%) had transient paresis that completely disappeared by 3 months. No recurrences were
posterolateral approach, observed during the follow-up period. Conclusion: PLPED combined with EMG monitoring
numeric rating scale, under general anesthesia is a safe and efficacious procedure for the treatment of LDH.
MacNab’s criteria

INTRODUCTION root (ENR) injury from the patient’s complaints
during operative manipulation. Even under general
[3]
Local anesthesia permits the performance of the anesthesia, free-running electromyography (EMG)
posterolateral approach for percutaneous endoscopic monitoring succeeds in preserving the lumbar plexus
discectomy (PLPED). In some cases, deep sedation [4-7]
[1]
is required for uncontrolled intraoperative pain. for the extreme lateral approach.
[2]
Uncontrolled intraoperative could lead to the early
termination of the operation. The purpose of this study was to evaluate the safety
of PLPED under general anesthesia with EMG
Local anesthesia is helpful to avoid exiting nerve monitoring.
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