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Mizuno. Mini-invasive Surg 2017;1:103-5 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.13
www.misjournal.net
Topic: Percutaneous endoscopic system for spinal diseases Open Access

Establishment of the Japanese training

system for percutaneous endoscopic

lumbar discectomy: from the stand point of

neurosurgery

Junichi Mizuno

Center for Minimally Invasive Spinal Surgery, Shin-Yurigaoka General Hospital, Kanagawa 210-0024, Japan.
Correspondence to: Dr. Junichi Mizuno, Center for Minimally Invasive Spinal Surgery, Shin-Yurigaoka General Hospital, Kanagawa 210-0024,
Japan. E-mail: mizuno@shibire.com
How to cite this article: Mizuno J. Establishment of the Japanese training system for percutaneous endoscopic lumbar discectomy: from the stand
point of neurosurgery. Mini-invasive Surg 2017;1:103-5.

Article history: Received: 5 Apr 2017 Accepted: 18 Apr 2017 Published: 30 Sep 2017

Historically, lumbar laminectomy and fusion is the the spinous process. This procedure was considered
traditional surgical intervention for lumbar degenerative to be a less invasive, but it still requires the removal
diseases such as herniated discs or canal stenosis with of the ligamentum flavum as well as to drill the lamina
or without spondylolisthesis. Although this procedure and the medial portion of the facet joint. Thus, this
was once the most commonly performed technique, procedure gained popularity among some spinal
serious complications were frequent. The most surgeons, however the outcomes were not superior to
common complications included instability and severe the micro-Love technique. Invasion of the spinal canal
back pain due to destruction of the biomechanical by either micro-Love or MED can destabilize the spinal
stability of the lumbar spine. To compensate for segment and create scarring in and around the spinal
these complications, an operating microscope was nerves. Destruction of soft tissues and bony structures
introduced to the field of spinal surgery in the 1950s. is inevitable when approaching the compressed spinal
Currently, microdiscectomy, the so-called “micro-Love nerves in micro-Love and MED.
method” based on the classic technique that Dr. Love
reported has been established as the gold standard Percutaneous endoscopic lumbar discectomy (PELD)
[1]
procedure for herniated lumbar discs. Due to the less and percutaneous endoscopic lumbar laminectomy
invasive approach and the fine surgical manipulations, (PELL) can avoid a significant portion of approach-
conventional complications dramatically decreased related complications. [3,4] Third generation systems,
and surgical outcome have significantly improved. such as the Yeung Endoscopic Spine System, [5]
include a cannula set with slotted openings that allow
In the beginning of this century, microendoscopic instruments to exit the cannula for surgical work while
discectomy (MED) was developed by using a less than a protruding tongue protects and retracts adjacent
20 mm tubular retractor. Serial dilators also are used structures. The beveled cannula allows for visualization
[2]
to avoid detachment of the paraspinal muscles from of the disc and epidural space simultaneously, thus
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