• Kyung-Chul Choi, Hyeong-Ki Shim, Dong Chan Lee, and Choon-Keun Park.
• Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Anyang, Korea. Electronic address: chul5104@hanmail.net.
• World Neurosurg. 2019 Mar 1; 123: 81-85.

BackgroundPercutaneous endoscopic lumbar discectomy (PELD) is regarded as an alternative treatment for lumbar disc herniation. Although the indication for PELD has expanded with remarkable evolution of the technique, sometimes unexpected complications have occurred during PELD. We report 3 cases of de novo disc prolapse during PELD.Case DescriptionIn 3 patients who underwent PELD for lumbar disc herniation with local anesthesia, postoperative magnetic resonance imaging demonstrated newly developed up-migrated disc herniation. Compared with their preoperative states, these patients experienced decreased intensity of both leg and back pain. There were no neurologic deficits. PELD was repeated for L1-L2 disc herniation only to relieve compression of the conus medullaris.ConclusionsAlthough the incidence was very low (0.3%) and the lesions were nonsymptomatic, de novo disc prolapse may be associated with an inside-out PELD technique. Discography and insertion of the obturator should be handled gently. The possibility of de novo disc prolapse should be kept in mind when performing PELD.Copyright © 2018. Published by Elsevier Inc.

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