Percutaneous lumbar diskectomy.

To the Editor.— I read with interest the article on percutaneous lumbar diskectomy in the January 6 issue of JAMA . 1 Although I do not believe it was the intention of the author to advocate or endorse any particular instrumentation, the discussion seemed to be more promotional than scientific, for the following reasons. Obviously, most of the panel members are neurosurgeons and users of the nucleotome (20 neurosurgeons and 6 orthopedic surgeons). The article quotes one surgeon who has performed 200 operations with no complications. The article even reports the opinion of the manufacturer of the nucleotome. To the best of my knowledge, the users of what are considered to be manual instruments were not included, consulted, or interviewed for this study. The term manual instrument is misleading. When the 4.5-mL cannula is positioned, one can introduce all kinds of automated instruments for evacuation of disk material. These