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Five levels of evidence developed by the US Preventive Services Task Force (USPSTF) 1 were used for quality analysis, which were grade I to III, and grade II consisted of three sub grades, as shown in Table 1 below.

Table 1. Level of evidence developed by USPSTF

The effectiveness of percutaneous discectomy was evaluated according to the improvement of nerve root symptoms. According to parr2 and manchikanti3 lumbar epidural injection system review criteria, if symptom relief is less than or equal to 6 months, it can be regarded as short-term success, and pain relief more than 6 months is considered as long-term success.

The safety of percutaneous discectomy and aspiration was evaluated according to the presence or absence of device-related serious adverse reactions defined in the international standard iso14155:2011.

Results: a total of 9 literatures were evaluated: Grade I quality evidence, n = 1, grade II-3 quality evidence, n = 3, grade III quality evidence, n = 5. A total of 243 patients received percutaneous discectomy. The research characteristics and review results are shown in Table 2.

The quality evidence of grade I and II-3 is the best embodiment of the overall performance of spinejet disc cutter suction system, both of which have a long follow-up period. A total of 50 patients were included in the two studies. About 73-80% of the patients had sustained long-term success rate, and no device-related adverse reactions were observed.

The short-term follow-up data included three data sets of grade II-3 and III evidence, with a total of 191 patients, with a sustained success rate of 88-94%, and no device-related adverse reactions (7,8,9,10,11).

Two level III cases reported short-term efficacy and positive safety outcomes in two patients.

The report of percutaneous water jet nucleotomy for lumbar disc herniation was jointly completed by the center of minimally invasive spinal interventional therapy of Zhongguancun hospital, School of medical devices and food of Shanghai University of technology, Shengjing Hospital of China Medical University, people's Hospital of Jilin Province, Beijing Tiantan Hospital Affiliated to Capital Medical University and the second Affiliated Hospital of Kunming Medical College Sixty nine patients with disc herniation were treated with spinjet (spinal intervertebral disc water jet) produced by hydro cision company in the United States. Under the guidance of C-arm X-ray machine, CT or DSA, percutaneous nucleus pulposus aspiration with water knife was performed. The curative effect of 15 days, 30 days, 90 days, 150 days, 210 days and 270 days after operation was observed and recorded. Results: the excellent and good rates of 15, 30, 90, 150, 210 and 270 days after operation were 56.5%, 82.6%, 88.4%, 98.6%, 98.6%, 98.6%, respectively. The therapeutic effect was positively correlated with the postoperative time (P < 0.01). Conclusion: percutaneous discectomy with water knife has the advantages of simple operation, easy to master, small trauma, no influence on the biomechanical stability of spine and no serious complications.