How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

Abstract

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has emerged as a less invasive technique to treat symptomatic lumbar disk herniation (LDH). PTED is performed under local anesthesia with the advantage of immediate intraoperative feedback of the patient. In this paper, the technique is described as conducted in our hospital.

Methods: PTED is performed under local anesthesia in prone position on thoracopelvic supports. The procedure is explained stepwise: e.g. marking, incision, introduction of the 18-gauge needle and guidewire to the superior articular process, introduction of the TomShidi needle and foraminotomy up to 9 mm, with subsequently removal of disk material through the endoscope. Scar size is around 8 mm.

Conclusion: PTED seems a promising alternative to conventional discectomy in patients with LDH and can be performed safely.

Keywords: Discectomy; Endoscopy; Lumbar disk herniation; Transforaminal.

Fig. 1

The operative setup during the PTED procedure. The patient is placed prone on a radiolucent table on thoracopelvic supports

Fig. 2

Marking of the trajectory. For level L4–L5, the incision is placed 10 cm from the midline

Fig. 3

With AP and lateral fluoroscopy the to be operated lumbar disk is approached

Fig. 4

With hand drills over the guidewire, a foraminotomy up to 9 mm can be performed

Fig. 5

The endoscope is placed into the working channel, showing fragments of the herniated disk on the right