Full-Endoscopic Transforaminal Approach for Lumbar Discectomy

Summary

The present protocol describes the full-endoscopic transforaminal approach for lumbar discectomy, which is a safe technique that does not require muscle retraction or bone removal.

Abstract

With technical advancements, the full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity. This technique utilizes various tools and instruments, including a dilator, a beveled working sleeve, and an endoscope with a 20-degree angle and 177 mm length, equipped with a 9.3-diameter oval shaft and a 5.6 mm diameter working channel. Additionally, the procedure involves using a Kerrison punch (5.5 mm), rongeur (3-4 mm), punch (5.4 mm), tip control radioablator applying a radiofrequency current of 4 MHz, fluid control irrigation and suction pump device, 5.5 mm oval burr with lateral protection, burr round, and the diamond round. During the surgery, it is essential to identify significant landmarks, including the caudal pedicle, ascending facet, annulus fibrosis, posterior longitudinal ligament, and the exiting nerve root. The steps of the technique are relatively easy to follow, especially when utilizing the appropriate instruments and having a good understanding of the anatomy. Research studies have demonstrated comparable outcomes to open microdiscectomy techniques. ETALD presents itself as a safe option for lumbar discectomy, as it minimizes tissue disruption, results in low postoperative surgical site pain, and allows for early mobilization.

Introduction

The full-endoscopic transforaminal approach for lumbar discectomy (ETALD) is gaining popularity as a minimally invasive technique in various medical centers. It offers the advantage of requiring less muscular retraction and bone removal compared to conventional techniques^1,2. Over time, the technique has undergone advancements since its initial description. Conventional surgeries have shown good results; however, epidural fibrosis occurs in around 10% of cases, leading to symptoms^3,4.

The transforaminal approach provides lat....

Protocol

This study protocol has been approved by the Institutional Review Board of Istanbul University, Faculty of Medicine, ensuring adherence to ethical guidelines and patient safety. Additionally, prior to their participation in the study, informed consent was obtained from all patients.

1. Preoperative procedures

1. Perform the surgery under general anesthesia, adhering to the institutionally approved protocol for anesthetization. Set the endoscope, optic instruments, and.......

Discussion

In cases of spinal disc herniation, achieving complete decompression is essential and can be optimally accomplished under visual control^17,18,19. Technical advancements have made it possible to achieve such decompression even through a full-endoscopic approach. The development of improved optics, endoscopes, and instruments introduced through the working channel has expanded the safe usage of this technique²⁰

Materials

Name	Company	Catalog Number	Comments
BURR OVAL Ø 5.5 mm	RiwoSpine	899751505	PACK=1 PC, WL 290 mm, with lateral protection
C-ARM	ZIEHM SOLO		C-arm with integrated monitor
DILATOR ID 1.1 mm OD 9.4 mm	RiwoSpine	892209510	For single-stage dilatation, TL 235 mm, reusable
ENDOSCOPE	RiwoSpine	892103253	20 degrees viewing angle and 177 mm length with a 9.3 mm diameter oval shaft with a 5.6 mm diameter working channel
KERRISON PUNCH 5.5 x 4.5 mm WL 380 mm	RiwoSpine	892409445	60°, TL 460 mm, hinged pushrod, reusable
PUNCH Ø 3 mm WL 290 mm	RiwoSpine	89240.3023	TL 388 mm, with irrigation connection, reusable
PUNCH Ø 5.4 mm WL 340 mm	RiwoSpine	892409020	TL 490 mm, with irrigation connection, reusable
RADIOABLATOR RF BNDL	RiwoSpine	23300011
RF INSTRUMENT BIPO Ø 2.5 mm WL 280 mm	RiwoSpine	4993691	for endoscopic spine surgery, flexible insert, integrated connection cable WL 3 m with device plug to Radioblator RF 4 MHz, sterile, for single use
RONGEUR Ø 3 mm WL 290 mm	RiwoSpine	89240.3003	TL 388 mm, with irrigation connection, reusable
WORKING SLEEVE ID 9.5 mm OD 10.5 mm	RiwoSpine	8922095000	TL 120, distal end beveled, graduated, reusable