Full-Endoscopic Foraminoplasty and Lumbar Discectomy for Single-Level Lumbar Disc Herniation

Summary

Compared to conventional transforaminal endoscopic surgery, full-endoscopic foraminoplasty and lumbar discectomy (FEFLD) is a unique technique that allows full visualization of foraminoplasty and reduces the need for intraoperative fluoroscopies. This article describes the surgical steps involved in the FEFLD technique, shedding light on surgical tips and potential pitfalls to ensure outstanding performance.

Abstract

The Transforaminal Endoscopic Surgical System (TESSYS) technique has gained popularity for the treatment of lumbar disc herniations. Foraminoplasty is the key procedure in TESSYS. However, it requires advanced skills and long-term learning, which hinder its widespread adoption among surgeons. Recently, the introduction of full-endoscopic solutions has made the process more manageable. The main difference from traditional single-portal endoscopic surgery is that full-endoscopic surgery is equipped with a larger working channel, allowing full visualization of foraminoplasty and decreasing reliance on intraoperative fluoroscopy. Recently, published studies have shown that full-endoscopic foraminoplasty and lumbar discectomy (FEFLD) could achieve comparable results to conventional microdiscectomy in terms of pain relief and functional outcomes, while enhancing postoperative recovery. This study describes the technique of FEFLD in detail, including every crucial step, such as patient positioning, puncture trajectory, endoscopic dissection of the superior articular process (SAP), endoscopic foraminoplasty, and more. We hope this will be helpful to beginners who wish to apply this approach.

Introduction

Percutaneous endoscopic transforaminal discectomy (PETD) is a well-accepted technique for the surgical treatment of lumbar disc herniation (LDH)^1,2. The significant advantages of PETD include fast recovery to daily activities, a lower risk of spinal destabilization, and reduced wound complications^2,3,4. Although various approaches have been developed over the decades, the anatomical basis of each PETD originates from the concept of a safe transforaminal triangle proposed by Parviz Kambin

Protocol

The protocol follows the guidelines of the Ethics Committee of the Third Hospital of Hebei Medical University. Written informed consent was obtained from all patients presenting with unilateral sciatica due to lumbar disc herniation. These symptoms persisted for more than 12 weeks and were refractory to conservative treatment. Exclusion criteria included the presence of cauda equina syndrome, spondylolisthesis, central canal stenosis, and previous spinal surgery at the same level. All eligible patients underwent examinat.......

Discussion

Despite significant advances in minimally invasive treatment of lumbar disc herniations (LDHs), percutaneous endoscopic transforaminal discectomy (PETD) surgery still remains technically demanding regarding various surgical steps, and it has not become a widely adopted surgical treatment yet²⁶. The concept of targeted discectomy requires accurate puncture and placement of the working cannula, which can be challenging for beginners²⁷. Yong et al. reported a mean cutoff of 24.......

Materials

Name	Company	Catalog Number	Comments
Dilator 1	UninTech	UNT-II-241540	1.5 mm × OD 4.0 mm × L 240 mm
Dilator 2	UninTech	UNT-II-214266	4.2 mm × OD 6.6 mm × L 215 mm
Dilator 3	UninTech	UNT-II-196888	6.8 mm × OD 8.8 mm × L195 mm
Endoscope	UninTech	UNTV-076.30.171	WL 171 mm/OD 7.6 mm/30°/ WChD 4.7 mm/2 x IC 1.5 mm
Radiofrequency coagulator	Kai Zhuo	RFS-4000KD	None
T-head cannula	UninTech	UNT-II-167989T	7.9 mm × OD 8.9 mm × L168 mm
Trephine	UninTech	UNT-III-177888	7.8 mm × OD 8.8mm × L 171 mm
U-head cannula	UninTech	UNT-II-159010U	9.0 mm × OD 10.2 mm × L151 mm