Technique of microendoscopy in medial lumbar disc herniation

Various percutaneous techniques to approach the lumbar disc were studied in the past. Chemonucleolysis, laser vaporization, lateral endoscopic foraminal approaches and different techniques of percutaneous nucleotomy remained disappointing due to insufficient root visualization, insufficient decompression or insufficient disc removal. The microendoscopic discectomy is performed via a median approach that allows thorough root exploration, direct evaluation of the compression and determination of contained or non-contained disc material. This is achieved by applying open surgical tools through a tubular retractor under endoscopic visualization. The endoscope is inserted via a sequential set of dilators passed over the initial guide wire. The technique allows a smaller incision and less tissue trauma with comparable visualization of the nerve structures than does standard open surgery.