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Updated: Feb 19, 2026
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
Percutaneous endoscopic lumbar discectomy for high-grade down-migrated disc using a trans-facet process and
Qing-Feng Hu1, Hao Pan2, Yi-You Fang2
1Department of Orthopaedics, The Affiliated Guang-Xing Hospital of Zhejiang TCM University, Hangzhou, 310007, China. huqingfeng258@163.com.
Purpose:
The use of conventional percutaneous endoscopic lumbar discectomy (PELD) for high-grade down-migrated lumbar disc herniation medial to the pedicle via the transforaminal route can result in less favorable outcomes. We report a new PELD technique for the treatment of high-grade down-migrated lumbar disc herniation via a facet process and pedicle-complex approach.
Methods:
Three patients with high-grade down-migrated L3-4 and L4-5 disc herniation presented to our hospital. Each underwent PELD via a facet process and pedicle complex approach to remove the herniated fragment and achieve complete decompression of the nerve root.
Results:
Patients' symptoms were relieved. Postoperative magnetic resonance imaging showed root decompression. Follow-up 12-month computed tomography revealed no pedicle or facet fracture and healing of the pedicle complex and facet process bone tunnel.
Conclusion:
PELD via a facet process and pedicle-complex approach may be an option for high-grade, down-migrated lumbar disc herniation with completely sequestrated nucleus pulposus.