Lumbar interlaminar uniportal endoscopic discectomy: techniques and case presentation

In this video we overview the techniques and methods of performing a lumbar interlaminar uniportal endoscopic discectomy utilizing a case presentation. A 26-year-old male presented with one year of low back pain radiating down his right lower extremity with associated numbness. Magnetic resonance imaging revealed a paramedian disc herniation at L5-S1 eccentric to the right side. An endoscopic discectomy was performed via an interlaminar approach. Intraoperative fluoroscopy was used to localize an incision. High quality video showed how to expose the ligamentum flavum and safely create a defect in the ligament for the working cannula, highlighting methods to prevent complications. Once the epidural space was entered, we detailed how to remove the epidural adipose tissue and separate the adhesions from the disc and adjacent thecal sac and nerve root. Detethering the tissue was a crucial step in alleviating patient symptoms. Once the disc was identified, an annulotomy was created. We reviewed how to protect the thecal sac during discectomy. We highlighted how the interlaminar approach can provide an excellent view medially permitting complete decompression of the thecal sac under direct visualization. The patient had improvement in his symptoms without recurrence at follow-up.