Transforaminal Endoscopic Approach for Combined Far Lateral and Paracentral Discectomies at L5-S1 Level

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Minimally Invasive Spine Surgery

Background:

• Endoscopic lumbar discectomy utilizes transforaminal (TF) and interlaminar (IL) approaches.
• TF approach is favored for higher lumbar disc herniations, while IL is used for caudal levels.
• The L5-S1 level presents anatomical challenges for discectomy due to the iliac crest and facet orientation.

Purpose of the Study:

• To present technical nuances of the TF approach for L5-S1 discectomy.
• To demonstrate TF approach for managing far-lateral and paracentral disc herniations at L5-S1.
• To treat a patient with distinct, noncontiguous L5 and S1 herniations causing severe radiculopathy.

Main Methods:

• Operative video demonstrating the TF endoscopic approach.
• Surgical technique focused on addressing far-lateral and paracentral disc herniations at L5-S1.
• Case study of a 52-year-old male with bilateral L5 and S1 radiculopathy.

Main Results:

• Successful discectomy for both far-lateral and paracentral herniations at L5-S1 using a single TF approach.
• Avoided the need for two separate endoscopic techniques or a more invasive open procedure.
• Effective management of severe acute radiculopathy in the patient.

Conclusions:

• The TF endoscopic approach is a viable and effective technique for complex L5-S1 disc herniations.
• This approach offers a minimally invasive alternative to open surgery for challenging lumbar pathologies.
• The presented technique allows for simultaneous treatment of multiple, noncontiguous herniations at L5-S1.