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Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
En bloc discectomy via anterior lumbar approach: a technical note
Harmantya Mahadhipta1, Amri Muhyi2, Muhamad Abdul Harist Fadhlizain3
1Department of Orthopaedics and Traumatology, Tangerang General Hospital, Banten 15117, Indonesia - Department of Orthopaedics and Traumatology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia - Orthopedics and Traumatology, Gatam Institute, Eka Hospital, Tangerang 15321, Indonesia.
Introduction:
Implant subsidence remains one of the complications following lumbar interbody fusion and total lumbar disc replacement, often attributed to excessive and uneven preparation of the subchondral bone. To address this limitation, we describe a novel surgical approach - en bloc discectomy - designed to enable more controlled disc removal, preserve subchondral endplate integrity, and minimize the risk of implant subsidence.
Methods:
We describe the procedural steps for the en bloc discectomy, including patient positioning, surgical approach, and the specific technique using a Cobb spinal elevator to remove the cartilaginous en bloc. The technique's advantages include controlled disc removal, minimized subsidence, and even subchondral endplate preparation.
Results:
En bloc discectomy was successfully performed in our patient. No intraoperative or postoperative complications occurred, and all patients reported immediate and sustained symptomatic improvement.
Conclusion:
En bloc discectomy provides a safe and reproducible alternative to conventional (standard piecemeal discectomy) disc excision. By reducing endplate damage and implant subsidence, this technique has the potential to improve long-term stability and clinical outcomes in patients undergoing lumbar interbody procedures.
