Related Experiment Video
Updated: Sep 25, 2026
Full-Endoscopic Transforaminal Approach for Lumbar Discectomy
Published on: September 8, 2023
How I do it: microsurgical extraforaminal sequestrectomy through a midline intertransverse approach
Victor E Staartjes1,2,3, Adrian Elmi-Terander4,5,6,7, Gunnar Nilsson5
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. victoregon.staartjes@usz.ch.
Background:
Several surgical approaches exist for extraforaminal (far lateral) lumbar disc herniations, including paraspinal Wiltse-type, interlaminar, lateral intertransverse, and combined medial-lateral techniques.
Method:
We present microsurgical extraforaminal sequestrectomy through a midline intertransverse approach, chosen for familiar anatomy, minimal facet joint resection, and avoidance of a muscle-splitting trajectory. Unilateral subperiosteal dissection exposes the isthmus, facet margin, and transverse processes with the intertransverse ligament; the facet margin is removed with a straight osteotome, the ligament resected, the intertransverse artery coagulated, and the nerve root and disc space exposed for sequestrectomy.
Conclusion:
This approach provides effective sequestrectomy while preserving spinal stability using familiar midline anatomy.
