Transforaminal Endoscopic Discectomy Protocol

The lesioned intervertebral space was located by fluoroscopy, and the side with severe symptoms was the operative side.The syringe needle was oriented directly opposite to the lower edge of the lamina and the junction area of the spinous process root as observed on lateral fluoroscopic view. In the AP view, the needle was 1 cm lateral to the spinous process on the operative side. Markings were made 1 cm above or below this point. After transverse incisions were created for the portals, serial dilators were inserted followed by transparent cannulas over the dilators. Water influx was then connected to the endoscopic portal inserted via the viewing cannula. A radiofrequency probe was used to clean the soft tissue and stop bleeding, and the intervertebral space was exposed. A guiding rod was inserted and positioned under fluoroscopy. In the AP view, the endoscopic tube and the guiding rod intersected at the intervertebral space, and the guide rod was anchored at the lower edge of the upper vertebral lamina.Bilateral partial laminectomy and medial facetectomy were performed. The nerve root canal entrance and lateral recess were carefully expanded to achieve decompression. Then, decompression was performed across the dorsal side of the dural sac, and the herniated disc was simultaneously resected (Figure 1). After adequate hemostasis, the equipment was withdrawn, drainage tubes were placed, and the incision was closed.