Herniated Disc: Endoscopic Low Back Partial Disc Removal—Transforaminal Approach Animation

Herniated Disc: Endoscopic Low Back Partial Disc Removal—Transforaminal Approach Animation

This animation demonstrates the partial removal of a herniated disc in the lower back using an endoscope through a transforaminal approach. When the central portion of a disc in the lower back herniates or breaks through the outer portion, it can put pressure on the spinal cord or nerve roots that exit from the spinal cord. This often results in nerve pain that travels down the legs.

A partial disc removal, also called a discectomy, removes the part of the herniated disc causing nerve compression while keeping the rest of the disc in place. This procedure can be performed endoscopically with a small incision, where surgical instruments are inserted through a small tube, called an endoscope, that contains a light, a camera, and a channel for tools to pass through.

In this case, the disc has herniated toward the side. Because of this, the surgery will be performed with a transforaminal approach, where the herniated disc is accessed through the opening between 2 vertebrae in the side of the spine, where nerve roots exit from the spinal cord. Here we see a patient lying face down on the operating table. Their head is toward the left side of the screen, and their feet are toward the right side of the screen.

First, x-rays are taken during surgery to help guide the placement of a needle into the opening between 2 vertebrae in the side of the spine. A guidewire is then inserted through the needle, and the needle is removed. A series of metal tubes are then placed over the guidewire to slowly stretch the opening for the endoscope. Another tube, called a cannula, is placed over the other metal tubes, which are then removed. The cannula is held in place with a clamp, and the endoscope is passed through the cannula.

As we look closer, we can see the herniated disc pressing on the exiting nerve root. Some portions of the bone may be shaved down to access the disc and create more space for the endoscope. Small instruments are used to carefully remove the herniated disc and repair the outer layer of the disc. Once the compression is relieved, the skin incision is closed with a suture, a dressing is applied, and the procedure is complete.