Herniated Disc: Endoscopic Mid-Back Partial Disc Removal—Transforaminal Approach Animation

Herniated Disc: Endoscopic Mid-Back Partial Disc Removal—Transforaminal Approach Animation

This animation demonstrates the partial removal of a herniated disc in the mid-back, also called the thoracic spine, by using an endoscope through a transforaminal approach. When the central portion of a disc in the mid-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.

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 draw lines with a skin marker to determine the best place to access the herniated disc. At the entry point drawn, a needle is inserted, and it enters the opening between 2 vertebrae in the side of the spine. An incision is made, a guidewire is inserted through the needle, and the needle is removed.

A series of metal tubes is 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 endoscope is passed through the cannula. Here we see a view through the camera of the endoscope. Fat and soft tissue that cover the opening between the vertebrae are removed.

An instrument called a burr is then used to shave down portions of bone to create more space for the endoscope to access the disc. Small instruments are used to carefully remove the herniated disc. When the compression is relieved, the nerve root returns to its normal position. The skin incision is closed with a suture, a dressing is applied, and the procedure is complete.