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

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

This surgical video 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 right side of the screen, and their feet are toward the left side of the screen. The surgeon begins by using x-ray during the surgery to draw lines with a skin marker to determine the best place to access the herniated disc. At the entry point drawn, the surgeon inserts a needle at the appropriate angle. Then, they make a small incision around the needle. The surgeon inserts a guidewire into the needle and removes the needle.

The surgeon pushes and twists a series of metal tubes over the guidewire to make space for the endoscope. Another metal tube, called a cannula, is placed over the other metal tubes, which are then removed. The surgeon passes the endoscope through the cannula. Here we see a view through the camera of the endoscope. Fat and soft tissue cover the opening between 2 vertebrae and are removed.

If needed, the surgeon can use instruments to remove small portions of bone to have better access to the disc. Then the surgeon uses small instruments to carefully remove the herniated disc and repair the outer layer of the disc. The surgeon confirms that the nerve compression is relieved by seeing the nerve root pulsing. The endoscope and other instruments will be removed. The surgeon will close the skin incision with a suture, and the procedure is complete.