Translaminar Fully Endoscopic Discectomy for Lumbar Foraminal Disc Herniation: A Technical Note

Abstract

Lumbar disc herniations (LDHs) located in foraminal lesions are difficult to approach using the normal posterior approach while preserving the facet joints. The translaminar approach (TLA) of fully endoscopic spine surgery allows access to a foraminal lesion through a small fenestration on the isthmus of the vertebral lamina, thereby preventing facet joint destruction. TLA is particularly suitable for L5/S1 foraminal LDH cases where the transverse diameter of the foramen is anatomically long. From 2020 to 2022, TLA was performed in 17 patients with foraminal LDH (12 men and 5 women), with a mean age of 67 years. The operative levels were L3/4 in 1 case, L4/5 in 2 cases, and L5/S1 in 14 cases. The mean operative time was 72 minutes, and the mean blood loss was negligible in all patients. The mean postoperative hospital stay was 1.2 days, and no major complications occurred. The mean preoperative and postoperative Numerical Rating Scale scores for leg pain were 6.4 and 1.8, respectively, and the mean patient satisfaction score at 3 months after TLA was 7. In conclusion, TLA is a minimally invasive approach for foraminal LDH, with particular advantages for facet joint preservation.