Journal List > J Korean Soc Spine Surg > v.14(3) > 1035776

Chung and Lee: Percutaneous Endoscopic Discectomy for Lumbar Disc Herniation


Percutaneous endoscopic lumbar discectomy is a widely used procedure. In addition to the surgical techniques, the proper selection of the patients and appropriate approaching portal is important improving the clinical results. The choice of the approaching portal is related to the distance of migration and spinal canal encroachment in addition to the type of herniation type. In addition, it is essential to know the anatomic characteristics at each level of the lumbar spine in addition to the indications of the various approaching portals.


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Figures and Tables%

Fig. 1.
Anatomical characteristics of lumbar spine (A) Relationships of the interpedicular distance, interlaminar space, and laminar overlap at each lumbar segment. (B) Schematic description of laminar overhanging
Fig. 2.
Schematic diagram of the ‘Three-storied anatomical house concept’.
Fig. 3.
Classification of the herniated disc related to the axial plane. A-intraspinal, B-foraminal, C-extraforaminal
Fig. 4.
Considerations to select endoscopic approaching portals.
Fig. 5.
Posterolateral approaching portal (A) uniportal method (B) biportal method
Fig. 6.
Insertion angle of the transforaminal approaching portal not to injure the internal organ.
Fig. 7.
Fluoroscopic image shows the obturator located just above superior wall of pedicle to avoid injury of the exit root.
Fig. 8.
Sagittal (A) and coronal (B) reformatting images of the CT scan show the enough interlaminar space at L5-S1.
Fig. 9.
Transiliac transforaminal approaching portal. (A) Axial T2-weighted MR image shows huge central disc herniaton related with bilateral symptoms. (B) Relationship between the iliac crest and neural foramen of L5-S1. (C, D) Intraoperative fluoroscopic images after insertion of cannula through the transiliac osseous tunnel. The dotted line represented an iliac crest.
Fig. 10.
Diagram of the contralateral transforaminal approach. (A) Contralateral insertion of the obturator and cannula with the low angle than expected. (B) Advance of the cannula not to cross the midline with backward direction of the oblique surface to avoid compression of the central neural structure.
Fig. 11.
Fluoroscopic images after insertion of the endoscope through the contralateral interlaminar space.
Fig. 12.
Intertransverse approaching portal for extraforaminal disc hernation of L5-S1.
Table 1.
Comparison of endoscopic approaches.
Perineural scar formation Recurrence Indication
Posterolateral approach least* least* narrow
Transforaminal approach less more wide*
Interlaminar approach moderate moderate narrow
Translaminar approach more moderate narrow

: advantage,

: disadvantage

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