Transforaminal Endoscopic Discectomy

Percutaneous endoscopic discectomy (PED) is a minimally invasive technique for the treatment of lumbar foraminal or extraforaminal and foraminal disc herniations that represent up to 11% of all lumbar herniated discs (1-4) Another study defined that farlateral disc herniations, constituting 7% to 12% of all disc herniations, typically migrate cranially as they extended laterally, foraminally, and farlaterally (5) In 1934 Mixter and Barr were the first authors who treated lumbar disc herniation surgically (6) In 1950 Hult L described the anterior transperitoneal approach (7) Hijikata S was the first author who performed the percutaneous discectomy technique in 1975 using fluoroscopy (8) During this time, long follow up results were obtained by others. Kambin described the uniportal arthroscopic discectomy in 1983 (9) Indications to use endoscopic discectomy technique have since changed. Kambin and Gellman have played major roles in forming the indications used today. Various minimal invasive intradiscal techniques have been described. Intradiscal techniques like percutaneous nucleotomy and laser decompression without chemonucleolysis revealed poor results in prospective randomized and controlled studies (6) Numerous surgical accesses, such as midline approaches involving partial or complete facetectomy, intramuscular extra foraminal and paramedian approaches have been described (10-14) These approaches are often associated with partial bone removal therefore the risk of spinal instability can develop (15-19) Percutaneous endoscopic technique is optional approach for disc removal through the foramen and this technique has gradually developed. The benefits of percutaneous endoscopic discectomy are less postoperative pain (20-22), less adhering and scarring (23-25) Direct and clear visualization is obtained by the irrigation of surgery space, increased efficacy of the intervention and avoided instabilization (26-28)