Full-Endoscopic Transpedicular Approach

Full-endoscopic lumbar discectomy has been an alternative in minimally invasive spine surgery to treat lumbar disc herniation. For the transforaminal approach, high-grade down-migrated disc below the suprapedicular border remains technically challenging and leads to a higher failure rate. Different full-endoscopic techniques regarding the issue have been proposed, including the transforaminal approach with foraminoplasty, contralateral transforaminal approach, and interlaminar or translaminar approach. In terms of anatomy, the pedicle is a barrier to reach the migrated fragment through the posterolateral trajectory. The full-endoscopic instruments allow surgeons to achieve fragmentectomy by creating a “keyhole” on the pedicle. The nerve roots are free of manipulation through the tract toward the target directly. Therefore, a full-endoscopic transpedicular approach can be a solution to treat high-grade downward disc migration. In this chapter, the authors will introduce the techniques of full-endoscopic transpedicular approach step by step.