Endoscopic translaminar approach for resection of migrated lumbar disc herniation

Abstract Lumbar disc herniation (LDH) is a common degenerative disease and up to 10% of LDH are migrated into the so called “hidden zone”. The traditional interlaminar approach carries the risk of subsequent instability due to osseous destruction by reaching the hidden zone and exposing the nerve root. In the 1990s first reports were published on the open microsurgical “translaminar approach” (TLA) for the resection of migrated LDH with the intension to minimize osseous destruction. However, the open technique still had the disadvantage of soft tissue and muscle dissection. Endoscopic tubular procedures were developed to reduce the approach related muscle trauma. Endoscopic tubular surgery combines bimanual microsurgical technique with continuous endoscopic visualization of the surgical field. The HD-endoscopic visualization allows for excellent illumination, identification of tissue and anatomical structures. The rate of clinical success for the treatment of migrated LDH via endoscopic TLA has been reported to be up to 95%. However, the endoscopic TLA has not been analyzed extensively and reports with a detailed description are rare. The purpose of the present video is to demonstrate the endoscopic tubular TLA and resection of a migrated LDH. This is the case of a 62 year old male patient with right sided leg pain and a quadtriceps paresis due to LDH which migrated behind the L3 vertebral body. Special focus was pointed out on planning of the skin incision and the trajectory towards the disc herniation. Furthermore, the dissection and extraction of large disc herniation is explained in detail.