Transforaminal Endoscopic Spine Surgery Research Articles

Transforaminal endoscopic thoracic discectomy: surgical technique.

The major challenge inherent to the surgical treatment of thoracic disc herniations is that the disc herniation is often ventral to the spinal cord. Posterior approaches are difficult and dangerous due to the morbidity associated with retraction of the thoracic spinal cord. A ventral approach is not feasible due to the thoracic viscera. A lateral transcavitary approach is the standard for treating ventral thoracic disc pathology but is also quite morbid. Transforaminal endoscopic spine surgery has emerged as a minimally invasive technique for treating thoracic disc pathology and it can be performed in the outpatient setting even with the patient awake. Advances in endoscopic camera technologies as well as the availability of specialty instruments that can be used down a working channel endoscope has now made a myriad of spine pathologies accessible to the minimally invasive spine surgeon. The transforaminal approach and the angled endoscopic camera are an ideal combination for creating a technical advantage to accessing thoracic disc pathology in a minimally invasive fashion. The principal challenges to the approach are needle targeting and understanding the endoscopic visual anatomy. Many surgeons interested in pursuing this technique are often deterred by the burden of the cost and time it takes to become adept and performing the technique. Detailed here are the authors' step-by-step technique and illustrative video that demonstrate transforaminal endoscopic thoracic discectomy (TETD).

End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

Objective: Executions of indications/extended indications are associated with higher than normal rates of symptomatic recurrences and treatment failures, especially for novice surgeons incorporating Percutaneous Transforaminal endoscopic lumbar discectomy/decompression (PTELD) techniques. Causes of failures can be manifold and can occur because of a residual or a complete fragment causing persistent compression or associated unaddressed stenosis. To prevent this problem, proper training, multiple instrument inventory, variable techniques are needed with progressive learning. Authors aim to suggest objective and subjective criteria to define end-points/adequacy of decompression (EPD).Methods: PubMed database search was limited to locate only adequacy of decompression of PTELD and thus included specific keywords: “ENDPOINT” OR “ADEQUATE” AND “DECOMPRESSION” AND “TRANSFORAMINAL” AND “ENDOSCOPY”. Authors added their experience to refine and define multiple EPD.Results: In the search we found 12 articles total. Upon reviewing these, we found 7 articles matching our criteria. Cross references of included articles were searched, 5 additional articles were included. EPD were described in only 9 articles. Author’s experience with other relevant references were added to complete the viewpoint (EPD, n=29). Direct observed/ provoked EPD and inferred EPD were defined separately. Videos, illustrations and descriptions of each EPD are illustrated to provide the ideation.Conclusion: EPD are variable and not all signs may be elicited in every case and may change with surgeon experience. The ability to recognize EPD is the crux for successful outcomes and maximum possible EPD’s should be aimed in every surgery to avoid failures.

Sympathetic conjoined lumbosacral nerve root in kambin's triangle during transforaminal endoscopy

Kambin's triangle is a safe corridor for transforaminal endoscopic approach as it is devoid of any neurovascular structure. We came across an interesting case where we encountered a large conjoined lumbosacral nerve root (CNR) in Kambin's triangle during transforaminal endoscopic spine surgery. Patient had intraoperative sympathetic shock which recovered after administering atropine. A 50-year-old female presented with low back pain with bilateral lower limb radiculopathy for 3 years. Magnetic resonance imaging revealed left L4-5 foraminal annular fissure. Radiculopathy was in L5 dermatomal pattern which was confirmed by diagnostic discography and lateral recess block. Left-sided L4-5 transforaminal endoscopic lumbar discectomy was done where we encountered a large CNR in safe zone of Kambin's triangle. Transforaminal endoscopic spine surgery done under monitored anesthesia care with patient in awake and aware state allows identification, diagnosis, and prevention of injury to anomalous neural structure in Kambin's triangle to avoid incidence of failed back syndrome.

Comparison of post-operative wound pain between interlaminar and transforaminal endoscopic spine surgery: which is superior?

Prospective cohort study PURPOSE: The objective is to compare post-operative wound pain in patients treated by endoscopic surgery between interlaminar and transforaminal approach at lumbar region. There are two common approaches for endoscopic lumbar spine surgery, interlaminar and transforaminal approach. The wound size of these two approaches is about the same. However, post-operative wound pain may differ according to the entrance area. We conducted a prospectively cohort study including all patients underwent full endoscopic lumbar spine surgery by single surgeon between January 2016 to October 2019. Wound pain using visual analog scale (VAS) at post-operative day 1 and day 14 were collected. VAS back pain, VAS leg pain, Oswestry Disability Index (ODI), modified McNab criteria and complications were also collected. There were 313 patients included in the study. There was no significant difference in VAS wound pain between interlaminar and transforaminal group. Interestingly, subgroup analysis in interlaminar group found statistically significant higher VAS for wound pain at post-operative day 1 when significant bone resection was done by power burr. VAS back-leg pain and ODI have improved significantly between pre-operative and last follow up in both approaches. Wound pain from endoscopic spine surgery is minimal. This study found no difference in wound pain between endoscopic interlaminar and transforaminal approach. Both approaches show favorable clinical outcomes with few serious complications rate. Further study with long term follow up is needed.

Transforaminal Endoscopic Surgical Treatment for Posterior Migration of Polyetheretherketone Transforaminal Lumbar Interbody Fusion Cage: Case Series

This study aims to report the clinical outcome of treating lumbar radiculopathy in the setting of retropulsed polyetheretherketone (PEEK) transforaminal lumbar interbody fusion (TLIF) cages with transforaminal endoscopic spine surgery. A retrospective study of 8 patients with lumbar radiculopathy in the setting of a retropulsed PEEK TLIF cage were included from January 2014 to January 2019. The inclusion criteria were 1) lumbar radiculopathy in the setting of a retropulsed PEEK TLIF cage causing nerve compression and 2) follow-up at least 1 year. Patients were asked to complete the following questionnaires for outcome evaluation: visual analog scales (VAS) for leg pain and the Oswestry Disability Index (ODI). Eight patients underwent transforaminal endoscopic surgery for treatment of radiculopathy in the setting of a retropulsed PEEK TLIF cage in the 5-year period evaluated. One year after surgery, the VAS and ODI scores showed a significant decrease: average preoperative VAS and ODI scores were 6.9 ± 1.2 and 50.5 ± 10.9, and 1-year postoperative VAS and ODI scores were 2.3 ± 1.3 and 17.3 ± 5.1. Transforaminal endoscopic spine surgery for the treatment of a retropulsed PEEK TLIF cage is a safe and effective approach with low morbidity and acceptable complication rates for patients with radiculopathy secondary to a retropulsed PEEK TLIF cage. Compared with a more invasive approach to removing or drilling the PEEK TLIF cage, endoscopic spine surgery could achieve a similar improvement in the patient-reported outcomes with possibly fewer complications.

Endoscopic Surgical Resection of the Retropulsed S1 Vertebral Endplate in L5-S1 Spondylolisthesis: Case Series

Background A severe grade I and grade II spondylolisthesis at L5-S1 creates an anatomic distortion that can compress the traversing S1 nerve with a retropulsed S1 vertebral body endplate and (sometimes) herniated disc. Objectives To evaluate the feasibility for awake, endoscopic treatment of symptomatic radiculopathy secondary to the deformity that results from the retropulsed superior endplate of S1 in grade I/II L5-S1 spondylolisthesis in patients with and without previous fusion surgery. Study design Retrospective chart review. Setting This study took place in a single-center, academic hospital. Methods In 325 patients over 4 years there were 19 patients (8 with previous L5-S1 fusions and 11 without) treated with transforaminal endoscopic spine surgery for decompression of the neural foramen at L5-S1 in the setting of spondylolisthesis (at least 5 mm) and a retropulsed superior vertebral endplate of S1. Results The average preoperative Visual Analog Scale (VAS) back and leg scores were 6.1 and 6.7, and the average preoperative Oswestry Disability Index (ODI) score was 50.4. The average 1-year VAS back and leg scores were 2.2 and 2.2, and the average 1-year postoperative ODI score was 20.5. There was no statistically significant difference between the fusion and nonfusion groups. Patients treated were patients who presented with an S1 or L5 and S1 radiculopathy as their primary complaint and a L5-S1 spondylolisthesis of 5 mm or greater. Patients treated had no instability on flexion-extension x-rays. Eleven patients had not had fusions at L5-S1, and 8 patients had previous fusions at L5-S1 but still had a spondylolisthesis of at least 5 mm. The average slip for nonfusion patients was 8.4 mm, and the average slip for fusion patients was 8.8 mm. At 1-year follow-up the improvement in VAS back scores was 44% in the nonfusion group and 49% in the fusion group, and the improvement in VAS leg scores was 84% in the nonfusion group and 58% in the fusion group. At 1-year follow-up the improvement in ODI scores was 63% in the nonfusion group and 54% in the fusion group. Limitations Retrospective case series. Conclusions Awake, endoscopic surgery for the treatment of radiculopathy in the setting of a grade I/II L5-S1 spondylolisthesis is a viable minimally invasive treatment option for patients with radiculopathy in the setting of a stable L5-S1 spondylolisthesis with foraminal narrowing caused by a retropulsed superior endplate of the S1 vertebral body.

The Evolution of Transforaminal Endoscopic Spine Surgery

Transforaminal endoscopic spine surgery (T-ESS) has become a well-accepted technique. The first attempts at percutaneous discectomy by Kambin and Hijikata opened a new chapter of endoscopic spine surgery. By the last quarter of the twentieth century, spine surgeons had begun to adopt this novel technique. Many researchers helped advance endoscopic spine surgery, but the turning point was the description of a safe transforaminal triangle of safety by Parviz Kambin. Since then, the indications for T-ESS have increased as a result of the description of different surgical approaches such as inside-out, outside-in, and half-and-half. We present a review of crucial historical advancements in T-ESS and also discuss the evolution of endoscopes, the techniques used, development of endoscopic instruments and equipment, transforaminal thoracic endoscopy, transforaminal endoscopic interbody fusions, the growth of extended indications, and the future direction of T-ESS. This review provides a detailed description of key historical moments and a bird's-eye view of the vast scope of T-ESS.

Modified Interlaminar Endoscopic Lumbar Discectomy for Highly Upmigrated Disc Herniation: A Proctorship Description of the Technique via Translaminar Route.

Lumbar disc herniation (LDH) comprises one of the most common causes of low back pain. 35%–72% of LDH is associated with disc fragment migration. The migration of the disc fragments can be high-grade up, low-grade up, high-grade down, and low-grade down. Spine surgeons deal with unique challenges during surgical management of migrated discs. Operational challenges with open surgery include extensive lamina excision, pars excision, and potential for iatrogenic instability without fixation. In contrast, rigid instruments and poor visualization are the challenges with transforaminal endoscopic spine surgery (ESS). Hence interlaminar approach with ESS is an excellent choice with these migrated LDH. The creation of a translaminar crater in the cranial lamina without dealing with the interlaminar window or ligamentum flavum could be an excellent option to deal with these herniations face front. The lamina is the only anatomical barrier between the endoscope and the migrated disc fragment. Hence with a translaminar approach, unnecessary flavectomy can be avoided. In this technical report and video, we demonstrate the surgical technique of performing the translaminar ESS for highly upmigrated LDH with the preservation of optimal natural anatomy.

Transforaminal Endoscopic Solutions for Anterior Lumbar Interbody Fusion Complications

Anterior lumbar interbody fusion (ALIF) is a widely performed lumbar fusion procedure especially suited for treating lower lumbar degenerative disk disease, discogenic disease, and revision of failed posterior fusion. Advantages of the technique include maximizing implant size and correction of lordosis, and disadvantages include approach-related complications such as retrograde ejaculation, visceral injury, and vascular injury. Transforaminal endoscopic spine surgery is an effective minimally invasive surgical approach that can be utilized to treat many complications of complex spine procedures. Reported here are 2 cases illustrating the success of treating recurrent lumbar radiculopathy with transforaminal endoscopic spine surgery as a minimally invasive solution to an ALIF complication. Transforaminal endoscopic spine surgery is suggested here as a possible treatment approach for lumbar radiculopathy after ALIF.

Endoscopic surgical treatment for symptomatic spinal metastases in long-term cancer survivors

To evaluate the feasibility of awake transforaminal endoscopic surgery in the management of symptomatic spinal metastases. Transforaminal endoscopic spine procedures were performed by 1 surgeon in 325 patients over a period of 4 years from 2014 to 2018. Four of these patients suffered from radicular pain secondary to nerve compression from metastatic spine disease and are the basis of our analysis. Data was evaluated retrospectively in these patients with a minimum follow up of 1 year. All 4 patients treated with transforaminal endoscopic spine surgery for decompression of their metastatic spine disease had successful resolution of their symptoms without any perioperative complications and only brief recovery periods required. Awake endoscopic surgery for the treatment of symptomatic metastatic spine disease is an effective outpatient surgical option for the treatment of patients suffering from radicular pain due to nerve compression from metastatic spine disease.

Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series

To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache. Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.

Transforaminal Endoscopic Approach for Lumbar Extraforaminal Synovial Cysts: Technical Note

Lumbar facet cysts are commonly seen in degenerative lumbar conditions causing stenosis and radiculopathy. Extraforaminal lumbar facet cysts are a rare entity and present a surgical challenge because of their location. Transforaminal endoscopic spine surgery is an emerging technique in spine surgery but has never been described as a treatment option for lumbar radiculopathy in the setting of extraforaminal lumbar facet cyst. A technique for the transforaminal endoscopic treatment of an extraforaminal lumbar facet cyst is presented in 2 patients. We retrospectively reviewed 321 cases of patients who underwent transforaminal endoscopic surgery in a 4-year period with a minimum follow-up of 2 years. A series of 2 patients who underwent transforaminal endoscopic foraminotomy and cyst resection procedures for extraforaminal lumbar facet cysts between 2014 and 2017 is presented: A 51-year-old woman with a right L4-5 extraforaminal cyst improved from a preoperative visual analog scale (VAS) of 7 and Oswestry disability index (ODI) of 26 to a 1-year postoperative VAS score of 2 and ODI of 4; and a 71-year-old woman with a left L5-S1 extraforaminal cyst improved from a preoperative VAS of 7 and ODI of 30 to a 1-year postoperative VAS score of 2 and ODI of6. Transforaminal endoscopic surgery for a lumbar radiculopathy in the setting of an extraforaminal lumbar facet cyst is presented as a unique minimally invasive approach for the treatment of extraforaminal lumbar facet cyst that avoids facet resection and fusion.

Transforaminal Endoscopic Decompression in the Setting of Lateral Lumbar Spondylolisthesis

Lateral subluxation of the vertebra is commonly seen in degenerative lumbar scoliosis. Transforaminal endoscopic spine surgery is an emerging technique in spine surgery but has never been described as a treatment option for lumbar radiculopathy in the setting of lateral lumbar spondylolisthesis. A technique for endoscopic treatment of lumbar disc herniation in the setting of lateral spondylolisthesis is presented. We retrospectively reviewed 199 cases of patients who underwent transforaminal endoscopic surgery in a 3-year period with a minimum follow-up of 1 year. Between 2014 and 2017, 4 patients (average age, 74.8 years; range, 69-82 years) underwent transforaminal endoscopic discectomy procedures for disc herniations at the level of lateral subluxation. One patient whose lateral subluxation was above an instrumented fusion required an extension of fusion to the operated level 5 months after endoscopic surgery for a reherniation. For the other 3 patients, mean visual analog scale score for radicular pain improved from an average pain score of 8.3 before surgery to 3.0 1 year after surgery, and Oswestry Disability Index improved from 26.7 to 4.7. Transforaminal endoscopic surgery for lumbar disc herniation in the setting of lateral subluxation of vertebral bodies is a unique minimally invasive approach for treatment of lumbar radiculopathy that might be considered as an alternative treatment to deformity correction surgery in older patients.

Intraoperative Computed Tomography Navigational Assistance for Transforaminal Endoscopic Decompression of Heterotopic Foraminal Bone Formation After Oblique Lumbar Interbody Fusion

Transforaminal endoscopic spine surgery is an emerging technique in spine surgery, but it offers 2 distinct challenges to spine surgeons looking to adopt it: 1) targeting spine pathology and 2) understanding the endoscopic anatomy visualized through the endoscope. Intraoperative computed tomography (CT)-guided navigation is also an emerging technique in spine surgery that is becoming widely adopted for its benefits in assisting surgeons in localizing pathology and guided spine instrumentation placement. In this technical note, we describe a technique that uses intraoperative CT-guided navigation concomitantly with a transforaminal endoscopic approach to decompress a L4-L5 foraminal heterotopic bone formation after an oblique lumbar interbody fusion. The addition of intraoperative CT-guided navigation proved beneficial in targeting the pathology during the procedure and ensuring that the pathology was resolved by offering postoperative CT visualization of the decompressed neural foramen.

Endoscopic Identification and Treating the Pain Generators in the Lumbar Spine that Escape Detection by Traditional Imaging Studies

Introduction: The ability to identify and treat pain generators in the lumbar spine is helped by incorporating diagnostic and therapeutic injections, followed by visualizing the pain generator with an endoscope. Although improvements in imaging are getting very sophisticated, visualization of the source of the pain generators is currently only possible with an endoscope. This has opened the door to more options for cost effective surgical treatment in staged manner by treating the pain source. Materials and methods: An FDA approved system endoscopic system and technique developed by A. Yeung in 1997, using a multichannel endoscope for the transforaminal approach to visualize the disc and foramen, is featured. After anesthetizing the disc foramen, and targeting the axilla of the foramen in the vicinity of the exiting and traversing nerve, known to spine surgeons as the “hidden zone” of MacNab, the technique has evolved to surgically provide pain relief for stratified conditions for patient selection. The standard translaminar approach to the disc and the spinal segment will usually miss visualizing the patho-anatomy of pain in this “hidden zone”, an area harboring common causes of “failed back surgery syndrome”. Recent minimally invasive techniques of decompression and fusion may help resolve the pain source, but fusion has its surgical morbidities and high costs. A less invasive highly successful transforaminal endoscopic method with 25-year data supports this technique. Discussion: Transforaminal Endoscopic Spine Surgery, the YESS™ technique, is effective using mobile cannulas to visualize and target the pain source. New instrumentation, techniques, specially configured endoscopes with different size working channels; facilitate effective surgical treatment of the pain generator. Incorporating visualization of the disc cavity to treat painful annular tears adds to the effectiveness of the procedure. The surgeon can also treat spinal stenosis with foraminoplasty by decompressing the ventral facet of the superior articular process as well as the axilla containing the exiting and traversing nerve. The purpose of this study is to demonstrate that the physiology of pain can be visualized as a pain generator. Patho-anatomy is identified and surgically decompressed. Diagnostic and therapeutic injections also aid in identifying pain generators by epidurography performed with the transforaminal approach. Conclusion: Interventional pain management, often the first line of minimally invasive treatment, provides pain relief only by targeting injections to block nerves. Visualizing the patho-anatomy with an endoscope targeting the patho-anatomy by the same interventional needle trajectories, however, provides a surgical option to decompress and ablate the pain generators.

Technical consideration of transforaminal endoscopic spine surgery for central herniation

Introduction: Lumbar disc prolapse is most common between 30 and 50 years of age and is associated with severe disability and pain. It commonly occurs at L4/5 and L5/S1. Transforaminal endoscopic discectomy is an emerging technique for treatment of degenerative disc disease. Literature has shown clinical outcomes, comparable to classical open and micro lumbar discectomy. Central disc herniations in lumbar spine pose technical challenge for transforaminal endoscopic decompression due to its location. Existing techniques to access central herniations and ventral epidural space have trajectory related challenges due to the proximity of the retroperitoneal space and abdominal organs and technically difficult for the less experienced surgeon. Materials and Methods: Thirty patients – 19 males and 11 females – with central, multifocal, central-paracentral disc herniations in the lumbar spine operated in 2015 and 2016 were considered in this study. All patients underwent selective endoscopic discectomy under monitored care anesthesia and local anesthesia with modification of the classical technique, medialization of annulotomy, undercutting the nonarticular part of superior articular process (foraminotomy) and use of articulating and long jaw instruments either alone or in combination. Results: In all the thirty patients, we were able to achieve adequate decompression with neurological recovery. All patients improved in their neurological status. Postoperatively, visual analog scale dropped from 7.8 to 1.8 and ODI dropped from 73.46% to 32. 90% of the patients reported excellent and good results. One patient had recurrent herniation and was treated with transforaminal surgery. One patient had persistent back pain and reported poor outcome. Three patients underwent medial branch block for facet joint pain followed by medial branch rhizotomy and reported excellent and good results. Conclusion: Transforaminal endoscopic spine surgery with modifications as described above to reach the dorsal part of the disc in the midline and to access ventral epidural space is safe and effective.

Percutaneous Endoscopic Interlaminar Approach: Medial Foraminal Decompression in Treating Lumbar Disc Herniation or Spinal Stenosis

Background: The technique of transforaminal endoscopic spine surgery is being widely used for lumbar degenerative diseases. But the interlaminar endoscopic surgery, which is more familiar and easier to be operated for spine surgeons, is more easily applied by traditionally trained surgeons. Objective: We propose the technique of percutaneous endoscopic medial foraminal decompression through interlaminar approach for the treatment of lumbar disc herniation (LDH) and spinal stenosis (LSS), and to explore the safety and efficacy of using this technique clinically. Methods: Thirty-two LDH and eleven LSS patients received medial foraminal decompression surgery with 22.6 ± 7.9 months follow-up. Through interlaminar space, we are able to perform discectomy and lateral recess decompression to decompress the medial foraminal area. Clinical efficacy was assessed by calculating the scores of VAS, SF-36, and lumbar disease JOA and ODI respectively at preoperative, postoperative and the discharge period, 3-6 months postoperatively and the final follow-up time point when patients were considered having received maximum surgical benefit. Follow-up time period varied because of the patients' follow-up logistics in China serving a large referral area made it difficult for rural patients to return at established intervals for the study. Results: For both LDH and LSS patients, the observational indexes of the follow-up time points showed significant differences compared with those preoperatively (P<0.01). Surgical results were assessed according to JOA scores: 22 cases were excellent, 16 cases were good, and 5 cases were fair by modified MacNab criteria. The satisfaction rate of PEMFD was 88.37% during the follow-up period with the improvement of daily life quality. One patient had postoperative radiation calf pain and foot numbness, and another one had the dorsal remnant of the dural sac without symptom. Conclusion: The treatment for LDH and LSS with medial foraminal decompression is safe and effective with minimal tissue trauma, less surgical morbidity to the lumbar canal, with full decompression of nerve roots and the cauda equina. It is more similar to traditional open surgery and easier to achieve adequate canal decompression, especially for LSS.

Transforaminal Endoscopic Foraminoplasty and Discectomy for the Treatment of a Thoracic Disc Herniation

Transforaminal endoscopic spine surgery has emerged internationally as a minimally invasive technique that can be performed in an awake patient in the outpatient setting. Advances in high-definition endoscopic camera technologies as well as the availability of specialty graspers, reamers, drills, and other instruments that can be used down a working channel endoscope have made a myriad of spine diseases accessible to the minimally invasive spine surgeon. The major challenge inherent in the surgical treatment of thoracic disc disease is that the disc herniation is often ventral to the spinal cord. The transforaminal approach and the angled endoscopic camera are an ideal combination for creating a technical advantage to accessing thoracic disc disease.

Technical considerations in transforaminal endoscopic spine surgery at the thoracolumbar junction: report of 3 cases

OBJECTIVE In this study the authors describe the technical considerations and feasibility of transforaminal discectomy and foraminoplasty for the treatment of lumbar radiculopathy in patients who have herniated discs at the thoracolumbar junction. METHODS After institutional review board approval, charts from 3 consecutive patients with lumbar radiculopathy and T12-L1 herniated discs who underwent endoscopic procedures between 2006 and 2014 were reviewed. RESULTS Consecutive cases (n = 1316) were reviewed to determine the incidence and success of surgery performed at the T12-L1 level. Only 3 patients (0.23%) treated with endoscopic surgery for their herniated discs had T12-L1 herniated discs; the rest were lumbar or lumbosacral herniations. For patients with T12-L1 disc herniations, the average preoperative visual analog scale score was 8.3 (indicated in the questionnaire as describing severe and constant pain). The average 1-year postoperative visual analog scale score was 1.7 (indicated in the questionnaire as mild and intermittent pain). CONCLUSIONS Transforaminal endoscopic discectomy and foraminotomy can be used as a safe yet minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a thoracolumbar disc herniation.

Transforaminal endoscopic surgery under local analgesia for ventral epidural thoracic spinal tumor: Case report

Operative management for ventral epidural spinal tumors typcally involves either a costotransversectomy approach or, less requently, a trans-thoracic approach that requires a corpectomy nd fusion. Transforaminal endoscopic spine surgery has been eported for the treatment of lumbar herniated discs (including far ateral and extruded), lumbar spondylolisthesis, lumbar juxtafacet ysts, lumbar discitis and even in the treatment neuropathic pain aused by a T11 colon metastases [1–7]. We report here the first ase of a ventral thoracic epidural spine tumor surgically treated ith a complete endoscopic spinal procedure via the foramen in an wake patient.