Transforaminal Lumbar Endoscopic Discectomy (Selective Endoscopic Discectomy)

Transforaminal endoscopic discectomy is a procedure in which an endoscope is inserted into the disc through the foramen using a “keyhole” incision 7mm in length (the diameter of a pencil). Muscle and tissue are dilated rather than being cut when accessing the disc, and a laminotomy does not have to be perfromed. The excellent visualization via the endoscope permits the surgeon to target the anatomy and selectively remove the portion of the herniated nucleus pulposus that is causing the patients’ leg pain. The procedure is performed with an “inside out” technique working directly underneath the herniation (within the disc) pulling it back into the disk and out through the tube, instead of through the spinal canal like a traditional microdiscectomy or microendoscopic discectomy. This significantly decreases the risk of scar tissue formation, and avoids the need for nerve root retraction.

The patient remains awake during the procedure. After a local anesthetic is administered, a small needle is inserted into the disc space. A 7mm (1/4-inch) skin incision is made and a tube is slipped over the needle into the abnormal disc. The endoscope is then inserted through the tube into the disc. Using x-ray guidance and endoscopic visualization, micro-instruments are used to remove the damaged disc. A laser may be used to further remove and shrink the disc (disc decompression) and to tighten the annulus. On average, the procedure takes about 30 minutes to one-hour per disc. Upon completion of the procedure, the probe is removed and a small bandage is applied over the needle incision.

Transforaminal Lumbar Endoscopic Discectomy also goes by the names:

• Discoscopic Discectomy
• YESS Selective Endoscopic Discectomy
• Selective Endoscopic Discectomy