Acta Neurochirurgica

, Volume 160, Issue 8, pp 1603–1607 | Cite as

Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations

  • Javier Quillo-Olvera
  • Kutbuddin Akbary
  • Jin-Sung KimEmail author
How I Do it - Spine - Other
Part of the following topical collections:
  1. Spine - Other



Surgical options for removing high-grade down-migrated lumbar disc herniations located medial to the pedicle include an extensive laminectomy and facetectomy. A direct percutaneous endoscopic approach through the pedicle for reaching the herniated disc without risk of iatrogenic instability is feasible.


The transpedicular approach consists of creating a tunnel through the pedicle. Subsequently, access to the parapedicular epidural space is obtained, and downward migrated disc can be removed.


This technique allows to reach migrated herniations medially to the pedicle safely and effectively.


Endoscopic spine surgery Disc herniation Minimally invasive Transpedicular 





Computed tomography


Magnetic resonance imaging


Percutaneous endoscopic lumbar discectomy




Visual analog scale


Author contribution

All authors have contributed to the material and preparation of this manuscript.

Compliance with ethical standards

The patient has consented to submission of this “How I Do It” to this journal.

Conflict of interest

The authors declare that they have no conflict of interest. This manuscript has not been submitted elsewhere.

Supplementary material (173.6 mb)
Video 1 We present the step by step of percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations. A real clinical case used to exemplify the technique, and detailed information about the procedure is shown in the video. (MOV 177781 kb)


  1. 1.
    Bernucci C, Giovanelli M (2007) Translaminar microsurgical approach for lumbar herniated nucleus pulposus (HNP) in the “hidden zone”: clinical and radiologic results in a series of 24 patients. Spine (Phila Pa 1976) 32(2):281–284CrossRefGoogle Scholar
  2. 2.
    Choi KC, Kim JS, Ryu KS, Kang BU, Ahn Y, Lee SH (2013) Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Physician 16:547–556PubMedGoogle Scholar
  3. 3.
    Choi KC, Kim JS, Park CK (2016) Percutaneous endoscopic lumbar discectomy as an alternative to open lumbar microdiscectomy for large lumbar disc herniation. Pain Physician 19:E291–E300PubMedGoogle Scholar
  4. 4.
    Choi KC, Lee DC, Shim HK, Shin SH, Park CK (2017) A strategy of percutaneous endoscopic lumbar discectomy for migrated disc herniation. World Neurosurg 99:259–266CrossRefPubMedGoogle Scholar
  5. 5.
    Krzok G, Telfeian AE, Wagner R, Iprenburg M (2016) Transpedicular lumbar endoscopic surgery for highly migrated disk extrusions: preliminary series and surgical technique. World Neurosurg 95:299–303CrossRefPubMedGoogle Scholar
  6. 6.
    Macnab I (1971) Negative disc exploration. J Bone Joint Surg Am 53:891–903CrossRefPubMedGoogle Scholar
  7. 7.
    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33(9):931–939CrossRefGoogle Scholar
  8. 8.
    Torun F, Tuna H, Buyukmumcu M, Caglar S, Baysefer A (2008) The lumbar roots and pedicles: a morphometric analysis and anatomical features. J Clin Neurosci 15:895–899CrossRefPubMedGoogle Scholar
  9. 9.
    Uniyal P, Choi G, Khedkkar B (2016) Percutaneous transpedicular lumbar endoscopy: a case report. Int J Spine Surg 10:31 eCollection 2016CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Spine Center, Department of Neurosurgery and The Catholic Central Laboratory of Surgery (CCLS), Seoul St. Mary’s Hospital, College of MedicineThe Catholic University of KoreaSeoulSouth Korea

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