History of Transforaminal Full-Endoscopic Lumbar Surgery

  • Koichi Sairyo
  • Toru Maeda


Transforaminal approach was started as the technique of percutaneous discectomy by Hijikata in Japan. Hijikata’s method was minimally invasive; however, it could not remove the entire herniated mass in the spinal canal because he did not use the endoscope. From the later 1980s, a trial was started by Kambin, Schreiber and Leu to utilize an endoscope or arthroscope in the percutaneous discectomy technique. The current single-portal endoscopic discectomy was established by Anthony Yeung. Initially, the indication was only for the herniated nucleus pulposus. Nowadays, thanks to the development of the instruments and high-speed drill, the indication enlarged to the spinal canal stenosis. These full-endoscopic spinal surgeries can be done under local anesthesia with 8 mm skin incision. This must be the least invasive spine surgery.


Full-endoscopic spine surgery Kambin triangle Local anesthesia Transforaminal approach 


  1. 1.
    Hijikata S. A method of percutaneous nuclear extraction. J Toden Hosp. 1975;5:39.Google Scholar
  2. 2.
    Hijikata S. Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop Relat Res. 1989;238:9–23.CrossRefGoogle Scholar
  3. 3.
    Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res. 1986;207:37–43.Google Scholar
  4. 4.
    Kambin P, Brager MD. Percutaneous posterolateral discectomy. Anatomy and mechanism. Clin Orthop Relat Res. 1987;223:145–54.Google Scholar
  5. 5.
    Kambin P, Schaffer JL. Percutaneous lumbar discectomy. Review of 100 patients and current practice. Clin Orthop Relat Res. 1989;238:24–34.CrossRefGoogle Scholar
  6. 6.
    Kambin P. Arthroscopic microdiskectomy. Mt Sinai J Med. 1991;58(2):159–64.PubMedGoogle Scholar
  7. 7.
    Schreiber A, Leu H. Percutaneous nucleotomy: technique with discoscopy. Orthopedics. 1991;14(4):439–44.PubMedGoogle Scholar
  8. 8.
    Yeung AT. The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med. 2000;67:327–32.PubMedGoogle Scholar
  9. 9.
    Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine. 2002;27:722–31.CrossRefGoogle Scholar
  10. 10.
    Yeung AT, Yeung CA. Minimally invasive techniques for the management of lumbar disc herniation. Orthop Clin North Am. 2007;38(3):363–72.CrossRefGoogle Scholar
  11. 11.
    Tsou PM, Alan Yeung C, Yeung AT. Posterolateral transforaminal selective endoscopic discectomy and thermal annuloplasty for chronic lumbar discogenic pain: a minimal access visualized intradiscal surgical procedure. Spine J. 2004;4(5):564–73.CrossRefGoogle Scholar
  12. 12.
    Dezawa A, Sairyo K. New minimally invasive discectomy technique through the interlaminar space using a percutaneous endoscope. Asian J Endosc Surg. 2011;4(2):94–8.CrossRefGoogle Scholar
  13. 13.
    Dezawa A, Mikami H, Sairyo K. Percutaneous endoscopic translaminar approach for herniated nucleus pulposus in the hidden zone of the lumbar spine. Asian J Endosc Surg. 2012;5(4):200–3.CrossRefGoogle Scholar
  14. 14.
    Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521–30.CrossRefGoogle Scholar
  15. 15.
    Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931–9.CrossRefGoogle Scholar
  16. 16.
    Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S. The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Physician. 2013;16(4):335–44.PubMedGoogle Scholar
  17. 17.
    Hofstetter CP, Choi G, Gibson JNA, Ruetten S, Zhou Y, Wagner R, Ahn Y, Lee JH, Sairyo K, Telfeian AE, Prada N, Shen J, Cortinas FC, Brooks NP, Van Daele P, Kotheeranurak V, Hasan S, Härtl R, Kim JS. AO consensus paper on nomenclature for working channel endoscopic spinal procedures. Global Spine J. 2020;10(2 Suppl):111S–121S. Epub 2020 May 28.
  18. 18.
    Henmi T, Terai T, Hibino N, Yoshioka S, Kondo K, Goda Y, Tezuka F, Sairyo K. Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note. J Neurosurg Spine. 2016;24(2):275–80.CrossRefGoogle Scholar
  19. 19.
    Henmi T, Terai T, Nagamachi A, Sairyo K. Morphometric changes of the lumbar intervertebral foramen after percutaneous endoscopic foraminoplasty under local anesthesia. J Neurol Surg A Cent Eur Neurosurg. 2018;79(1):19–24.CrossRefGoogle Scholar
  20. 20.
    Yoshinari H, Tezuka F, Yamashita K, Manabe H, Hayashi F, Ishihama Y, Sugiura K, Takata Y, Sakai T, Maeda T, Sairyo K. Transforaminal full-endoscopic lumbar discectomy under local anesthesia in awake and aware conditions: the inside-out and outside-in techniques. Curr Rev Musculoskelet Med. 2019;12:311–7.CrossRefGoogle Scholar
  21. 21.
    Yamashita K, Higashino K, Sakai T, Takata Y, Hayashi F, Tezuka F, Morimoto M, Chikawa T, Nagamachi A, Sairyo K. Percutaneous full endoscopic lumbar foraminoplasty for adjacent level foraminalstenosis following vertebral intersegmental fusion in an awake and aware patient under local anesthesia: a case report. J Med Invest. 2017;64(3.4):291–5.CrossRefGoogle Scholar
  22. 22.
    Yeung A, Gore S. Endoscopic foraminal decompression for failed back surgery syndrome under local anesthesia. Int J Spine Surg. 2014;8 eCollection 2014.
  23. 23.
    Sairyo K, Higashino K, Yamashita K, Hayashi F, Wada K, Sakai T, Takata Y, Tezuka F, Morimoto M, Terai T, Chikawa T, Yonezu H, Nagamachi A, Fukui Y. A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: technical considerations in a fresh cadaver model and a literature review. J Med Invest. 2017;64(1.2):1–6.CrossRefGoogle Scholar
  24. 24.
    Lewandrowski KU. Endoscopic transforaminal and lateral recess decompression after previous spinal surgery. Int J Spine Surg. 2018;12(2):98–111.CrossRefGoogle Scholar
  25. 25.
    Nakajima D, Yamashita K, Tezuka F, Manabe H, Ishihama Y, Sugiura K, Takata Y, Sakai T, Maeda T, Sairyo K. Successful percutaneous endoscopic decompression surgery under the local anesthesia for L5 radiculopathy caused by L5-S1 foraminal stenosis and L4-5 lateral recess stenosis: a case report. J Med Investig. 2020;67(1.2):192–6.CrossRefGoogle Scholar
  26. 26.
    Sugiura K, Yamashita K, Manabe H, Ishihama Y, Tezuka F, Takata Y, Sakai T, Maeda T, Sairyo K. Prompt return to work after bilateral transforaminal full-endoscopic lateral recess decompression under local anesthesia: a case report. J Neurol Surg A. 2020. in press.Google Scholar

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© Springer Nature Singapore Pte Ltd. 2021

Authors and Affiliations

  • Koichi Sairyo
    • 1
  • Toru Maeda
    • 1
  1. 1.Department of OrthopedicsTokushima UniversityTokushimaJapan

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