Outside-in Direct Fragmentectomy of TELD After Foraminoplasty
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As a minimally invasive surgery for lumbar disc herniation, full-endoscopic discectomy (FED) is gaining attention. There are three types of FED, transforaminal and posterolateral method with local anesthesia and interlaminar method with epidural anesthesia and general anesthesia. There are two methods of transforaminal endoscopic lumbar discectomy (TELD) for accessing the lumbar intervertebral discs in transforaminal approach: “inside-out technique” and “outside-in technique.” Following foraminoplasty, the cannula was moved into the epidural space with the outside-in technique. With epidural observation just beneath the nerve root, the extruded transligamentous fragment was confirmed. The direct fragmentectomy of TELD is possible from outside of the intradiscal space. In conclusion, the outside-in technique during the transforaminal approach for TELD is a useful and reliable technique to remove extruded transligamentous disc fragments. We describe the outside-in technique of TELD in this review.
KeywordsLumbar disc herniation Full-endoscopic discectomy Local anesthesia Transforaminal approach Outside-in technique
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