Transforaminal Approach for L5-s Level

  • Fumitake Tezuka


The trajectory of TELD can be limited by the surrounding anatomical structure. TELD for the central-type lumbar disc herniation at the L5-s disc level is more technically demanding than TELD at the L4–L5 disc level because of the interference of the iliac crest. However, in the clinical setting, such anatomical particularities can be overcome by using a hand-down technique with the possible addition of a foraminoplasty when we perform TELD at the L5-s disc level.


Lumbar disc herniation L5-s intervertebral disc TELD Iliac crest Foraminoplasty 


  1. 1.
    Tezuka F, Sakai T, Abe M, et al. Anatomical considerations of the iliac crest on percutaneous endoscopic discectomy using a transforaminal approach. Spine J. 2017;17(12):1875–80.CrossRefGoogle Scholar
  2. 2.
    Choi G, Lee SH, Raiturker PP, et al. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5–S1 using rigid working channel endoscope. Neurosurgery. 2006;58:ONS59–68.PubMedGoogle Scholar
  3. 3.
    Dezawa A, Sairyo K. New minimally invasive endoscopic discectomy technique through the interlaminar space using a percutaneous foraminoscope. Asian J Endosc Surg. 2011;4:94–8.CrossRefGoogle Scholar
  4. 4.
    Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg. 1997;3:301–7.Google Scholar
  5. 5.
    Destandeau J. Technical features of endoscopic surgery for lumbar disc herniation: 191 patients. Neurochirurgie. 2004;50:6–10.CrossRefGoogle Scholar

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© Springer Nature Singapore Pte Ltd. 2021

Authors and Affiliations

  • Fumitake Tezuka
    • 1
  1. 1.Department of OrthopedicsTokushima UniversityTokushimaJapan

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