Direct foraminoplasty in endoscope-assisted transforaminal lumbar interbody fusion for the treatment of lumbar disc herniation

Objective As a new minimally invasive surgery developed in recent years, the procedure of endoscope-assisted transforaminal lumbar interbody fusion (TLIF) has not been well described. We herein describe a patient with lumbar disc herniation who underwent direct foraminoplasty and thorough decompression using a self-designed endoscopic trephine in endoscope-assisted TLIF at L4-5. Methods A 57-year-old man presented with a 3-month history of low back and right leg pain. Lumbar spine magnetic resonance imaging indicated protrusion of the L4-5 intervertebral disc in the right posterior direction. The patient underwent endoscopic surgery involving direct foraminoplasty, removal of the L4-5 intervertebral disc, and thorough decompression around the nerve roots. Results During the 1-year follow-up, the patient was generally in good condition and had no significant limitation of lumbar spine activity. Conclusions Endoscopic resection for the treatment of lumbar disc herniation is not a novel concept, but the improvement in the efficacy of endoscope-assisted TLIF and other endoscope-assisted spinal surgeries deserves to be reported. Through the innovation and improvement of surgical equipment for endoscope-assisted TLIF, direct foraminoplasty and thorough decompression can be effectively realized. These advances will help to promote the postoperative efficacy and enhance the prognosis.