Endoscopic Laminotomy, Foraminotomy, and Discectomy for Herniated Lumbar Disc

Proper operation room setup requires a radiolucent table with a hyperkyphotic frame, one C-arm, and a tower with the usual monitor for endoscopic viewing. Second-generation foraminal scopes have larger operating channels that allow for larger forceps and motorized equipments such as high-speed burrs to aid in foraminal decompression. These new endoscopes can be used for lateral and central stenosis, treatment of failed back surgery syndrome caused by stenosis, and dorsal laminotomy if the scope is used fully endoscopically in the dorsal approach. The technique utilized a posterolateral approach to the foraminal zone of the disc bordered by the superior facet dorsally, the exiting nerve ventrally, and the endplate of the inferior vertebra caudally. The early efforts were limited to a nonvisualized central discectomy to achieve an indirect decompression of the nerve roots, but improvements in surgical equipment and technique evolved gradually.