Technical considerations in transforaminal percutaneous endoscopic lumbar discectomy: Detailed description of 2 cases and literature review

While lumbar disc herniation is perhaps the most common spinal problem treated by neurosurgeons, foraminal stenosis has always been a particularly difficult challenge to manage. The older open techniques described the need to completely remove the facet to manage this problem, intrinsically destabilizing the spine, and necessitating spinal fusion. As endoscopic technology has expanded, one result of which is the development of smaller high-definition 3-D endoscopes, surgeons began to realize that the only truly natural opening into the spinal canal was the foramen. Despite this natural corridor which can be used as is when devoid of disease, entering the foramen in the context of foraminal stenosis, in close proximity to the overlying nerve root, demands the surgeon have a set of essential technical considerations. Several papers describe a series of specific technical steps, and technical tips, to maximise the effectiveness of the procedure and importantly how to avoid complications. We describe a short series of 2 patients, who presented to our unit with a foraminal component to their lumbar disc herniations, that were ultimately taken to the operating room for a transforaminal percutaneous endoscopic lumbar discectomy, with favourable results. Our case series is unique as it comes from South Africa.