Name: Endoscopic Trans-SAP Approach: Case of a 77-Year-Old Patient With a Cranially Migrated L4-L5 Disc Herniation
Uploaded: 2026-07-31T12:19:00Z
Channel: Arthrex
Description: Henri d'Astorg, MD (Lyon, France), presents a case of a cranially migrated L4- L5 disc herniation in a 77-year-old patient treated via an endoscopic trans-SAP approach.

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Henri d'Astorg, MD (Lyon, France), presents a case of a cranially migrated L4- L5 disc herniation in a 77-year-old patient treated via an endoscopic trans-SAP approach.

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VID1-009598-en-US | A | Endoscopic Trans-SAP Approach: Case of a 77-Year-Old Patient With a Cranially Migrated L4-L5 Disc Herniation

Henri d'Astorg, MD

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Endoscopic Trans-SAP Approach: Case of a 77-Year-Old Patient With a Cranially Migrated L4-L5 Disc Herniation

Speaker  Hi. My name is Henry. I'm a spine surgeon in France. Lyon. I'm going to talk about a technique. Let's focus about the patient. This is 77 year old patient. He had previous surgery in L4-l5, laminectomy and disc herniation. Now, a recent l4-l5 lumbar disc herniation with crural and sciatic radicular pain. He present at the office with a deficit on the foot. Extensor. As you can see on the MRI. On the sagittal view you can see that there is a fresh disc herniation cranially migrated, and on the axial view you can see that it's compressed. In the meantime, the L4 root and the L5 root on the right side. So how to deal with that kind of patient? Transfix ASAP approach could reach both roots minimally. Invasively. So it means that you need small diameter scope, long scope, trephine burs, and you're going to create a tunnel to be able to access, decompress and remove all the compressive stuff that you need. First step is the positioning of the trocar on the lateral fluoroscopic view and positioning under AP control. After that, you remove and you put a wire. And after you put the first reamer, the second reamer and the third reamer, to be able to create a corridor, to be able to approach the spinal canal and the foramen. At least you put the rocking cannula and you're gonna start the endoscopic work. Speaker  So at the beginning you have to to find your bony corridor. The roof is bone, the floor is disc. And you can see at 3:00 the exiting nerve root. You're going to use your working cannula as a retractor pushing a little bit the exiting root. And you can discover the disc herniation because you use the working cannula as a retractor. You're going to be able to grasp safely all the pieces that you have to remove. You remove big pieces. You can see that the soft tissue fat tissue starting to float. It's going to. It's mean that the decompression is coming. And after you rub all around to be sure that there is no pieces remaining, you feel. If the structure seems to be decompressed and you can see that darkness with the empty herniation sac, and you can see that the exiting nerve root is at the good positioning. And you can also control the spinal canal or the soft tissue are floating. And in the darkness you can feel the L5 root who has been decompressed by the corridor that you create at the beginning, removing all the bony structures that were compressing the nerve. At least you can control where you are with the X-ray. And the surgery has been done really minimally. Invasively avoiding fusion, avoiding a lot of. Bony work and avoiding scar tissue. Thank you for your attention.

Endoskopischer Trans-SAP-Ansatz für die lumbale Diskektomie

Endoscopic Trans-SAP Approach: Case of a 77-Year-Old Patient With a Cranially Migrated L4-L5 Disc Herniation

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