Name: L4-L5 Far Lateral Endoscopic Discectomy: Case Presentation of a 47-YearOld Patient
Uploaded: 2026-07-10T00:00:00Z
Channel: Arthrex
Description: Henri d'Astorg, MD (Lyon, France), presents a case in which he used a far lateral endoscopic approach to treat an L4-L5 disc herniation in a 47-year-old male.

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Henri d'Astorg, MD (Lyon, France), presents a case in which he used a far lateral endoscopic approach to treat an L4-L5 disc herniation in a 47-year-old male.

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VID1-009596-en-US | A | L4-L5 Far Lateral Endoscopic Discectomy: Case Presentation of a 47-YearOld Patient

Henri d'Astorg, MD

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L4-L5 Far Lateral Endoscopic Discectomy: Case Presentation of a 47-YearOld Patient

Speaker  My name is Doctor Henry Dastoor. I'm from France. Lyon. I work in the French centre. Orthopedics, santé. I'm going to talk about the Transforaminal approach for far lateral disc herniation. This is the case of a 47 year old male with a L4 left pain becoming unbearable despite of steroid morphine. And he came to my office and he was bent, unable to walk. All the provocative tests were positive. He had a quadriceps motor weakness and the X-ray findings. There were no instability. Foramina in iliac crest were okay. Under MRI, on the axial view, you can see a huge lateral and far lateral disc herniation. And there is a part migrated cranially in the foramen just under the nerve root and a part for lateral. I used to take a lot of time to analyze my images before to get a pre-op planning and to know how to deal with my cannula during the surgery. But first we have to choose the way to treat this patient. So we have many options. Tubular Microdiscectomy mysterious because of the modic one or far lateral endoscopic discectomy. I choose this one. I think it was the better way to treat him. But how I do it. So the setup is in prone position. General anesthesia without muscle relaxant. I used to draw my landmark. First line was the AP view a line between the upper part of the ipsilateral pedicle to the lower part of the contralateral pedicle in lateral view. I target the corner of the lower vertebra and in the intersection between my two lines going to be my skin incision. I scrub myself and I'm going to target with my needle first. The aim of this technique is to be as close as possible to the compressive disc, removing not so many tissues. Speaker  So I'm going to put my warrior after and different dilators and I'm gonna reme if necessary, to have a good docking in the common triangle after I start the endoscopic work at the beginning, because of the targeting, you're exactly the nose inside the disc herniation. So some pieces move out. And then I discovered the Wagner Arch, which will be your landmark during the surgery. Bone is home after you have some debulking to do, removing the pieces all around you. What is difficult to know when it's when to stop during this technique. So I suggest to look for the proximal piece as I said for the prior planning. So I'm moving my cannula if necessary. I use my X-ray to know exactly where I am, and I have to be just in the axilla of the exiting route. I rub and remove the pieces that it's needed. After I slip out with the cannula to remove the far lateral piece, turning the screw up to control the exiting route at the end. I suggest to see the nerve to be sure that it's free. The soft tissue and fat tissue all around are floating, so it's mean that it has been decompressed and you control the bleeding and the job is done. Final result for this patient was good. In the end all the disc herniation has been removed. Recovery was good and kind of leg pain and functional outcome. I chose this technique because I really think that this is ultra mini invasive, technique inducing, fast recovery and few muscle aggression. But it's also a safe and effective procedure that you can develop. And we published that last year. Thank you.

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L4-L5 Far Lateral Endoscopic Discectomy: Case Presentation of a 47-YearOld Patient

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