Name: Endoscopic Transpedicular Lumbar Discectomy
Uploaded: 2026-08-07T10:47:00Z
Channel: Arthrex
Description: Prof Dr med Mazda Farshad (Zurich, Switzerland) demonstrates the endoscopic transpedicular approach for a lumbar discectomy.

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Prof Dr med Mazda Farshad (Zurich, Switzerland) demonstrates the endoscopic transpedicular approach for a lumbar discectomy.

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English  - en

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VID1-009873-en-US | A | Endoscopic Transpedicular Lumbar Discectomy

Mazda Farshad, MD

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Endoscopic Transpedicular Lumbar Discectomy

Speaker  My name is Maisa Farshad from Zurich, Switzerland. I will demonstrate a trans pedicular endoscopic approach to the lumbar spine. So first we have to define the anatomical marks midline. First we draw the midline. Then we define which pedicle we want to go to. In this case this pedicle two. That's exactly the point. We want to land with our mark the lateral border of the pedicle that is going to be approached. Remember that this approach is for far migrated upward or downward sequestered disc Herniations. So basically a good point to remember is what would be your trajectory of a pedicle screw that would perforate medially. That's more or less the trajectory that you want to use to approach the recess. Endoscopically. Transpedicular. So then we take the ruler and based on our preoperative MRI, we have defined the exact trajectory and angle we want to aim. So here I'm going to select between 3 to 4cm from the midline, which is around one centimetre from my mark. I will take the access needle. And basically point towards the TPI. So I'm on the TPI now and I will palpate my way towards the entry point where in the middle here. So that's exactly where we want to go. The docking point. So now I will do the skin incision. So we perform the skin incision including the thoracolumbar fascia. Speaker  Once this is done we take the guidewire. We once again control under fluoroscopy. Now we see a displacement of the guidewire. We reposition it one step dilator. And palpation of the pedicle. So I can palpate the upper border and the lower border palpation of the TP here. And when this is done we take the cannula. The working cannula. And with the sharp edge we again scratch off soft tissue from the TP. So that's how we access at the junction of the TP and the pedicle of L2 on the left side here. Once this is done we can start with using our endoscope. So this is a small size short endoscope used for usually Interlaminar and Transforaminal approach. So after approaching, the important step is to visualize your anatomical landmarks, which is the TP and the junction to the joint medially. It wouldn't be unusual that when visualizing, you basically perform a medial branch transection. So let's get rid of any soft tissue on the TP and at the junction. Palpation of the lower border of the TP and the upper border. Soft tissue removal and control of bleeding. Important to visualize the lateral border of the joint. A common mistake is that the trajectory is aimed to. Laterally, and therefore perforation of the TP can happen. Okay, so now we have visualized it. Speaker  Once again. This is the TP here, the upper border of the TP, the lower border of the TP here, and the junction to the joint and the middle of the TP at the junction is where the drilling point will be. Then we will start drilling. At this point, it's a good idea to check under fluoroscopy that still, you're at the wanted TPI, which is the case. That's exactly where we want to start our drilling and make sure that you're you're not orthogonal, but dropping your hands, because otherwise you might perforate the TPI and land laterally to the pedicle instead of in the pedicle. So convergence and not orthogonality. Once you have considered this point, you start with drilling. There is some soft tissue in our way that we're going, we're going to remove. So this is the beginning of our cone that we will create towards the recess in our transpedicular approach. Exactly. So now we're midway. It's always good to control with fluoro. Sometimes creation of a cone configuration is necessary for better visualization. Palpation while burying is important. Be careful to not push too much on the TPI, otherwise it might break in brittle bone in osteoporotic patients. Okay, now we are perforating the medial border of the pedicle, which I already also could palpate. So this is now the recess already the perforation in the recess. Speaker  You can use your Kerrison to enlarge it. So to define how far the drilling should be a lateral view can be very useful. Here we see that we have still a way to go. So here we see the perforation of the second cortical bone. Let's give you an overview again. Tp junction. So we drilled our cone. We used lateral fluoroscopy to make sure that we are approaching the recess. Now we have perforated the medial part of the pedicle. Here are ready. And below that usually you would see your disc herniation that could be removed easily. The hole can be enlarged as needed. At this point also a kerosene can be used. And here we have the access to the spinal canal. The Hoffman ligament can be removed to displace the lateral descending nerve root. And here is where the disc herniation could be removed. Usually a large disc herniation is sitting here and can be easily removed just by the pituitary. So the Baltic probe can be used to mobilize a disc herniation and to displace the descending nerve medially. So let's repeat TPI upper border and lower border of the TPI junction to the joint here. Junction to the joint here and our cone shaped access Transpedicular. Which was supported by fluoroscopy. And here we have access to the lateral recess. Speaker  Here we see that we're at the lateral recess. Okay. Okay. Here we see nicely how we have access the lateral recess. The trans particular approach is indicated for far migrated disc herniation, where the Interlaminar or transforaminal approach is more challenging. The Transpedicular approach should appreciate that the bony structures should be kept intact as much as possible, and the hole should be kept small, otherwise biomechanically there will be a weakening of the pedicle. The docking point is where you would put in a pedicle screw. So visualize the TPI, the upper border here and the lower border of the TPI and the junction to the joint. That's where you dock with your burr. Then FiberRing is performed in a cone shaped configuration until the second cortical bone is palpated and perforated. After that, you have immediate access to the lateral aspect of the descending nerve root as shown here, usually with a disc herniation. That's where it would sit. And you could remove it with your curved pituitary. Palpation of the medial border of the pedicle can then be performed. Visualization under fluoroscopy for checking craniocaudal extension. Here we see that we're at the medial border of the pedicle with a nice access to the lateral aspect of the descending nerve root as shown here. So I'm happy. Happy with that. Great. Thank you everybody.

Discectomia lombar endoscópica transforaminal

Endoscopic Transpedicular Lumbar Discectomy

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