Name: Endoscopic Approach to Transforaminal Discectomy
Uploaded: 2026-07-13T00:00:00Z
Channel: Arthrex
Description: Henri d'Astorg, MD (Lyon, France), demonstrates an endoscopic transforaminal approach for discectomy in the lumbar spine.

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Henri d'Astorg, MD (Lyon, France), demonstrates an endoscopic transforaminal approach for discectomy in the lumbar spine.

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video

VID1-009576-en-US | A | Endoscopic Approach to Transforaminal Discectomy

Henri d'Astorg, MD

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

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Endoscopic Approach to Transforaminal Discectomy

Speaker  Hi, I'm Doctor Henry Dastoor. I'm from France. Lyon. I work in the center for Orthopedic Safety. I'm going to talk about Transforaminal approach for Discectomy Endoscopically. So we're going to approach L3-l4 level. So first of all we're going to draw our landmark on the skin. So I'm gonna draw the center of the spine. So drawing the midline now. And after the level that we target okay, so we draw this cross and to target Transforaminal, we're gonna have to draw the first line, the first line going to be on AP. And this is a line between the upper part of the ipsilateral pedicle to the lower part of the contralateral pedicle. So I'm gonna draw that line. The aim is to be able to enter in the spinal canal through the recess if it's needed. Okay. The second line is going to be on lateral view the corner of the lower body of L4 after the intersection between two lines going to be where I'm going to open the skin. So go back to AP. We're going to target after with the needle first. So now I take the needle and I'm going to target controlling a p view to be sure that I'm not going through the spinal canal. I'm always controlling that way. The aim is to go that way at the end of the recess. And at this time we have to control laterally. If the targeting is okay. So now I check my targeting. It's okay. I'm exactly in the coming triangle. Speaker  So I go back with my X-ray to AP view. I'm going to open the skin now. So I keep my trajectory with my left hand. I'm a right hand man. Okay. Open the skin if you can open the fascia. It could be helpful. After, I'm going to put my wire. And I'm gonna check all the steps with my X-ray. Okay? My wire is soft. I want to go too far to the spinal canal. You have to keep the good trajectory. Be careful about the fascia. Okay? Second dilator. So I put my crown. Reamer has to my scrub nurse to help me to target. She's gonna open the skin. Please. Thank you. So also clockwise to be soft with a soft tissue. I feel my bony contact now, and I'm gonna start to ream after an X-ray control. Okay. Now I remove it with my stopper, catch it not to loose dilator. So I put the delayed raw. Undercooked rice pushing to bony contact and I'm gonna start to rim. Okay. Remove that one. So last reaming filling my bony contact. Okay. Reaming. So I'm removing. The crown reamer. Okay. I put one more reamer. So I'm gonna introduce my walking cannula and the opening of the cannula. Gonna look to the pedicle of the lower vertebra. So I push it. My walking cannula is exactly at the right positioning. We're gonna introduce the scope and start endoscopy because my patient are operated in general anesthesia without muscle relaxant. I'm going to use my bipolar first like a nerve stimulator, and I'm going to control that everything is okay. Speaker  I'm not too close to the root, the exiting roots or passing roots. And at this time I'm going to discover the arch between the pedicle. At this time, you can see that the lip of your working cannula is protecting you from the exiting root. Okay. On the floor, you have the disc. Okay. Here you have the pedicle, and there you have the sap. So when you have all your landmarks, okay, you can approach easily the neural structure. So it means that if you have to go to the spinal canal to decompress The L4 root. The passing root. You have to work on that direction. You can see all the tissue, vena and fat tissue there. And so you can rub to create a space and the saline gonna help you. Okay. I have to my scrub nurse to put a hand on the leg of the patient. And if it's moving, she's gonna tell me, and I'm gonna stop what I'm doing to be sure that I'm not hurting the nerve. I prefer to to use that kind of angulated instrument, to be able to see the tip of my instrument and to be sure that I'm not grasping something bad. Okay. But More than grasping. I'm gonna rub during a long time on that surgery with my probe. Please. Okay. You can see some vessels. You know, when you need to be guided. Speaker  It's very easy in that technique to have an AP view, to be sure that your the tip of your instrument is in the good area. So I'm under the nerve root now, so I have to remove that to be better. I'm gonna push a little bit my scope to see the spinal canal. I'm gonna use the probe always to rub and to have a better vision and to decompress the passing route. Okay. So if I need to be sure and to know where I am. I can easily do An X-ray. So I'm exactly in the spinal recess, and if it's necessary, I can also remove some soft tissue there. When you have this cover what you want, you can turn your cannula. And at this time my field is bigger. But on that side, I'm not protecting so much my exiting route. So what I want to know if I release everything, I like to see my probe there at the lower part of the disc. And I'm going to also control if I work enough on that part at the upper end plate. Okay. So I'm gonna be sure between there to there that my passing route is free. So at this moment, you can see that we have made a good decompression of the passing route. If you have a migrated or a formal or extraforaminal disc herniation, you have to work a little bit more lateral. So to do that, you have to slip out your cannula like this and to work in the foramina. Speaker  Okay. And I'm gonna be able to protect my exiting route with the lip of my working cannula. If I turn more, I'm gonna open the field of the exiting route so you can see the fat tissue. And if I rub, they're always controlling with my scrub nurse. I'm gonna discover there the exiting route. So be careful, okay? Because we are very close to the DRG, not to induce some iatrogenic pain. So you can work easily on that direction. So now you're in the axilla of the exiting route. Okay. We can discover it at 3:00. This is the exiting route. Okay. I go back a little bit. So we're going to remove a little bit more. What is very important in spine endoscopy is to fill in the meantime that you see. But I can feel with my probe that I'm exactly on the right positioning to be sure that I'm not dangerous. I don't use the cutting when I'm in the spinal canal, so I'm only doing some coagulation. Okay, so there we can see the exiting route, but we don't want to hurt it too much so that at this time, this is a good way to control that the passing route is free and the exiting route is free. So I think Transforaminal approach is a game changer. It's a very good way to approach the foramen to decompress the exiting route. Be careful for beginners or for l5-s1. Thank you for your attention.

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