Name: Endoscopic Transpedicular Discectomy: Case Presentation of a 74-Year-Old Patient
Uploaded: 2026-07-31T12:01:00Z
Duration: 3 min 32 s
Channel: Arthrex
Description: Prof. Dr. med. Mazda Farshad (Zurich, Switzerland) presents a case of a 74- year-old female with a L1-L2 caudally migrated disc herniation causing L2 radiculopathy, characterized by anterior thigh pain, hip flexor weakness, and hypesthesia, treated using an endoscopic transpedicular approach.

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<p>Prof. Dr. med. Mazda Farshad (Zurich, Switzerland) presents a case of a 74- year-old female with a L1-L2 caudally migrated disc herniation causing L2 radiculopathy, characterized by anterior thigh pain, hip flexor weakness, and hypesthesia, treated using an endoscopic transpedicular approach.</p>

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VID1-009760-en-US | A | Endoscopic Transpedicular Discectomy: Case Presentation of a 74-Year-Old Patient

Mazda Farshad, MD

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Endoscopic Transpedicular Discectomy: Case Presentation of a 74-Year-Old Patient

Speaker  My name is Zafar from Zurich, Switzerland. I will present a typical case for the Transpedicular approach. The particular approach can be a valuable option for addressing pathologies located medial to the pedicle, such as high grade Caudally migrated disc herniations. However, the technique requires experience in spinal endoscopy and has biomechanical limitations. This case involves a 74 year old female patient presenting with a L2 radiculopathy caused by a right sided caudally migrated disc sequestration. Clinically, she reported anterior type pain and demonstrated the M4 minus weakness of the hip flexors. Surgical removal using a monopolar endoscopic technique was indicated. Three potential surgical approaches were evaluated the interlaminar endoscopic lumbar discectomy, the transforaminal, endoscopic lumbar discectomy, and the trans particular approach. While each technique has its merits, application of the established complexity classification system suggested that the Transpedicular approach could technically be the least complex. The Interlaminar approach is limited by a bony, occluded interlaminar window at L1 two, whereas the Transforaminal approach was constrained by the anatomy and position of the dural sac and the far migrated disc herniation. Consequently, a particular approach was selected. The procedure was performed using a small diameter endoscope and a bur through an approach with a skin entry eight centimetres paramedian oriented perpendicular to the spinal alignment line. The anesthesiologist was instructed to avoid muscle relaxation and to maintain systolic blood pressure below 110mm mercury. Speaker  Tranexamic acid and fortecortin were administered according to the standard protocol, beginning eight centimetres lateral to the midline. The trajectory was directed towards the typical entry point of a pedicle screw. The transverse process lateral facet junction was exposed by clearing the surrounding soft tissue. Burring was performed under continuous fluoroscopic guidance to minimize biomechanical compromise. The bony defect was kept as small as possible given the risk of pedicle weakening after perforation of the second cortical layer, the ligamentum flavum was visualized and removed using rongeurs. The nerve root was then identified and gently mobilized medially, allowing stepwise removal of the disc herniation fragments. Throughout the procedure, excessive pressure on the endoscope was strictly avoided to reduce the risk of transverse process fracture. Postoperative computed tomography confirmed the trajectory and extent of the bony defect. The patient was discharged two days after surgery, pain free, with improved strength of the hip flexors. We have extensively investigated the biomechanical consequences of the trans radicular approach, and identified an approximately 30% reduction in pedicle load bearing capacity. This finding limits the broader clinical application of this technique, and supports its use only in carefully selected cases, where it provides a clear and specific surgical advantage.