Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications

Transforaminal percutaneous endoscopic lumbar discectomy is regarded as an effective alternative to open discectomy. Remarkable technical evolution now enables selective endoscopic removal of an epidurally extruded disc fragment. As a result, the surgical indications for this technique are becoming broader. However, as the use of endoscopic techniques increases in spinal procedures, related complications emerge as important problems. These include postoperative dysesthesia, dural tears, hematoma, infection and visceral injury. There are several technical guidelines to increase the effectiveness of endoscopic techniques and prevent complications. Initial landing should be as close to the target as possible. Complete herniotomy after thorough release of annular anchorage is a key to success. The definitive end point of the procedure is free mobilization of neural tissues, not direct exposure of neural tissues.