Introduction: Since Kambin introduced the concept of percutaneous transforaminal disc surgery in 1973, there has been numerous advances in the field of spine endoscopy and the concept of central debulking of the disc has changed to targeted fragmentectomy and disc preservation. The lumbar disc fragments which are down migrated and to the medial aspect of the pedicle are extremely challenging to deal by transforaminal approach even after foraminoplasties and by various other approaches. Therefore most spine surgeons prefer open procedures which requires extensive removal of pars and facet leading to the risk of instability.
Aims and objectives: To describe a safe and effective technique for lumbar intra-canal high grade down migrated disc herniation, medial to the pedicle by transpedicular endoscopy.
Methods and treatment: Two patients underwent percutaneous transpedicular lumbar endoscopy under local anaesthesia for high grade down migrated disc herniation and for discal cyst at the medial aspect of pedicle respectively.
Results: We achieved the complete successful decompression by percutaneous transpedicular lumbar endoscopy.
Conclusion: Authors found this technique very promising in complete removal of disc material under direct visualisation for high grade down disc herniations.
Keywords: high grade down migrated disc herniation; percutaneous transpedicular lumbar endoscopy; spine endoscopy.