Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments for lumbar disc herniation, and has 3 different operative approaches. Here, we will review the posterolateral approach (PLA) known as Exraforaminal PELD.

1. ENDOSCOPIC SPINE SURGERY
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2. DR. REZA AMINNEJAD

3. INTRODUCTION
Extraforaminal disk herniations or “the hidden zone” as described by
Macnab extend out from the far lateral reaches of the spinal canal.
Clinical syndrome became clear only after Abdullah in 1974 described
extreme lateral disk herniation.
This endoscopic approach called the targeted fragmentectomy approach by
Choi et al.
In comparison to the regular TF approach:
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4. CLINICAL PRESENTATION
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5. TYPES OF LUMBAR DISC HERNIATION CLASSIFICATION
BASED ON THE LOCATION OF THE DISC HERNIATION
RELATIVE TO THE FACET JOINT AND SPINAL CANAL.
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6. DR. REZA AMINNEJAD

7. Fig 1 Axial T2-weighted lumbar MRI slice showing the anatomic zones for
classifying the location of disc herniation according to the combined task
forces of the North American Spine Society, the American Society of Spine
Radiology and the American Society of Neuroradiology. This patient has a
paracentral herniation (b). a = central; b = paracentral; c = foraminal; d =
extraforaminal.

8. SURGICAL TECHNIQUE
Prone position & conscious sedation
Axial MRI or CT guided skin entry point
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9. NEEDLE INSERTION & TARGET POINT
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10. TF PELD VS EF PELD
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11. DISCOGRAPHY
2-3 ml of a mixture of radiopaque dye, indigo carmine and normal saline in
a 2:1:2 ratio
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12. DILATOR & CANNULA INSERTION
Radicular leg pain may appear due to irritation of the existing nerve root (use serial
dilators).
Circular cannula is preferred to beveled cannula (protection of the exiting nerve root)
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13. ENDOSCOPIC VIEW
Soft tissue clearance  flexible tip bipolar RF
Annulus penetration  RF cautery
Opening widening  RF or side firing laser
Further removal of pathologic disk  forceps
Palpation for remaining disk  blunt tip probe
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14. DR. REZA AMINNEJAD

15. THE ADEQUACY OF DECOMPRESSION  VISUAL INSPECTION OF THE
EXITING ROOT
THE RETAINED DISK MATERIAL  INSPECTION OF EXITING ROOT SHOULDER
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16. Hemostasis  bipolar coagulation ± suction drain
Skin closure  single nonabsorbable suture
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17. COMPLICATION AVOIDANCE
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18. CONCLUSION
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19. DR. REZA AMINNEJAD

20. THANKS FOR YOUR
ATTENTION
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