A Modified Paraspinal Approach for Full-Endoscopic Discectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process.

Introduction: The use of least invasive full-endoscopic spine systems has decreased the amount of tissue dissection, blood loss, and duration of post-operative recovery after intervention for far-lateral disc herniations (FLDH). Case Report: In this technique, docking over the caudal transverse process is described as an efficient alternative approach with a decreased need for manipulation of the exiting nerve root. All cases diagnosed with FLDH in the outpatient department who opted for surgical intervention after a failed non-invasive trial were included. A review of the literature on FLDH regarding the key anatomy used during a far-lateral approach was also performed. Conclusion: The subjects showed significant improvement at 6-week and 12-week post-operative visits, and at 6-month follow-up had near-complete relief of symptoms, including resolution of lower limb numbness. Prior techniques for full-endoscopic discectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. This technical note details that docking at the caudal transverse process improves upon these established techniques and provides a more straightforward and safer alternative.