Percutaneous Endoscopic Lumbar Discectomy for Highly Upmigrated Disc Herniation Through the Transforaminal Isthmus Plasty Approach.

BACKGROUND: Highly upmigrated herniation can be difficult to remove using percutaneous endoscopic lumbar discectomy (PELD) and the conventional transforaminal approach. Although many surgeons have constantly explored new techniques and approaches, we still lack a more effective, convenient, and economical technique to treat highly upmigrated herniation. We have described a novel approach, the transforaminal isthmus plasty approach, for PELD to treat highly upmigrated disc herniation. CASE DESCRIPTION: A 72-year-old man with L3-L4 highly upmigrated disc herniation, who had experienced no relief after a long period of conservative treatment, underwent PELD through the transforaminal isthmus plasty approach. The operation was successful, and he experienced significant symptom relief after the surgery.
CONCLUSIONS: The transforaminal isthmus plasty approach is an effective and viable alternative approach for PELD to treat highly upmigrated disc herniation.