Percutaneous endoscopic transpedicular approach for high-grade down-migrated lumbar disc herniations.

Background: Surgical options for removing high-grade down-migrated lumbar disc herniations located medial to the pedicle include an extensive laminectomy and facetectomy. A direct percutaneous endoscopic approach through the pedicle for reaching the herniated disc without risk of iatrogenic instability is feasible.Method: The transpedicular approach consists of creating a tunnel through the pedicle. Subsequently, access to the parapedicular epidural space is obtained, and downward migrated disc can be removed.Conclusion: This technique allows to reach migrated herniations medially to the pedicle safely and effectively. [ABSTRACT FROM AUTHOR]