Endoscopic Diskectomy of Rostrally and Caudally Migrated Lumbar Disk Herniations: A Technique Video.

Surgical treatment of extremely migrated caudal and rostral lumbar disk herniations is technically challenging. Traditional open technique often requires more bone resection, which can lead to rare but significant complications such as pars fracture or instability requiring fusion surgery. Endoscopic diskectomy is a safe alternative to traditional open surgery with acceptable complication rates.1-4 Endoscopic diskectomy provides the advantage of excellent visualization and maneuverability while minimizing soft tissue trauma and bony resection, which can result in less postoperative pain, less opioid consumption, and quicker recovery.5 We present a surgical technique guide (Video 1) for endoscopic diskectomy of 2 patients with very high rostral (grade 1) and caudal (grade 6) lumbar disk herniations as graded by Ahn's modification of the Lee-Kim grading classification.6,7 Risks, benefits, and alternatives to surgery were discussed with the patients, and they consented to the procedure. This video is not a replacement for hands-on training.