Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Abstract

Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

Keywords: Transforaminal Percutaneous Endoscopic Discectomy; Transforaminal Endoscopic Spine System; Lumbar disk herniation; Pitfalls; Spine surgery

Core tip: Transforaminal Percutaneous Endoscopic Discectomy (TPED) is an evolving minimally invasive technique that has been proven to be safe and effective in treating symptomatic lumbar disc herniation (LDH). However, this relatively new therapeutic approach requires special training and expertise so as to evade complications that may endanger the safety of the patient. In this review, current concepts regarding challenging indications and contraindications of this novel technique are analyzed focusing on several conditions and pitfalls that a beginner spine surgeon should avoid when treating LDH using TPED with Transforaminal Endoscopic Spine System technique, so as to eliminate possible risks and thus improve outcomes.