Transforaminal Endoscopic Approach for Combined Far Lateral and Paracentral Discectomies at L5-S1 Level

The transforaminal (TF) and interlaminar (IL) approaches compose the two endoscopic approaches to lumbar discectomy. There is a growing tendency to utilize the TF route for higher lumbar disc herniations and the IL approach related to anatomical factors for the caudal lumbar levels. The L5-S1 level produces a particular challenge due to anatomical barriers, including the height of the iliac crest and the orientation of the facet when confronted with a lateral or far-lateral disc herniation. Traditional approaches can lead to significant joint destabilization in the effort to resect the disc fragment Here we present an operative video with technical nuances of the TF approach utilized to perform both a far-lateral and paracentral discectomy at L5-S1 to treat a 52-year-old male with two distinct and noncontiguous herniations with severe acute right-sided L5 and S1 radiculopathy. This would have otherwise required either two different endoscopic approaches or a more extensive open approach for successful discectomy.