Paramedian Unilateral ‘Bitubular’ Endoscopic Access for a Far Lateral Disc Herniation: A Novel Approach for Far Lateral Lumbar Pathologies

We present a novel technique to approach far lateral lumbar pathologies using a bitubular, biportal endoscopic system and a paramedian approach. Background: Conventional approaches for lumbar far lateral discectomy range from open approaches to newer minimally invasive approaches such as tubular discectomy and single portal endoscopic discectomy. We present a case of a patient suffering with a left L3-4 and left L4-5 extraforaminal disc herniation who was treated successfully with a left sided bitubular, biportal endoscopic 2 level far lateral discectomy. A paramedian 'bitubular' biportal endoscopic approach is safe and effective for far lateral lumbar pathologies with excellent visualisation due to good outflow of irrigation fluid.