Gas-Containing Disc Herniation at L1/2 Successfully Treated by Full-Endoscopic Transforaminal Discectomy: A Case Report

Gas-containing lumbar disc herniation is a rare condition, with limited reports detailing its management. This case report presents the successful treatment of a gas-containing lumbar disc herniation using full-endoscopic discectomy via the transforaminal approach (FED-TFA) at an upper lumbar level, a challenging clinical scenario for which the application of this technique has been scarcely reported. An 81-year-old male patient with a complex surgical history involving multiple lumbar decompressions and spinal instrumentation presented with persistent numbness in the left lateral calf and progressively worsening pain in the left thigh. Magnetic Resonance Imaging and Computed Tomography scans confirmed a gas-containing disc herniation at L1/2. Conservative treatment was unsuccessful, and symptoms worsened significantly, prompting surgical intervention via FED-TFA. The patient's leg pain resolved immediately postoperatively; the visual analog scale score for leg pain improved from 6/10 preoperatively to 0/10 on postoperative day 1. This symptom relief was sustained, with no recurrence of leg symptoms at the one-year follow-up. This case highlights the potential of FED-TFA as an effective surgical option for treating refractory gas-containing lumbar disc herniation. Its key advantages include the ability to circumvent scarred posterior tissue while preserving posterior elements (such as the facet joint) and avoiding paraspinal muscle dissection, offering a critical "fusion-sparing" benefit. Furthermore, direct endoscopic visualization enables the thorough and controlled evacuation of intradiscal gas. These combined advantages make FED-TFA particularly suitable for complex cases at challenging spinal levels.