Combination of Transpedicular and Transforaminal Endoscopic Approaches for Removal of Lumbar Disc Herniations with Very High Degree of Migration: A Small Case Series and Literature Review

Objective. To evaluate the effectiveness of a combination of transpedicular and transforaminal endoscopic approaches for the removal of lumbar spine herniations with a double compressive intracanal component: significant protrusion in the disc plane combined with an extremely high degree of rostral or caudal migration. Material and Methods. An analysis of two clinical cases and literature data on the use of a combination of transpedicular and transforaminal endoscopic approaches through a single skin incision was performed. The dynamics of pain syndrome according to the Visual Analog Scale (VAS), neurological status and MRI results were assessed. Results. In both cases, the migrated sequestrated fragments and significant disc plane protrusions were successfully removed, with complete regression of pain syndrome and restoration of function. No complications were reported. Conclusion. The presented combination of transpedicular and transforaminal endoscopic approaches is a promising and safe surgical method for treating patients with disc herniations, compressing neural structures both in the plane of the disc and in the area of the migrated fragment. Further studies on a larger sample are required.