The “Laminar Lifting” Technique for Full-Endoscopic Discectomy of Highly Upmigrated Herniation in Lytic Spondylolisthesis: A Technical Note and Report of 3 Cases

Full-endoscopic surgery for highly upmigrated lumbar disc herniation often requires foraminotomy or laminotomy. However, in the presence of lytic spondylolisthesis, the “laminar lifting” technique can be used to directly access the highly upmigrated fragment without bone removal. We report 3 cases of recent-onset radiculopathy caused by highly upmigrated disc herniation with concurrent lytic spondylolisthesis. The affected level was L5–S1 in two cases and L4–5 in one case. Interlaminar endoscopic lumbar discectomy was performed at L5–S1, and transforaminal endoscopic lumbar discectomy at L4–5. After gaining access to the epidural space, the working cannula was depressed at its proximal end, thereby elevating its distal end. This maneuver produced a levering effect that lifted the lamina and created additional space in the epidural area. The working cannula could then be advanced further superiorly, allowing removal of the highly upmigrated disc fragment with endoscopic forceps. All patients had excellent outcomes without complications. These findings demonstrate that the “laminar lifting” technique is a safe and effective method for full-endoscopic removal of highly upmigrated disc herniation in the setting of lytic spondylolisthesis. It eliminates the need for bone removal and helps prevent further instability in lytic spondylolisthesis.