A Simplified and Efficient Transforaminal Endoscopic Lumbar Discectomy Technique With Reduced Radiation: A Retrospective Study

<sec><title>Background</title> Most transforaminal endoscopic lumbar discectomy (TELD) surgeries performed under local anesthesia involve intricate procedures, require multiple fluoroscopy sessions, and have a steep learning curve. This study introduces a modified technique aimed at optimizing TELD for lumbar disc herniation. </sec><sec><title>Methods</title> A total of 76 patients (42 men and 34 women, mean age 53.8 years) underwent TELD using a “Guiding Rod” for simplified positioning and visual trephine for foraminoplasty. Parameters, including the fluoroscopy frequency, positioning time, foraminoplasty time, operation time, and intraoperative blood loss, were meticulously recorded and retrospectively analyzed. The Visual Analog Scale pain score, Japanese Orthopedic Association, and Oswestry Disability Index score were evaluated preoperatively and at 3 days, 3 months, and 6 months postoperatively. </sec><sec><title>Results</title> Implementing our modified technique resulted in a mean fluoroscopy frequency of 3.93 ± 0.97 times and a mean positioning time of 3.60 ± 1.10 minutes. The mean foraminoplasty time was 3.88 ± 1.82 minutes, and the mean operation time was 48.38 ± 10.85 minutes. Intraoperative blood loss remained consistently below 15 mL, with no reported complications. All clinical scores (visual analog scale, Japanese Orthopedic Association, and Oswestry Disability Index) improved significantly compared with preoperative values. </sec><sec><title>Conclusions</title> The use of the “Guiding Rod” for simplified positioning alongside visual trephine application in TELD for lumbar disc herniation demonstrates ease of operation and safety and minimizes radiation exposure, thereby optimizing TELD technology. </sec><sec><title>Clinical Relevance</title> This study highlights advanced techniques in transforaminal endoscopic discectomy. </sec><sec><title>Level of Evidence</title> 4. </sec>