Full endoscopic contralateral sublaminar approach for lumbar disc herniation with very high-grade migration: A technical note and case series
- 1Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Spine Division, Department of Orthopaedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Taiwan
Abstract
Background: Very high-grade migrated lumbar disc herniation (LDH) is difficult to reach through conventional endoscopic corridors. The full endoscopic contralateral sublaminar approach (FECSA) offers a wider cranio-caudal working angle and may allow removal of both migrated and intradiscal fragments. We report the technique and its early outcomes. Methods: Fourteen of 34 consecutive patients treated by full endoscopic discectomy for very high-grade migrated LDH at a single center between August 2022 and May 2025 underwent FECSA, between October 2024 and May 2025. Preoperative neurologic status, operative time, hospital stay and complications were recorded. Pain and function were assessed by visual analog scale (VAS) and Oswestry Disability Index (ODI), compared using the Wilcoxon signed-rank test. Radiographs were reviewed for segmental stability. The 11 interlaminar and 9 transforaminal patients from the same period are reported descriptively for context. Results: Migration was upward in 6 patients, downward in 7 and bidirectional in 1. Mean operative time was 58.4 min and mean hospital stay 1.3 days. Five patients had a preoperative motor deficit of MRC grade 4/5 and ten had sensory disturbance; all had recovered by 3 months. Back pain, leg pain and ODI improved significantly. No recurrence, instability or major complication occurred. Conclusion: In this small, non-randomized series FECSA was feasible for very high-grade migrated LDH, allowing inspection of the annular defect and removal of intradiscal fragments through the same corridor while preserving the facet joint on the herniation side. These findings are preliminary; the series was small and single-surgeon, with follow-up of less than one year.
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BibTeX
@article{hu2026full,
title = {{Full endoscopic contralateral sublaminar approach for lumbar disc herniation with very high-grade migration: A technical note and case series}},
author = {Yung-Hsueh Hu and Yu-Cheng Yeh and Tsung-Ting Tsai and Po-Liang Lai},
journal = {World Neurosurgery: X},
year = {2026},
month = oct,
doi = {10.1016/j.wnsx.2026.100637},
url = {https://doi.org/10.1016/j.wnsx.2026.100637},
note = {CC BY},
}
RIS
TY - JOUR
TI - Full endoscopic contralateral sublaminar approach for lumbar disc herniation with very high-grade migration: A technical note and case series
AU - Yung-Hsueh Hu
AU - Yu-Cheng Yeh
AU - Tsung-Ting Tsai
AU - Po-Liang Lai
PY - 2026
DA - 2026/10/26
JO - World Neurosurgery: X
DO - 10.1016/j.wnsx.2026.100637
UR - https://doi.org/10.1016/j.wnsx.2026.100637
AB - Background: Very high-grade migrated lumbar disc herniation (LDH) is difficult to reach through conventional endoscopic corridors. The full endoscopic contralateral sublaminar approach (FECSA) offers a wider cranio-caudal working angle and may allow removal of both migrated and intradiscal fragments. We report the technique and its early outcomes. Methods: Fourteen of 34 consecutive patients treated by full endoscopic discectomy for very high-grade migrated LDH at a single center between August 2022 and May 2025 underwent FECSA, between October 2024 and May 2025. Preoperative neurologic status, operative time, hospital stay and complications were recorded. Pain and function were assessed by visual analog scale (VAS) and Oswestry Disability Index (ODI), compared using the Wilcoxon signed-rank test. Radiographs were reviewed for segmental stability. The 11 interlaminar and 9 transforaminal patients from the same period are reported descriptively for context. Results: Migration was upward in 6 patients, downward in 7 and bidirectional in 1. Mean operative time was 58.4 min and mean hospital stay 1.3 days. Five patients had a preoperative motor deficit of MRC grade 4/5 and ten had sensory disturbance; all had recovered by 3 months. Back pain, leg pain and ODI improved significantly. No recurrence, instability or major complication occurred. Conclusion: In this small, non-randomized series FECSA was feasible for very high-grade migrated LDH, allowing inspection of the annular defect and removal of intradiscal fragments through the same corridor while preserving the facet joint on the herniation side. These findings are preliminary; the series was small and single-surgeon, with follow-up of less than one year.
SN - 2590-1397
ER -