Laser-assisted Transforaminal Endoscopic Lumbar Discectomy: Technical Pearls for Prevention of Complications

Laser-assisted transforaminal endoscopic lumbar discectomy is regarded as an effective treatment option for herniated lumbar disc disease. Technical evolution has enabled selective endoscopic removal of an epidurally extruded disc fragment with assisted laser. As a result, the clinical applications for this technique are broadening. However, with increased use of laser and endoscopic techniques, related complications such as postoperative dysesthesia, dural tears, hematoma, infection, and visceral injury emerge as important problems. In addition, considerable radiation dose during the procedure may cause a health problem to medical personnel. There are several technical pearls that can be used in the effort to increase the effectiveness of endoscopic laser procedures and prevent complications. Initial placement of the working cannula should be as close to the target as possible. Complete herniotomy after adequate annular release is the key to success. Free mobilization of the nerve root is the definitive end-point of the procedure.