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Fig. 4 | Journal of Orthopaedic Surgery and Research

Fig. 4

From: Percutaneous transforaminal endoscopic surgery (PTES) for symptomatic lumbar disc herniation: a surgical technique, outcome, and complications in 209 consecutive cases

Fig. 4

Male patient of 65 years with L5/S1 disc herniation underwent the procedure of PTES. a Sagittal and axial MR image showed L5/S1 disc herniation. A transverse line bisecting the disc was drawn along the metal rod which was placed transversely across the center of the target disc on b posteoanterior C-arm view. c Photography showed the surface marking of anatomic disc center identified by the intersection of transverse line and longitudinal midline, and the entrance point of puncture located at the corner of flat back turning to lateral side. The puncture needle was inserted at about 35° angle (25°–45°) to the horizontal plane anteromedially toward the perpendicular line through anatomic disc center on d schematic diagram. The tip of puncture needle was in the posterior intervertebral space close to spinal canal on e lateral C-arm view and near the medial border of pedicle on f posteoanterior C-arm view. Through the 8.8-mm cannula, a 7.5-mm hand reamer was introduced to ream facet bone until the resistance faded, which was checked with g posteoanterior image. h Lateral C-arm view showed that the tip of the thick guiding rod was positioned at the herniated fragment. A 7.5-mm working cannula was advanced over the guiding rod directly to the sequestrated fragment on i posteoanterior fluoroscopic image. Under j, k endoscopic view, the fragments underneath the nerve root were removed and the freed nerve root could be visualized. l Photography showed minimally invasive result 1 months after surgery

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