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Fig. 5 | Journal of Orthopaedic Surgery and Research

Fig. 5

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

Fig. 5

a Sagittal and b axial MR images showed L4/5 disc herniation in 41-year-old man. c, d Photography showed the surface marking of anatomic disc center identified by the intersection of transverse L4/5 level line and longitudinal midline, and the entrance point of puncture located at the corner of the flat back turning to the lateral side. The tip of puncture needle was in the posterior one third of intervertebral space on e lateral C-arm view and beyond the medial border of pedicle on f posteoanterior C-arm view. A 7.5-mm hand reamer was introduced through the cannula to ream away the ventral bone of superior facet joint and ligmentum flavum for enlargement of foramen (press-down enlargement of foramen) until the resistance disappeared. The tip of reamer should exceed the medial border of pedicle till the midline between the pedicle and spinal process on g posteoanterior C-arm view, and it should be close to posterior wall of target disc on h lateral C-arm view. i Endoscopic picture showed that both the ipsilateral nerve root and the contralateral nerve root were exposed for complete decompression after removal of j sequestrated disc fragments

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