Outside-in Technique for Transforaminal Full-Endoscopic Lumbar Discectomy Under Local Anesthesia : A Review Article

Transforaminal full-endoscopic lumbar discectomy (TF-FELD) was first introduced more than 20 years ago, followed by interlaminar full-endoscopic lumbar discectomy (IL-FELD). Both TF-FELD and IL-FELD require only an 8-mm skin incision and damage to the back muscles is minimal. Thus, these methods are the least invasive disc surgery at present. However, unlike the interlaminar method, the transforaminal method can be performed under the local anesthesia, which is its biggest advantage. Although an inside-out approach after foraminoplasty was initially recommended, an outside-in approach has recently been proposed for safety reasons. This technique is less invasive and allows an early return to the original level of activity. TF-FELD has also been used in athletes because of its minimal invasiveness. It was initially thought that the transforaminal approach would be difficult to perform at L5/S1, so the interlaminar approach was recommended. However, with the advent of foraminoplasty, TF-FELD is now possible even at L5/S1. This review article explains the TF-FELD technique in detail.

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