Abstract
Downward migrated lumbar disc herniation can present a challenge to any
spine surgeon. Open spine surgery requires an aggressive decompression of the
posterior bony elements, which ultimately may lead to postlaminectomy syndrome and
instability – both of which have been associated with higher reoperation rates. The
interlaminar endoscopic approach is a reasonable alternative to open translaminar
surgery but still carries the risk of dural tear and does not afford the ability for an
intradiscal discectomy. The authors offer a modification of the outside-in
transforaminal approach - the suprapedicular circumferential opening technique
(SCOT) to gain better access to downward- and far-migrated extruded lumbar disc
herniations.
Keywords: Downward migrated lumbar herniated disc, Suprapedicular decompression, Transforaminal approach