Visualized reamer foraminoplasty in transforaminal endoscopic lumbar discectomy for upward-migrated lumbar disc herniation: a case report with surgical video.

INTRODUCTION AND IMPORTANCE: This article provides a detailed demonstration of the surgical procedure for treating an upward-migrated lumbar disc herniation using a visualized reamer for foraminoplasty during transforaminal endoscopic lumbar discectomy (TELD). Foraminoplasty is a critical step in TELD for achieving adequate decompression and establishing a working channel. The visualized reamer enables surgeons to perform precise foraminoplasty under direct endoscopic visualization.

CASE PRESENTATION: This article reports the case of a 65 year-old male patient with a chief complaint of low back pain and radiating pain in the left lower limb for over two years. His Oswestry Disability Index was 71.11%, and his Visual Analog Scale scores were 8 for low back pain and 9 for leg pain. Neurological examination revealed a positive femoral nerve stretch test and grade 3/5 muscle strength in the left quadriceps. Imaging confirmed a highly upward-migrated lumbar disc herniation at the L3/4 level. The patient successfully underwent TELD with a visualized reamer foraminoplasty, resulting in significant postoperative symptom relief and an excellent outcome at the 1-year follow-up.

CLINICAL DISCUSSION: Two factors likely contributed to the favorable outcome: first, direct endoscopic visualization allowed controlled adjustment of bone resection; second, preemptive soft-tissue coagulation helped maintain a clear surgical field.

CONCLUSION: Visualized reamer foraminoplasty can address such challenging cases and could represent a feasible approach in selected patients.