Full-endoscopic uniportal wiltse paraspinal approach with inferior foraminal docking for extraforaminal lumbar disc herniation and foraminal stenosis: technical note and preliminary clinical outcomes.

BACKGROUND

Extraforaminal lumbar disc herniations and foraminal stenosis are challenging due to nerve root proximity. Conventional lateral transforaminal endoscopy requires a long oblique trajectory and is obstructed by the iliac crest at L5-S1. We describe a full-endoscopic monoportal Wiltse paraspinal technique with inferior foraminal docking and its preliminary outcomes.

METHODS

Ten consecutive patients (4 women, 6 men; mean age 61.1 years, range 50-76) were prospectively analyzed between September and December 2025. Pathologies comprised 7 extraforaminal disc herniations and 3 foraminal stenoses at L3-L4, L4-L5, and L5-S1 (2, 3, and 5 cases, respectively). Through a paraspinal incision 4-6 cm from midline, dilatation of the multifidus-longissimus interval allows inferior bony docking on the caudal transverse process before foraminal recalibration. VAS leg/back pain, ODI, and satisfaction were assessed preoperatively and at 3 months.

RESULTS

No intraoperative complication, conversion, or postoperative instability occurred. Mean VAS leg pain decreased from 7.9 to 2.8 (-65%); VAS back pain from 7.4 to 4.1; ODI from 55.2% to 28.7% (-48%). All 4 patients with preoperative neurological deficits improved. Satisfaction was very satisfied (4, 40%), satisfied (5, 50%), and undecided (1, 10%), yielding 90% satisfactory outcomes. At L5-S1, the iliac crest never obstructed the trajectory.

CONCLUSIONS

The full-endoscopic monoportal Wiltse approach with inferior foraminal docking is a feasible, safe, and coherent technique for lateral lumbar disc pathology and foraminal stenosis. Its principal advantage is that it avoids the risk of exiting nerve root injury inherent to the percutaneous targeting of the transforaminal approach. These preliminary results support further prospective comparative studies.