I’m presenting the case of a 15-year-old male patient with recurrent back pain with radiculopathy in his right leg. Upon examination, he is neurologically intact, but has a positive straight leg raising test on his right leg. His symptoms did not improve despite conservative treatment including epidural blocks and surgical management was chosen.

The preoperative magnetic resonance imaging (MRI) and computed tomography (CT) show a large bilateral posterior apophyseal ring separation and L3–4 level lumbar with disc herniation and central and paracentral area. The patient has symptoms predominantly more on right side and right-side approach was chosen for this procedure.

Skin incision was made at approximately 15 cm from the midline and a 6.3-mm transforaminal 30° endoscope docking was done at SAP using outside-in technique. The disc has been stained with methylene blue dye prior to scope insertion. Circumferential bone resection around SAP was done and ligamentum flavum was removed to expose the dura and disc space.

The protruded apophysis on the cranial aspect is removed. Further removal of the apophysis was done and the contralateral apophysis was accessed and decompress.

Further SAP and partial removal of pedicle was done to access the apophysis caudally. The apophysis and bone fragments were completely resected using a high-speed burr and pituitary rongeur. Contralateral lesion was accessed ventral to the dura and decompressed.

The decompression was completed by removal of the remaining protruded disc and bone fragment.

Postoperative MRI and CT demonstrated thorough removal of protruded disc and apophysis in both ipsilateral and contralateral sides. The sagittal images also show good decompression of the dural sac.

The patient has significant improvement of axial back pain and radicular pain after surgery. The use of percutaneous transforaminal full-endoscopic discectomy represents a more minimally invasive approach compared to microsurgery or conventional open surgery [1,2]. Utilizing a single portal, a 6.3-mm endoscope is inserted right into the area of pathology, minimizing soft tissue trauma and blood loss [3]. This approach also results in less postoperative pain and enhanced postoperative recovery [4,5]. The endoscopy via transforaminal approach provides an excellent view of the pathology intraoperatively, allowing ipsilateral and contralateral decompression within single approach. The advantages of this technique include small skin incision, less damage to surrounding soft tissue, faster recovery and less blood loss. However, it is a technically demanding procedure and requires extensive endoscopic experience.