Spondylodiscitis is on rise due to increasing elderly population and immunocompromised people and now gets early detected due to early imaging. Percutaneous Transforaminal Endoscopic Discectomy and Drainage (PTELDD), is simple procedure that yields high culture wihich helps in specific targeted antimicrobial bombardment. Dr. Satishchandra Gore has been pioneer in introducing transforaminal endoscopy in India way back in 1999. His persistent efforts has made inroads into traditional spine care treatments and endoscopy bandwagon is flying high and many surgeons are able to give results with the technique all over India. The available english literature of transforaminal endoscopy in spondylodiscitis is reviewed here with technical note of this simplistic procedure. The reported outcome in literature is excellent in majority of cases. Authors unpublished report of 16 cases is also comparable with literature. PTELDD is a simplistic most minimalist minimally invasive procedure that gives very positive outcome in early cases of spondylodiscitis.

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INTRODUCTION: In the quest for better alternatives for open transforaminal lumbar interbody fusion (TLIF), minimally invasive surgery-TLIF (MIS-TLIF) has evolved, and feasibility studies of transforaminal endoscopic fusion are also getting reported in western literature. However, the cost of instrumented expandable cage may make it non-feasible for Indian setup whenever it will be commercially available. METHODS: This is a retrospective study of 13 patients of single-level percutaneous transforaminal endoscopic decompression and cageless percutaneous bone graft TLIF with percutaneous pedicle screw fixation under combined local with epidural anesthesia. The results of all patients as measured by validated tools of visual analogue score-Back and Leg, Oswestry Disability Index, patient satisfaction index, and fusion. The operating time, Estimated Blood Loss, Length of hospital stay and tolerance of patient for procedure was also scored. RESULTS: All the outcome measures were significant (P < 0.05) and fusion achieved in all with a mean follow-up period was 39 ± 6.36 months. Operating room time was 250.23 ± 52.90 min (187–327). Postoperative LOH hospital stay was 29.92 ± 4.94 h (24–39). The tolerance score was 2.30 ± 0.85 (1–3). One superficial bone graft site infection resolved with antibiotics. CONCLUSION: It not appealing to be recommendable to general population inspite of it being low cost and with negligible complications. Further research and engineered tools are needed to reduce the operating time.

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Symptomatic lumbar facets manifest as low back pain located paraspinally of varying intensity. The pain may increase with extension and rotation and can be well localized or diffuse and associated with extension lag on prolonged sitting. This pain can be easily identified by facet or medial branch block and then treated by ablating under vision this medial branch. Results are gratifying and can delay need for fusion in patients.

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Transforaminal endoscopic lumbar spine surgery has evolved leaps and bounds in the last 10 years, and as such, it is now not limited to simple contained herniation. It can now be successfully done for central, extraforaminal, extruded, and migrated herniations, which were considered bad indications when the procedure was limited to central intradiscal nucleotomy or debulking. With better understanding of the foraminal anatomy, more bold approaches to intervertebral foramen are now being undertaken. Moreover, with further development in instruments, such as motorized burrs and lasers, we can now successfully treat the foraminal and lateral canal stenosis. With the advantages of Transforaminal endoscopic techniques, such as use of local anesthesia, minimal skin incision, no need for neuromuscular retraction, and no excessive bone removal, with minimal approach-related morbidity, allows it to be applied safely in extremes of age, with early return to normal life. The procedure of foraminoplasty is vital to achieve these extended targets in Transforaminal endoscopic surgeries. The term foraminoplasty is used among the spine endoscopists to broadly describe the expansion of the foraminal boundaries and it is reversibly used to describe foraminotomy. However, foraminotomy is performed for widening the foramen to reach far off and difficult targets, whereas foraminoplasty is performed for decompression of neural structures in the treatment of foraminal and lateral stenosis. In this article, we discuss both the procedures. To understand the principles and successfully employ the technique, let us first understand the foraminal anatomy.

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