Jacobs Journal of Clinical Case Reports

The Endoscopic Lateral Approach for the Lumber Spine Hidden Zone in Sciatica Patients: Two Cases

Published on: 2017-08-14


We performed micro-endoscopic discectomy (MED) using the lateral approach on patients with sciatica and achieved good results with high patient satisfaction. Case 1: A 34-year-old man, who was a restaurant manager, had been experiencing back pain for 4 years. Only a nerve root block at L5 was effective in improving his symptoms. Surgery, using an intra-spinal approach at L4/5 and a lateral (extra-foraminal) approach at L5/S1, was employed for the treatment of extra-foraminal disc herniation (EFDH, often called hidden zone herniation). The patient returned to his original work without any complaints. Case 2: A 77-year-old housewife who developed recurrent right sciatic pain. The nerve root at L5 had been impinged by the costotransverse ligament and herniation from the ventral and dorsal sides. Her pain started to lessen on the next postoperative day. We believe that this approach is suitable for patients with sciatica due to lesions located in the hidden zone, thus preventing definitive diagnosis.


Micro-endoscopic discectomy; Lateral (extra-foraminal) Approach; Hidden Zone; Nerve Root block