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OBJECTIVE The aim of this study was to describe patient radiation exposure during single-level transforaminal endoscopic lumbar discectomy procedures at levels L2–5 and L5–S1. METHODS Radiation exposure was monitored in 151 consecutive patients undergoing single-level transforaminal endoscopic lumbar discectomy procedures. Two groups were studied: patients undergoing procedures at the L4–5 level or above and those undergoing an L5–S1 procedure. RESULTS For the discectomy procedures at L4–5 and above, the average duration of fluoroscopy was 38.4 seconds and the mean calculated patient radiation exposure dose was 1.5 mSv. For the L5–S1 procedures, average fluoroscopy time was 54.6 seconds and the mean calculated radiation exposure dose was 2.1 mSv. The average patient radiation exposure dose among these cases represents a 3.5-fold decrease compared with the senior surgeon's first 100 cases. CONCLUSIONS Transforaminal lumbar endoscopic discectomy can be used as a minimally invasive technique for the treatment of lumbar radiculopathy in the setting of a herniated lumbar disc without the significant concern of exposing the patient to harmful doses of radiation. One caveat is that both the surgeon and the patient are likely to be exposed to higher doses of radiation during a surgeon's early experience in minimally invasive endoscopic spine surgery.

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Posterior cervical foraminotomy is an effective surgical treatment method for relieving radicular symptoms that result from cervical nerve root compression. Minimally invasive techniques and tubular retractor systems are available to minimize tissue retraction, but minimally invasive approaches can carry with them the surgical challenge of trying to pass instruments through a long narrow retractor that is also the port for visualizing the surgical pathology. Herein, the authors present a case of a 65-year-old man who presented with symptoms of a left C6 and C7 radiculopathy and left C5-6 and left C6-7 foraminal narrowing on MRI. A minimally-invasive fully endoscopic left C5-6 and C6-7 posterior foraminotomy was performed through a 1cm outer diameter working channel endoscopic with a 6 mm working channel. Clinicians should be aware that new minimally invasive non-fusion approaches for the treatment of cervical radiculopathy that utilize endoscopic visualization are now coming into use in clinical practice.