Transpedicular Endoscopic Approach in High-Grade Migrated Hernia: Case Report

Abstract

Extruded disc herniations with a high degree of caudal migration represent a surgical challenge due to the location of the extruded fragment in a difficult-to-access area known as the “hidden zone”. Traditional endoscopic approaches, such as interlaminar and transforaminal routes, can be challenging in these cases. This study aims to report a case of a transpedicular endoscopic approach in the treatment of an extruded disc herniation with high-grade caudal migration (Lee’s zone 4). We present a 52-year-old male patient with intense pain radiating to the right lower limb and motor deficit. After the failure of conservative treatment, a transpedicular endoscopic discectomy was performed at L4-L5. The procedure was successfully completed without complications, resulting in immediate pain relief and significant functional recovery, maintained over 24 months of follow-up. This case demonstrates that the transpedicular endoscopic approach can be an effective and safe alternative for treating extruded disc herniations with high caudal migration, provided it is performed by experienced surgeons with appropriate planning. Level of Evidence IV; Case Report.