E-ISSN: 1019-5157
ISSN: 2651-5024
Technical Note
Limited Pars Fenestration for Full-Endoscopic Treatment of Upper Lumbar Hidden-Zone Disc Herniation: A Technical Note
Mohammed ALADDAM✉ ,
Salim ŞENTÜRK
Neurosurgery, Istanbul Medeniyet University; Neurosurgery, Academic Hospital, Department Of Neurosurgery, Istanbul, Turkey
Accepted: 07/09/2026
Article in Press
Corresponding Author:
Mohammed ALADDAM (mohammedaladdam@gmail.com)
Abstract
ABSTRACT
Background: Upper lumbar disc herniations present unique anatomical challenges because of the sagittal orientation of the facet joints, shorter laminae, and more prominent lateral pars interarticularis. Current trans-pars endoscopic techniques do not routinely account for these level-specific anatomical characteristics.
Case Description: A 40-year-old man presented with right anterior thigh pain and hip flexion weakness (MRC 3/5). MRI revealed a right L2–3 cranially migrated, sequestrated disc fragment extending into the hidden zone and foramen. A modified full-endoscopic trans-pars interarticularis approach was performed using limited medial pars fenestration while preserving the lateral pars interarticularis. A 2–3-mm medial bony window was created to access the fragment, which was removed en bloc. Adequate neural decompression was confirmed both endoscopically and radiologically.
Results: The patient experienced immediate pain relief and complete recovery of motor strength. Postoperative MRI confirmed complete removal of the disc fragment without residual neural compression. Three-dimensional CT demonstrated limited pars fenestration with preservation of the lateral pars interarticularis buttress.
Conclusion: A modified full-endoscopic trans-pars approach with limited medial pars fenestration provides safe and effective access to upper lumbar hidden-zone disc herniations while preserving critical posterior elements and accommodating level-specific anatomical constraints.
Background: Upper lumbar disc herniations present unique anatomical challenges because of the sagittal orientation of the facet joints, shorter laminae, and more prominent lateral pars interarticularis. Current trans-pars endoscopic techniques do not routinely account for these level-specific anatomical characteristics.
Case Description: A 40-year-old man presented with right anterior thigh pain and hip flexion weakness (MRC 3/5). MRI revealed a right L2–3 cranially migrated, sequestrated disc fragment extending into the hidden zone and foramen. A modified full-endoscopic trans-pars interarticularis approach was performed using limited medial pars fenestration while preserving the lateral pars interarticularis. A 2–3-mm medial bony window was created to access the fragment, which was removed en bloc. Adequate neural decompression was confirmed both endoscopically and radiologically.
Results: The patient experienced immediate pain relief and complete recovery of motor strength. Postoperative MRI confirmed complete removal of the disc fragment without residual neural compression. Three-dimensional CT demonstrated limited pars fenestration with preservation of the lateral pars interarticularis buttress.
Conclusion: A modified full-endoscopic trans-pars approach with limited medial pars fenestration provides safe and effective access to upper lumbar hidden-zone disc herniations while preserving critical posterior elements and accommodating level-specific anatomical constraints.
Keywords
Intervertebral disc herniation
lumbar vertebrae
endoscopic spinal surgery
diskectomy
Minimally Invasive Surgical Procedures