Neurological safety during transforaminal endoscopic surgery of the spine is of paramount importance. In order not to irritate neurological structures close to the foramen and to ensure safe access to the spinal canal, the caudal part of the foramen is widened incrementally with specially designed, patented manual bone drills. To approach the spinal canal & disc through the foramen a posterolateral approach to the intervertebral foramen is used. The needle is guided to the superior articular process / lateral facet and infiltrated with local anaesthetic. A guide wire is inserted through the needle and the needle removed. Soft tissue is dilatation is performed with serial dilators. The Tom Shidi Needle (Bone needle) is introduced over the guide wire & docked on the superior articular facet ventrally and gently tapped with mallet till it reaches in line with the medial border of the pedicle to the desired location targeting the herniation. The SAP is sequentially drilled with the patented manual bone drills till the desired size is achieved & foramen enlarged. A conical dilator is tapped to the desired location and working sleeve introduced over the dilator.

The Endoscope is introduced through the working sleeve. With resection instruments, the herniated disc material is removed under direct vision. Confirmation of decompression & free neurological structures are confirmed under direct vision.