[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-450954-105":59,"doc-detail-450954-en":123},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":116,"head_meta":118,"extra_data":120,"updated_unix":122},105,"en","translaminar-fully-endoscopic-approach-for-lumbar-disc-herniations-in-the-hidden-zone","Translaminar fully endoscopic approach for lumbar disc herniations in the hidden zone","","Minimally invasive endoscopic procedures for lumbar disc herniations (LDHs) have expanded in spine surgery, as most cases can be treated with interlaminar or transforaminal routes that decompress the affected nerve root with less morbidity than conventional open surgery. Management becomes substantially harder when LDHs migrate cranially or caudally beyond the usual disc space into the “hidden zone,” where limited access and higher complication risk persist. The postoperative instability threat is linked to partial or total facetectomy needed for exposure. A detailed translaminar fully endoscopic approach (TFEA) is presented as a safe, effective alternative that minimizes anatomical disruption, preserves stability, and extends endoscopic applications.",{"@graph":69,"@context":115},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/translaminar-fully-endoscopic-approach-for-lumbar-disc-herniations-in-the-hidden-zone/450954/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/translaminar-fully-endoscopic-approach-for-lumbar-disc-herniations-in-the-hidden-zone/450954.png","ImageObject",300,407,{"name":92,"@type":93},"Aditya","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109],{"name":110,"@type":111,"acceptedAnswer":112},"What does the translaminar fully endoscopic approach (TFEA) aim to achieve compared with other techniques?","Question",{"text":113,"@type":114},"TFEA aims to minimize anatomical disruption, preserve the facet joint, and limit flavectomy to prevent iatrogenic instability, while still providing sufficient access to the hidden zone.","Answer","https://schema.org",{"og:url":83,"og:type":117,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":119,"canonical":83},"index,follow",{"doc_id":121,"site_id":62},450954,1790794960,{"code":4,"msg":5,"data":124},{"doc_id":121,"user_id":125,"nickname":92,"user_avatar":126,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":127,"file_id":128,"file_url":129,"file_type":130,"file_size":131,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":132,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":133,"faqs":134,"seo_title":135,"seo_description":67,"update_tm":136,"read_time":105,"preview_page_count":4},962085564549,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Surgical Technique  \nTranslaminar fully endoscopic approach for lumbar disc herniations in the hidden zone  \nLuis Alfonso Castillejo-Adalid1^, Omar Jair Castillejo-Adalid2, Víctor Ramzés Chávez-Herrera1, Félix Domínguez-Cortinas1  \n1Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Mexico City, Mexico; 2Department of General Surgery, Hospital General de Zona 194, Instituto Mexicano del Seguro Social, Naucalpan, Mexico  \nContributions: (I) Conception and design: LA Castillejo-Adalid; (II) Administrative support: F Domínguez-Cortinas; (III) Provision of study materials or patients: F Domínguez-Cortinas; (IV) Collection and assembly of data: LA Castillejo-Adalid, VR Chávez-Herrera, OJ Castillejo-Adalid; (V) Data analysis and interpretation: F Domínguez-Cortinas; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Luis Alfonso Castillejo-Adalid, MD. Department of Neurosurgery, Hospital de Especialidades, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Av. Cuauhtémoc 330, Doctores, 06720 Mexico City, Mexico. Email: [lancaster081194@gmail.com](lancaster081194@gmail.com).  \nAbstract: Minimally invasive endoscopic procedures for the treatment of lumbar disc herniations (LDHs) have gained increasing popularity among spine surgeons during the last decade. The majority of LDH cases can be effectively managed using endoscopic techniques, particularly the interlaminar or transforaminal approaches, which allow for direct decompression of the affected nerve root with reduced morbidity compared to conventional open surgery. However, when LDHs migrate cranially or caudally beyond the usual intervertebral disc space, their surgical management becomes significantly more challenging. This difficulty arises from the increased risk of postoperative instability, which is often associated with partial or total facetectomy required to achieve adequate exposure. These migrated herniations, commonly referred to as occurring in the so-called “hidden zone”, represent a surgical dilemma due to their limited accessibility and the potential for increased complications. Furthermore, reports in the literature describing their management, particularly through minimally invasive endoscopic routes, remain relatively scarce. In this context, we present a detailed description of the translaminar fully endoscopic approach (TFEA) for the treatment of LDH in the hidden zone. In the authors’ opinion, this approach offers a safe and effective minimally invasive alternative that minimizes anatomical disruption, preserves spinal stability, and broadens  \nthe spectrum of endoscopic spine surgery applications.  \nKeywords: Translaminar endoscopic approach; hidden zone; lumbar disc herniation (LDH); minimally invasive  \nSubmitted Aug 27, 2024. Accepted for publication Jul 21, 2025. Published online Dec 19, 2025.  \ndoi: 10.21037/jss-24-110  \nView this article at: [https://dx.doi.org/10.21037/jss-24-110](https://dx.doi.org/10.21037/jss-24-110)  \nIntroduction  \nEndoscopic approaches for the treatment of lumbar disc herniation (LDH) have become an invaluable surgical resource for spine surgeons (1) . Typically, access to intracanal LDH can be achieved using endoscopic transforaminal approaches, except at the L5–S1 level, where the interlaminar route is generally preferred (1,2). However,  \ncranially or caudally migrated LDH may be difficult to remove endoscopically, and traditional treatments for these cases are associated with an increased risk of postoperative instability and major anatomical disruption. Such disc herniations are located within the so-called hidden zone, bordered posteriorly by the lamina and laterally by thepedicle (1) (Figure 1) .  \n^ ORCID: 0000-0002-8680-4493.  \n© AME Publishing Company. J Spine Surg 2025;11(4):1029-1034 | [https://dx.doi.org/10.21037/jss-24-110](https://dx.doi.org/10.21037/jss-24-110)  ","cbCaibU2P1jTpZmc","https://ap.wps.com/l/cbCaibU2P1jTpZmc","pdf",626951,"English","# Introduction\n## Surgical considerations and hidden zone access\n# Highlight box\n## Key findings\n## Conventional vs novel/modified approach\n## Implications","[{\"question\":\"What does the translaminar fully endoscopic approach (TFEA) aim to achieve compared with other techniques?\",\"answer\":\"TFEA aims to minimize anatomical disruption, preserve the facet joint, and limit flavectomy to prevent iatrogenic instability, while still providing sufficient access to the hidden zone.\"}]","Translaminar fully endoscopic approach for lumbar disc herniations in the hidden zone | PDF",1790734122]