Mobile Outside In, SCOT (Suprapedicular Circumferential Opening Technique) Approach for Highly Inferior Migrated HNP

Downward migrated lumbar disc herniation can present a challenge to any spine surgeon. Open spine surgery requires an aggressive decompression of the posterior bony elements, which ultimately may lead to postlaminectomy syndrome and instability – both of which have been associated with higher reoperation rates. The interlaminar endoscopic approach is a reasonable alternative to open translaminar surgery but still carries the risk of dural tear and does not afford the ability for an intradiscal discectomy. The authors offer a modification of the outside-in transforaminal approach - the suprapedicular circumferential opening technique (SCOT) to gain better access to downward- and far-migrated extruded lumbar disc herniations.