Obesity is a challenge for herniated disc excision, especially with extrusion and sequestration open removal. The transforaminal approach is best, but may be challenging if the cannula is too short.
This patient was challenging because the proximal cannula was buried below the skin. The procedure was done under local anesthesia and the patient was able to communicate and provide feedback during surgery.
The patient volunteered that her pain was gone in the recovery room. Transforaminal Percutaneous Endoscopic spine surgery was much less surgically morbid than a similar translaminar or open discectomy which is an ideal approach for large patients. Minimal sedation is also an advantage for efficacy and safety.
This patient had 90% relief 1 week after surgery. The patient requested an MRI to assess the extent of the decompression. The post-op MRI showed that the extruded herniated disc was resolved.