Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Table 1 Summary of the indications, contraindications, advantages and disadvantages of the technique

Indications	Contraindications (for the beginners)
Radiculopathy	Surgical technique-related conditions
Positive nerve root tension sign	Recurrent disc herniation
Sensory or motor neurologic lesion on clinical examination	Scar tissue formation
Cauda equine syndrome	Migrated or extruded LDH
Hernia confirmed by MRI of the lumbar spine in compliance with clinical findings	Patient-related conditions
Failure of 12-wk conservative treatment	Intracanal LDH at the L5/S1 level with a high and steep iliac crest
	Scoliosis
	Spondylolysis-Spondylolisthesis
	Obese patients
	Muoskeletal malformations
	High LDH levels in conjunction with abnormal location/variations of adjacent anatomic formations
Advantages	Disadvantages
Safe and effective technique	Careful selection of patients is needed
Direct visualization of the pathology	Limited space for surgical maneuvering
Less blood loss	Long learning curve
Less trauma and scar tissue
Faster rehabilitation
Preservation of the spine stability and the adjacent anatomy

LDH: Lumbar disc herniation; MRI: Magnetic resonance imaging.