We present a novel technique to approach far lateral lumbar pathologies using a bitubular, biportal endoscopic system and a paramedian approach. Background: Conventional approaches for lumbar far lateral discectomy range from open approaches to newer minimally invasive approaches such as tubular discectomy and single portal endoscopic discectomy. We present a case of a patient suffering with a left L3–4 and left L4–5 extraforaminal disc herniation who was treated successfully with a left sided bitubular, biportal endoscopic 2 level far lateral discectomy. A paramedian ‘bitubular’ biportal endoscopic approach is safe and effective for far lateral lumbar pathologies with excellent visualisation due to good outflow of irrigation fluid.
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A Fixed Left-Sided Surgeon Position in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation: A Technical Note with Variations According to Herniation Type Aurore Sellier, Francois Lechanoine, Guillaume Lonjon, Louis-Marie Terrier, François-Xavier Ferracci, Philippe Cam, Anthony Melot, Joseph Cristini World Neurosurgery.2026; 208: 124890. CrossRef
Full-endoscopic trans-pars interarticularis discectomy for foraminal and extraforaminal lumbar disc herniation: surgical technique and early clinical outcomes Mohammad Badra, Georges Sakhat, Ahmad Haj Hussein, Ralph Maroun, Ramzi Moucharafieh, Karim Areslan, Youssef Jamaleddine Brain and Spine.2026; 6: 106058. CrossRef
Far-Lateral Transforaminal Unilateral Biportal Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniations Jin Seop Hwang, Sang Hyub Lee, Dain Jeong, Jae-Won Jang, Yong Eun Cho, Dong-Geun Lee, Choon Keun Park, Chung Kee Chough Neurospine.2025; 22(1): 14. CrossRef
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