A patient was presented with right inguinal and gluteal pain for 2 weeks.

Weakness of the right hip flexors and hypoesthesia at the right L2 dermatome were observed.

The sagittal MRI scan showed an L2-L3 disk herniation that was migrated upward ( Fig. 18.22A,B ) and the axial MRI and CT scan with topogram also showed the soft migrated fragment lying beside the pedicle of the L2 vertebra ( Fig. 18.22C,D ).

For migrated disk herniations, the skin entry point is usually chosen from an opposite direction (i.e., for an upward-migrated disk herniation), making the skin entry point a little inferior than usual is preferred. This helps in easy manipulation of the working cannula while removing the migrated fragments.

AP and lateral view x-rays showed the intended trajectory of the working cannula (caudal to cranial angle of ~10 degrees).

Skin entry point is ~8.5 cm from the midline and make caudal to cranial direction ( Fig. 18.22E ).