Objective: To investigate the surgical method and efficacy of percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of lumbar disc herniation (LDH) with different migration levels by introducing the strategy of foramenoplasty with the “distal nucleus pulposus as the core”.
Methods: Clinical data of LDH patients who underwent single-segment PETD surgery were retrospectively analyzed. Three groups were categorized according to the degree of nucleus pulposus migration in the sagittal position: no migration group, mild migration group, and high migration group. Different sites of foramenoplasty were used for LDH with different degrees of migration. All patients were followed up for at least 12 months. The clinical and follow-up data of the three groups were compared.
Results: A total of 102 patients were included, of which 46 (45.1%) were in the no migration group, 36 (35.3%) in the mild migration group, and 20 (19.6%) in the high migration group. Encouraging treatment results were obtained in all three groups.
Conclusion: PETD is effective in the treatment of LDH with different degrees of migration, and the foramenoplasty concept of “distal nucleus pulposus as the core” can effectively guide the molding site of foramenoplasty and facilitate the accurate placement of the working trocar.

Keywords: PETD, nuclear migration, superior articular process, foraminoplasty, 3D slicer