The fully endoscopic technique has become the most effective and safest option for the treatment of lumbar disc herniation. Specifically, the interlaminar approach, which was first described at the beginning of the 21st century, is used for the treatment of L4–5 and L5–S1 intracanal disc herniation. Learning protocolized maneuvers facilitates reproducibility and increases the safety of the procedure. The description of the main maneuvers in this article aims to reduce complications and the learning curve with their widespread implementation.

Objective: The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration. Methods: The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis. Results: The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p<0.05). Conclusion At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.