Abstract
Background
Percutaneous endoscopic lumbar foraminotomy (PELF) is a good alternative for foraminal stenosis. The steep learning curve and lack of a practical manual can make this technique challenging.
Method
We describe a step-by-step technique based on the literature review and our experience in actual practice: (1) posterolateral foraminal landing, (2) bony unroofing of the superior articular process, and (3) full-scale soft tissue decompression. Technical tips for preventing complications are also discussed.
Conclusion
PELF may be effective and minimally invasive. Standardized surgical techniques are essential for clinical success.
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References
Ahn Y, Kim JU, Lee BH, Lee SH, Park JD, Hong DH, Lee JH (2009) Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy. J Neurosurg Spine 10:595–602
Ahn Y, Lee SH, Park WM, Lee HY (2003) Posterolateral percutaneous endoscopic lumbar foraminotomy for L5–S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 99:320–323
Ahn Y, Oh HK, Kim H, Lee SH, Lee HN (2014) Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery 75:124–133
Choi I, Ahn JO, So WS, Lee SJ, Choi IJ, Kim H (2013) Exiting root injury in transforaminal endoscopic discectomy: preoperative image considerations for safety. Eur Spine J 22:2481–2487
Jasper GP, Francisco GM, Telfeian AE (2013) A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients. Pain Physician 16:225–229
Kambin P, O’Brien E, Zhou L, Schaffer JL (1998) Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 347:150–167
Knight MT, Vajda A, Jakab GV, Awan S (1998) Endoscopic laser foraminoplasty on the lumbar spine–early experience. Minim Invasive Neurosurg 41:5–9
Müller SJ, Burkhardt BW, Oertel JM (2018) Management of dural tears in endoscopic lumbar spinal surgery: a review of the literature. World Neurosurg 119:494–499
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:931–939
Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976) 27:722–731
Acknowledgements
The authors would like to thank Ah Jin Jeon and Geon Ah Lee for their assistance with this study.
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Contributions
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Yong Ahn and Sang Gu Lee. The first draft of the manuscript was written by Yong Ahn, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Key points
• Thorough preoperative evaluation and appropriate patient selection are essential for minimally invasive endoscopic spine surgery.
• Safe and precise docking (landing) of the working sheath in the safety zone of the stenotic foramen is the first critical step in PELF.
• Starting orientation under endoscopic view should consist of confirmation of disc surface and ENR.
• The first and primary decompression process is resectioning SAP using endoscopic burr (foraminal unroofing).
• After bone resection, the thickened LF and foraminal ligaments should be removed using endoscopic punches and supplementary devices (soft tissue decompression).
• The proximal decompression should be conducted until the ENR and dural sac are exposed simultaneously in the axillary area.
• Distally, the ENR should be released at the lateral exit zone.
• The endpoint of this procedure is full-scale foraminal decompression in which the ENR becomes freely mobilized, and a robust dural sac pulsation is secured.
• Preventing intraoperative complications, such as a dural tear, bleeding, and neural injury, is essential for clinical success.
• The technique will be more practical by developing various surgical instruments, such as flexible instruments and visual designs.
This article is part of the Topical Collection on Spine degenerative
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Ahn, Y., Lee, S.G. Percutaneous endoscopic lumbar foraminotomy: how I do it. Acta Neurochir 164, 933–936 (2022). https://doi.org/10.1007/s00701-022-05114-z
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DOI: https://doi.org/10.1007/s00701-022-05114-z