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Neural Foramen Decompression Using Transforaminal Access

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Endoscopic Procedures on the Spine

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Abstract

The current gold standard surgical technique for lumbar foraminal stenosis is open paraspinal facetectomy and foraminal decompression. There may be some drawbacks such as segmental instability or postoperative dysesthesia. Recently, percutaneous endoscopic lumbar foraminotomy (PELF) has been developed as a minimally invasive surgical option. The standard surgical procedure is composed of three stages: first, transforaminal percutaneous access of the working channel endoscope into the foraminal pathologies (foraminal endoscopic landing); second, endoscopic foraminal unroofing and resection of the hypertrophied superior articular process (SAP) using specially designed surgical instruments including an endoscopic burr and endoscopic punches (bony decompression); and finally, full-scale foraminal decompression and release of the exiting nerve root using fine instruments including forceps and radiofrequency (soft decompression). The clinical outcomes were comparable to those of conventional open foraminotomy with benefits of minimal tissue trauma and less complications. PELF technique will become more practical and popular with technical advancement in surgical instruments and optics in the near future.

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References

  1. Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976). 2000;25(3):389–94.

    Article  CAS  Google Scholar 

  2. Chang SB, Lee SH, Ahn Y, Kim JM. Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine (Phila Pa 1976). 2006;31(10):1163–7.

    Article  Google Scholar 

  3. Darden BV 2nd, Wade JF, Alexander R, et al. Far lateral disc herniations treated by microscopic fragment excision. Techniques and results. Spine (Phila Pa 1976). 1995;20(13):1500–5.

    Article  Google Scholar 

  4. Hodges SD, Humphreys SC, Eck JC, Covington LA. The surgical treatment of far lateral L3-L4 and L4-L5 disc herniations. A modified technique and outcomes analysis of 25 patients. Spine (Phila Pa 1976). 1999;24(12):1243–6.

    Article  CAS  Google Scholar 

  5. Knight MT, Vajda A, Jakab GV, Awan S. Endoscopic laser foraminoplasty on the lumbar spine – early experience. Minim Invasive Neurosurg. 1998;41(1):5–9.

    Article  CAS  PubMed  Google Scholar 

  6. Knight MT, Goswami A, Patko JT, Buxton N. Endoscopic foraminoplasty: a prospective study on 250 consecutive patients with independent evaluation. J Clin Laser Med Surg. 2001;19(2):73–81.

    Article  CAS  PubMed  Google Scholar 

  7. Knight M, Goswami A. Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression. Spine (Phila Pa 1976). 2003;28(6):573–81.

    Google Scholar 

  8. Ahn Y, Lee SH, Park WM, Lee HY. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg. 2003;99(3 Suppl):320–3.

    PubMed  Google Scholar 

  9. Schubert M, Hoogland T. Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation. Oper Orthop Traumatol. 2005;17(6):641–61.

    Article  PubMed  Google Scholar 

  10. Jasper GP, Francisco GM, Telfeian AE. Clinical success of transforaminal endoscopic discectomy with foraminotomy: a retrospective evaluation. Clin Neurol Neurosurg. 2013;115(10):1961–5.

    Article  PubMed  Google Scholar 

  11. Jasper GP, Francisco GM, Telfeian AE. A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients. Pain Physician. 2013;16(3):225–9.

    PubMed  Google Scholar 

  12. Ahn Y, Oh HK, Kim H, Lee SH, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery. 2014;75(2):124–33. discussion 132-3.

    Article  PubMed  Google Scholar 

  13. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices. 2014;11(6):605–16.

    Article  CAS  PubMed  Google Scholar 

  14. Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, Böni T, Hodler J. Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology. 1998;207:391–8.

    Article  CAS  PubMed  Google Scholar 

  15. Lee S, Lee JW, Yeom JS, Kim KJ, Kim HJ, Chung SK, Kang HS. A practical MRI grading system for lumbar foraminal stenosis. AJR Am J Roentgenol. 2010;194:1095–8.

    Article  PubMed  Google Scholar 

  16. Jasper GP, Francisco GM, Telfeian AE. Transforaminal endoscopic discectomy with foraminoplasty for the treatment of spondylolisthesis. Pain Physician. 2014;17(6):E703–8.

    PubMed  Google Scholar 

  17. Lewandrowski KU. “Outside-in” technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg. 2014;8. https://doi.org/10.14444/1026. eCollection 2014.

    Article  PubMed Central  Google Scholar 

  18. Li ZZ, Hou SX, Shang WL, Song KR, Zhao HL. Modified percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar discectomy: instrument design, technique notes, and 5 years follow-up. Pain Physician. 2017;20(1):E85–98.

    Article  PubMed  Google Scholar 

  19. Knight MT, Jago I, Norris C, Midwinter L, Boynes C. Transforaminal endoscopic lumbar decompression & foraminoplasty: a 10 year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery. Int J Spine Surg. 2014;8. https://doi.org/10.14444/1021. eCollection 2014.

    Article  PubMed Central  Google Scholar 

  20. Yeung A, Gore S. Endoscopic foraminal decompression for failed back surgery syndrome under local anesthesia. Int J Spine Surg. 2014;8. https://doi.org/10.14444/1022. eCollection 2014.

    Article  PubMed Central  Google Scholar 

  21. Telfeian AE, Jasper GP, Francisco GM. Transforaminal endoscopic treatment of lumbar radiculopathy after instrumented lumbar spine fusion. Pain Physician. 2015;18(2):179–84.

    PubMed  Google Scholar 

  22. Henmi T, Terai T, Nagamachi A, Sairyo K. Morphometric changes of the lumbar intervertebral foramen after percutaneous endoscopic foraminoplasty under local anesthesia. J Neurol Surg A Cent Eur Neurosurg. 2017. https://doi.org/10.1055/s-0037-1599059. [Epub ahead of print].

    Article  Google Scholar 

  23. Evins AI, Banu MA, Njoku I Jr, Elowitz EH, Härtl R, Bernado A, Hofstetter CP. Endoscopic lumbar foraminotomy. J Clin Neurosci. 2015;22(4):730–4.

    Article  PubMed  Google Scholar 

  24. Ahn Y, Kim WK, Son S, Lee SG, Jeong YM, Im T. Radiographic assessment on magnetic resonance imaging after percutaneous endoscopic lumbar Foraminotomy. Neurol Med Chir (Tokyo). 2017;57(12):649–57. [Epub ahead of print].

    Article  PubMed  PubMed Central  Google Scholar 

  25. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976). 2002;27(7):722–31.

    Article  Google Scholar 

  26. Ahn Y, Lee SH, Park WM, Lee HY, Shin SW, Kang HY. Percutaneous endoscopic lumbar discectomy for recurrent disc herniation: surgical technique, outcome, and prognostic factors of 43 consecutive cases. Spine (Phila Pa 1976). 2004;29(16):E326–32.

    Article  Google Scholar 

  27. Ruetten S, Komp M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine. 2007;6(6):521–30.

    Article  PubMed  Google Scholar 

  28. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931–9.

    Article  Google Scholar 

  29. Ahn Y, Lee SH, Lee JH, Kim JU, Liu WC. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir. 2009;151(3):199–206.

    Article  PubMed  Google Scholar 

  30. Cho JY, Lee SH, Lee HY. Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation: floating retraction technique. Minim Invasive Neurosurg. 2011;54(5–6):214–8.

    CAS  PubMed  Google Scholar 

  31. Kim DH, Choi G, Lee S-H. Complications in percutaneous endoscopic lumbar diskectomy. In: Endoscopic spine procedures. New York, NY: Thieme Medical Publishers, Inc.; 2011. p. 253–67.

    Google Scholar 

  32. Ahn Y. Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices. 2012;9(4):361–6.

    Article  CAS  PubMed  Google Scholar 

  33. Ahn Y, Kim JU, Lee BH, et al. Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy. J Neurosurg Spine. 2009;10(6):595–602.

    Article  PubMed  Google Scholar 

  34. Kim HS, Ju CI, Kim SW, Kim JG. Huge psoas muscle hematoma due to lumbar segmental vessel injury following percutaneous endoscopic lumbar discectomy. J Korean Neurosurg Soc. 2009;45(3):192–5.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ahn Y, Lee HY, Lee SH, Lee JH. Dural tears in percutaneous endoscopic lumbar discectomy. Eur Spine J. 2011;20(1):58–64.

    Article  PubMed  Google Scholar 

  36. Choi KB, Lee CD, Lee SH. Pyogenic spondylodiscitis after percutaneous endoscopic lumbar discectomy. J Korean Neurosurg Soc. 2010;48(5):455–60.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ahn Y, Lee SH. Postoperative spondylodiscitis following transforaminal percutaneous endoscopic lumbar discectomy: clinical characteristics and preventive strategies. Br J Neurosurg. 2012;26(4):482–6.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea

    Yong Ahn

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  1. Yong Ahn
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Editors and Affiliations

  1. Department of Neurosurgery, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seocho gu, Seoul, Korea (Republic of)

    Jin-Sung Kim

  2. Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea (Republic of)

    Jun Ho Lee

  3. Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea (Republic of)

    Yong Ahn

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Ahn, Y. (2020). Neural Foramen Decompression Using Transforaminal Access. In: Kim, JS., Lee, J., Ahn, Y. (eds) Endoscopic Procedures on the Spine. Springer, Singapore. https://doi.org/10.1007/978-981-10-3905-8_14

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  • DOI: https://doi.org/10.1007/978-981-10-3905-8_14

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-3904-1

  • Online ISBN: 978-981-10-3905-8

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