Neural foramen decompression using transforaminal access

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.