Percutaneous endoscopic lumbar foraminotomy: how I do it

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.