Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug;75(2):124-33; discussion 132-3.
doi: 10.1227/NEU.0000000000000361.

Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes

Yong Ahn  1 , Hyun-Kyong Oh, Ho Kim, Sang-Ho Lee, Haeng-Nam Lee
Affiliations
Free PMC article

Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes

Yong Ahn et al. Neurosurgery. 2014 Aug.
Free PMC article

Abstract

Background: Although several authors have reported the use of endoscopic techniques to treat lumbar foraminal stenosis, the practical application of these techniques has been limited to soft disc herniation.

Objective: To describe the details of the percutaneous endoscopic lumbar foraminotomy (ELF) technique for bony foraminal stenosis and to demonstrate the clinical outcomes.

Methods: Two years of prospective data were collected from 33 consecutive patients with lumbar foraminal stenosis who underwent ELF. The surgical outcomes were assessed using the visual analog scale, Oswestry Disability Index, and modified MacNab criteria. The procedure begins at the safer extraforaminal zone rather than the riskier intraforaminal zone. Then, a full-scale foraminal decompression can be performed using a burr and punches under endoscopic control.

Results: The mean age of the 18 female and 15 male patients was 64.2 years. The mean visual analog scale score for leg pain improved from 8.36 at baseline to 3.36 at 6 weeks, 2.03 at 1 year, and 1.97 at 2 years post-surgery (P < .001). The mean Oswestry Disability Index improved from 65.8 at baseline to 31.6 at 6 weeks, 19.7 at 1 year, and 19.3 at 2 years post-surgery (P < .001). Based on the modified MacNab criteria, excellent or good results were obtained in 81.8% of the patients, and symptomatic improvements were obtained in 93.9%.

Conclusion: Percutaneous ELF under local anesthesia could be an efficacious surgical procedure for the treatment of foraminal stenosis. This procedure may offer safe and reproducible results, especially for elderly or medically compromised patients.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Schematic illustrations and corresponding intraoperative fluoroscopic and endoscopic views of the surgical procedure. A, extraforaminal placement of the working cannula for foraminal decompression. B, foraminal unroofing using an endoscopic burr. C, sophisticated foraminal decompression using various instruments, including punches, forceps, and a laser. Note the exiting nerve root decompression using a micropunch. D, final view of the full-scale foraminal decompression status. Note the decompressed exiting nerve root and annulotomy site.
FIGURE 2
FIGURE 2
Illustrated case of a 78-year-old female patient. A, preoperative magnetic resonance (MR) images showing severe foraminal stenosis at the right L5-S1 level. B, postoperative MR images showing full-scale foraminal decompression (arrow) after endoscopic lumbar foraminotomy.
FIGURE 3
FIGURE 3
Illustrated case of a 67-year-old male patient. A, preoperative magnetic resonance and computed tomography (CT) images showing severe foraminal stenosis with disc herniation and facet impingement at the left L4-5 level. B, postoperative MR and CT images showing complete foraminal unroofing and visualization of exiting nerve root after endoscopic lumbar foraminotomy.
FIGURE 4
FIGURE 4
A, Visual analog scale (VAS) pain score for back pain preoperatively (preop) and at 6 weeks, 6 months, 1 year, and the final review (2 years) post-surgery. B, VAS pain score for radicular pain preoperatively and at 6 weeks, 6 months, 1 year, and the final review (2 years) post-surgery.
FIGURE 5
FIGURE 5
Oswestry Disability Index (ODI) scores preoperatively (preop) and at 6 weeks, 6 months, 1 year, and the final review (2 years) post-surgery.
FIGURE 6
FIGURE 6
The global outcome according to the modified MacNab criteria. Twenty-seven of the 33 patients (81.8%) experienced excellent or good results, and 31 of the 33 patients (93.9%) experienced symptomatic improvement.
Figure
Figure
No available caption
See this image and copyright information in PMC

References

    1. Reulen HJ, Pfaundler S, Ebeling U. The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation. I: a technical note. Acta Neurochir (Wien). 1987;84(1-2):64-67 - PubMed
    1. Garrido E, Connaughton PN. Unilateral facetectomy approach for lateral lumbar disc herniation. J Neurosurg. 1991;74(5):754-756 - PubMed
    1. Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976). 2000;25(3):389-394 - PubMed
    1. Epstein NE. Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord. 2002;40(10):491-500 - PubMed
    1. Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine (Phila Pa 1976). 1988;13(6):696-706 - PubMed