Percutaneous endoscopic decompression for lumbar spinal stenosis

Abstract

Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery.

Keywords::

• endoscopic
• extraforaminal
• foraminotomy
• interlaminar
• lateral recess
• lumbar stenosis
• percutaneous
• transforaminal

Acknowledgements

The author would like to thank Sang-Ho Lee, Ho Kim and Nayoung Choe for inspiration and Jae Eun Park and Sol Lee for preparing figures.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Percutaneous endoscopic lumbar discectomy is regarded as an efficient alternative for open lumbar microdiscectomy.

• Due to revolutionary advances in technology, the paradigm of percutaneous endoscopic spine surgery is shifting from the treatment of soft disc herniation to the treatment of lumbar stenosis.

• The highlights of the percutaneous endoscopic decompression technique for various conditions of lumbar stenosis include minimally invasive bone resection under endoscopic control.

• Interlaminar percutaneous endoscopic decompression via the posterior interlaminar approach is mainly used for the decompression of central and/or lateral recess stenosis.

• Transforaminal percutaneous endoscopic decompression via the lateral approach is suitable for lateral recess stenosis with or without foraminal stenosis.

• Endoscopic lumbar foraminotomy via the posterolateral extraforaminal approach is adequate for foraminal or extraforaminal stenosis.

• The learning curve is relatively steep. However, once it is mastered, the advanced endoscopic technique will achieve relevant and reliable outcomes.

• Development of optics design and navigable instruments will make the procedure easier and more practical.