Percutaneous Stenoscopic Lumbar Decompression with Paramedian Approach for Foraminal/Extraforaminal Lesions

Abstract

The lumbar foramen is affected by different degenerative diseases, including extraforaminal disc herniation, foraminal stenosis (FS), and degenerative or spondylolytic spondylolisthesis. The purpose of this study was to describe percutaneous stenoscopic lumbar decompression with a paramedian approach (para-PSLD) for foraminal/extraforaminal lesions. All operative procedures were performed using a complete uniportal endoscopic instrument system. The para-PSLD can be easily applied to patients with FS and narrow disc space or facet joint hypertrophy. The anatomical view of a para-PSLD is similar to that of a conventional open surgery and allows for good visualization of the foraminal/extraforaminal areas. We suggest that para-PSLD is an alternative and minimally invasive procedure to treat degenerative lumbar foraminal/extraforaminal stenoses.

SPINE: High heterogeneity and no significant differences in clinical outcomes of endoscopic foraminotomy vs fusion for lumbar foraminal stenosis: a meta-analysis

“…The titles and abstracts of the remaining 561 references were screened, and 506 were excluded because they did not meet the inclusion criteria. The remaining 55 articles underwent full-text screening, of which a further 28 articles were excluded because 17 ( 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ) were on patients with foraminal stenosis and an excluded indication, 4 ( 26 , 27 , 28 , 29 ) were on open decompression, 3 ( 30 , 31 , 32 ) reported no outcomes of interest, 2 ( 33 , 34 ) were letters to editors or surgical technique notes, 1 ( 35 ) was on foraminal stenosis secondary to fusion surgery, and 1 ( 36 ) was on a combination of 2 or more procedures. A further four articles were excluded because one ( 37 ) was on a subset of a larger cohort ( 38 ), and three ( 39 , 40 , 41 ) presented the outcomes of interest graphically or as net changes but did not present specific postoperative values (the authors were contacted at least three times but none responded).…”

Full Endoscopic Paramedian Partial Lumbar Corpectomy for a Lumbar Burst Fracture With Spinal Canal and Foraminal Stenosis: A Case Report With a Technical Note

“…However, when the retropulsion fragments present around the foramen, performing foraminoplasty and directly extending the distal end of the cannula to the posterior end of the vertebral body can be challenging and may pose an increased risk of nerve root injury. The full endoscopic paramedian approach was introduced with the advantage of effectively addressing foraminal and extraforaminal lesions [19]. To our knowledge, this is the first report describing the use of the paramedian approach with hemilaminectomy and foraminoplasty to simultaneously address fragments in the foramen and spinal canal in burst fracture patient with neurological deficits.…”

End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

“…This needs very specific diagnosis and target unlike COSS which focuses on an exploratory decompression solutions and hence is more forgiving [15]. It is known that for Inter-laminar ESS (Unilateral Biportal, Destandeau, Uniportal Interlaminar Lumbar Decompression) [16][17][18][19] the endpoint is still the same as COSS. However, in PTELD the suggested EPD is three tier.…”