A less invasive surgery using a full-endoscopic system for L5 nerve root compression caused by lumbar foraminal stenosis.

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the usefulness of a full-endoscopic system for PELD to treat L5 nerve root compression caused by lumbar foraminal stenosis (L5-LFS).

Methods: Between November 2016 and December 2017, a total of 10 patients with unilateral leg pain due to L5-LFS underwent surgery using a full-endoscopic system for PELD. Patients with bilateral L5-LFS or L5-LFS with coexisting LDH and/or spondylolysis were excluded from this study. A percutaneous endoscopic translaminar approach (PETA) was performed via the ipsilateral vertebral isthmus using a 3.5-mm diameter high-speed drill. Preoperative and postoperative statuses were evaluated using the modified Japanese Orthopedic Association (mJOA) and Numerical Rating Scale (NRS) scores.

Results: The patients' mean age was 62.2 years; there were 7 male and 3 female patients. The mean recovery rate was 58.2% with the mJOA score; mean pre- and postoperative NRS scores were 7.4 and 2.3, respectively. The mean operative time was 77.6 min. Although there were no major complications, pain did not improve in an 80-year-old woman with coexisting spondylolisthesis (Meyerding grade 2).

Conclusions: PETA using a full-endoscopic system is a safe and effective minimally invasive treatment for L5-LFS, with potential to be an alternative surgical strategy for L5-S1 interbody fusion.