1Department of Orthopedics, Tokushima University, Tokushima, Japan
2Department of Orthopedic Surgery, Tokushima Prefecture Naruto Hospital, Naruto, Japan
Foraminal stenosis is a type of lumbar spinal canal stenosis. This pathology is a good indication for full-endoscopic decompression surgery using a transforaminal approach, called foraminotomy. However, considering the proximity to the iliac crest, decompression at L5/S1 may be challenging. In this technical note, the technique used to perform foraminotomy at L5/S1 is explained step by step. After local anesthesia with 1% lidocaine, an 8-mm skin incision is made, usually 4 to 5 cm away from the midline. Using a serial dilating maneuver, an 8-mm cannula is docked on the lateral aspect of the superior articular process (SAP). Decompression is started at the SAP and pedicle junction. Drilling then proceeds cranially to the tip of the SAP. About 80% to 90% of the SAP is usually removed, after which the thickened ligamentum flavum (LF) is exposed. The attachment of the LF to the inferior articular process (IAP) of L5 is confirmed. The thickened LF is then detached by drilling the IAP using the high-speed drill. Following removal of the floating LF, the decompressed exiting nerve is visible. Anatomically, the radicular artery runs with the exiting nerve. Pulsation of the nerve is a good indicator of adequate decompression.
Keywords: Full-Endoscopic Decompression; Foraminal Stenosis; L5/S1 Level
Toshihiko Matsumura., et al. “Step-By-Step Explanation of Full-Endoscopic Lumbar Foraminotomy at the L5/S1 Level Under Local Anesthesia: An Editorial Technical Note”. EC Orthopaedics 14.7 (2023): 47-53.
© 2023 Toshihiko Matsumura., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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