title: A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: Technical considerations in a fresh cadaver model and a literature review.
abstract: Percutaneous endoscopic surgery for the lumbar spine, which was established in the last decade, requires only an 8-mm skin incision and causes minimal damage to the paravertebral muscles; thus, it is considered to be a minimally invasive technique for spinal surgery. It has been used to perform percutaneous endoscopic discectomy via two main approaches: the TF approach is a posterolateral one through the intervertebral foramen and can be done under local anesthesia; the IL approach is a more traditional one through the interlaminar space and is difficult to perform under local anesthesia. Recently, these techniques have been applied for lumbar spinal stenosis (LSS), the TF method for foraminal stenosis under local anesthesia, and the IL method for central and lateral recess stenosis under general anesthesia. In this study, using a fresh human cadaver model, we performed simultaneous decompression of the lateral recess and foraminal stenosis at L4-5 using the TF approach. Computed tomography confirmed enlargement of the lateral recess and intervertebral foramen. This technique, which can be performed under local anesthesia, should benefit elderly patients with LSS and poor general condition due to multiple comorbidities. Finally, we introduce the concept of percutaneous transforaminal ventral facetectomy using a spinal percutaneous endoscope. J. Med. Invest. 64: 1-6, February, 2017.
authors.affiliation: Department of Orthopedics, Tokushima University.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sairyo
authors.forename: Kosaku
authors.initials: K
authors.lastname: Higashino
authors.forename: Kazuta
authors.initials: K
authors.lastname: Yamashita
authors.forename: Fumio
authors.initials: F
authors.lastname: Hayashi
authors.forename: Keizo
authors.initials: K
authors.lastname: Wada
authors.forename: Toshinori
authors.initials: T
authors.lastname: Sakai
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Takata
authors.forename: Fumitake
authors.initials: F
authors.lastname: Tezuka
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Morimoto
authors.forename: Tomoya
authors.initials: T
authors.lastname: Terai
authors.forename: Takashi
authors.initials: T
authors.lastname: Chikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yonezu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nagamachi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Fukui
mesh_terms: D002102:Cadaver; D019299:Decompression, Surgical / Q000379:methods; D017587:Diskectomy, Percutaneous / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008953:Models, Anatomic; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*