Enhanced Recovery after an Innovative Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis: A Prospective Observational Study

Figure 3

Full-endoscopic decompression. (a, b) The optimal position of the working channel is confirmed under the fluoroscopy of the C-arm. In anteroposterior fluoroscopy, the front end of the working channel reaches the outer edge of the vertebral body. In lateral fluoroscopy, the front end of the working channel reaches the posterior edge of the vertebral body (image from the other patient). (c) Place the endoscope, the blue disc is easy to find and the nerve root should be protected carefully. Confirm the exiting nerve root under endoscopy and protect the nerve root by rotating the tongue-shaped working channel. Remove the surrounding nucleus pulposus tissue and relieve the nerve root. (d) The stump of the superior articular process after trephine cutting. (e) The stump is dealt with an osteotome under an endoscope to ensure complete resection of the superior articular process until the upper wall of the pedicle is exposed. (f) The laminar rongeur is used to remove the hyperplastic ligamentum flavum and reveal the transversing nerve roots under the endoscope.

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