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Koga. Mini-invasive Surg 2017;1:3-5 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2016.07
www.misjournal.net
Editorial Open Access

Improved percutaneous endoscopic

translaminar approach for lumbar foraminal

stenosis at L5/S1

Hisashi Koga
1,2
1 Department of Neurosurgery, Iwai Orthopaedic Medical Hospital, Tokyo 133-0056, Japan.
2 Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo 140-0002, Japan.
Correspondence to: Dr. Hisashi Koga, Department of Neurosurgery, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo
133-0056, Japan. E-mail: hkoga0808@gmail.com

How to cite this article: Koga H. Improved percutaneous endoscopic translaminar approach for lumbar foraminal stenosis at L5/S1. Mini-invasive
Surg 2017;1:3-5.

Article history: Received: 22-11-2016 Accepted: 09-02-2017 Published: 31-03-2017

Dr. Hisashi Koga, is the Deputy Director and the Head of Education and Training Center, Iwai Orthopaedic Medical
Hospital, Japan. He obtained his MD in the University of the Ryukyu Faculty of Medicine (Okinawa, Japan) and PhD in
the Graduate Medical School of Kumamoto University (Kumamoto, Japan). His research interest focuses on endoscopic
spinal surgery and minimally invasive spinal surgery. He has authored 8 articles on his research field in recent 3 years.
He also obtained research grant from Humboldt foundation.

The operative approach for lumbar foraminal access becomes more difficult.
stenosis (LFS) is one of the most challenging for
spinal surgeons. [1-3] Excessive removal of the dorsal Recent advances in the percutaneous endoscopic
area of the foramen in a posterior approach can lumbar discectomy (PELD) technique have made
easily lead to iatrogenic spondylolysis, subsequently access to the lateral aspect of the lumbar foramen
increasing lumbar instability and spondylolisthesis. possible without excessive removal of surrounding
A posterolateral approach is one solution to this structures. Despite this advance using a fully
[4]
problem. However, LFS in the L5/S1 region is difficult endoscopic system, access to the L5/S1 region
to treat using a posterolateral approach, because of an remains difficult. At L5/S1, the surgeon cannot
anatomic peculiarity: the lateral aspect of the foramen adequately tilt the endoscope to access the medial
is surrounded by the L5 transverse process, sacral portion of the foramen due to the obstacle created by
ala, and hypertrophic facet joint. LFS usually develops the ipsilateral iliac crest. To access the medial part of
after the age of 50 and is one of the most common the L5 foramen, we improved the PELD approach,
degenerative spinal diseases in the elderly. As a result of which had been developed for lumbar disc herniation
this the vertebral height generally decreases, depending (LDH) with migration into the hidden zone. [5]
on the degree of disc degeneration. Compared with the
younger patients without disc degeneration, the surgical This improvement uses a primarily posterior approach

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