Introduction: Why This Matters?
Lumbar spine problems are common, especially among older adults. Among them, foraminal and extraforaminal lesions (i.e. narrowing or compression in and around the neural foramina) are important culprits of nerve pain, radiculopathy, and disability.
The traditional open surgeries to decompress these areas often involve significant dissection, risk to adjacent tissues, and longer recovery times. In recent decades, minimally invasive spinal surgery (MISS) and endoscopic techniques have gained traction as they aim to reduce complications, preserve tissue, and speed recovery.
In this context, Nam et al. (2019) describe a novel technique: percutaneous stenoscopic lumbar decompression using a paramedian approach (para-PSLD). Their goal is to show that this method can effectively treat degenerative lumbar foraminal and extraforaminal stenoses with less invasiveness and good visualization. PMC+1
Moreover, this blog dives into what they did, what they found, where the strengths and limitations lie, and what it might mean for patients and spinal surgeons.
Background: The Problem of Foraminal/Extraforaminal Stenosis
What is foraminal versus extraforaminal stenosis?
- The neural foramen (plural: foramina) is the opening on each side of the vertebra through which spinal nerve roots exit. When this space narrows (foraminal stenosis, FS), it directly compresses the nerve.
- Extraforaminal lesions are located even further laterally, outside the bony border of the vertebra and can also cause nerve compression.
- These degenerative changes may arise from facet joint hypertrophy, disc height reduction, bone spurs, ligamentous thickening, or disc herniations that impinge on the nerve root.
These pathologies commonly cause radicular pain, numbness or weakness in the legs, and sometimes back pain. Doctors often recommend surgical decompression when conservative measures fail. PubMed+1
The Technique: PSLD (Percutaneous Stenoscopic Lumbar Decompression, Paramedian Approach).
Key features & steps
- Firstly, patient positioning & incision
- Patient lies prone on a radiolucent table.
- Surgeons make a tiny 7 mm skin incision, 4–6 cm off the midline.
- The working channel will docked onto the “isthmus” (bony bridge) of vertebrae as a reference. PubMed+1
- Next, Use of working sleeve
- Surgeons insert a working sleeve and guide in the stenoscope.
- The rigid stenoscope (endoscope designed for stenosis work) is introduced through this sleeve.
- The stenoscope has an 8.4 mm outer diameter, 5.7 mm working channel, and ~12° viewing angle. PMC+1
- Then, visualization & decompression maneuvers
- Under continuous irrigation, the surgeon tilts the endoscope toward the foramen.
- Bone and ligamentous elements are removed via Kerrison rongeurs, drills, curettes and dissectors to open up the foramen.
- The surgeon can trace the nerve root, confirm decompression, and ensure free nerve mobility. PMC
- Finally, drainage & closure
- A small drainage catheter may be placed through the same incision.
- Skin closure is minimal; the small incision aids in quicker healing. PMC
Why This Matters?
- Less pain, quicker recovery compared to traditional open surgery.
- Smaller scars and less soft tissue damage.
- Better visibility than some older minimally invasive methods.
What the Research Shows?
In the study:
- MRI scans showed nerves free from compression.
- In addition, complications stayed rare, and patients left the hospital sooner.
⚠️ However, this was a small patient group, so larger studies are still needed before it becomes a standard option everywhere.
Final Takeaway
The idea of treating stubborn back and leg pain with just a 7mm cut sounds almost too good to be true. Yet, para-PSLD shows that modern spinal surgery is moving toward tiny cuts with big relief. While it’s still early days, this technique could reshape how we think about back surgery in the future.
✨ What’s your take? Would you choose the smaller cut if it promised quicker recovery?
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