Minimizing Invasiveness by Percutaneous Stenoscopic Lumbar Decompression (PSLD) for Lumbar Spinal Canal Stenosis

<p>Introduction: In an aging society, elderly people have many problems such as frailty syndrome, and locomotive syndrome, and it is important that their hospitalization is short-term, incisions are small, return to home early, and invasiveness is minimal. Full endoscopic laminotomy (FEL) using an 8 mm full endoscope has been performed in a tight working space of 4.1 mm. Consequently, it took a long time to perform surgery. Therefore, an endoscope with a more wide working space is required while keeping the invasion minimal and incisions small as much as possible. We have had discussions with Korean endoscopic specialists and participated in the development project of the percutaneous stenoscopic lumbar decompression (PSLD^®) system with Maxmore Co., Ltd. in Germany.</p><p>Methods: The PSLD^® endoscope using bilateral decompression through one-portal unilateral approach for lumbar canal stenosis has an outer tube of 9.5 mm and a working space of 5.5 mm, and Kerrison with a diameter of 1-5.0 mm, diamond burr of the same diameter, chisel, sharp curratage, etc., can be used. Quickly ablate the soft tissue and superficial layer of the ligamentum flavum with high frequency electrode, roughly cut the spinal laminar arch with a 4 mm burr, and then carefully drill the deep part with a 2.5-3 mm burr. The ligamentum flavum is detached and resected from the deep part of the spinal laminar enthesis with various Kerrisons, and when it floats, it is vertically torn in the center and removed as a mass.</p><p>Results: The results for 77 patients with spinal canal stenosis with one to three segments were excellent and good in 85.7% as per the Macnab's criteria. There were five cases of dural injury, all of which were repaired via the patch repair method or open suture, and there were no problems.</p><p>Conclusions: It was possible to use instruments similar to open surgery, and the drilling of spinal laminar bone, resection of ligamentum flavum, removal of intervertebral disc, etc., could be performed smoothly.</p><p>It is important that spinal surgery for the patient is minimally complicated and invasive; moreover, it is desirable to return to home early.</p>