Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis

To begin, remove the soft tissues, mainly the paraspinal muscles, using the rongeur. Remove the superficial layer of the ligamentum flavum with a 5.4-millimeter punch for a total exposure of the descending facet. To expose the ascending facet, use the 5.5-millimeters oval bur with lateral protection and remove the bone from the medial side of the descending facet from its inferior tip.

Use the oval bur with lateral protection again for thinning the ascending facet so that the total removal can be achieved by the Kerrison punch. Use the Kerrison punch for further bone removal toward the lateral, then resect the ligamentum flavum using the punch from the midline toward the lateral. Ensure that the ligamentum flavum is removed from medial to lateral and cranial to caudal to visualize the lateral recess completely.

Then, using the rongeur, cautiously remove the epidural fat tissue until adequate exposure to the neural structures is obtained. Mobilize the nerve root medially using the dissector to relieve it from any adhesions. Address any discopathy contributing to the lateral recess stenosis.

Medialize the nerve root using the dissector or turn the long side of the working sleeve. Achieve decompression by resecting half of the pedicle and the ligamentum flavum at the lateral recess. The preoperative sagittal and axial magnetic resonance images show right-sided lateral recess stenosis.

Postoperative images confirm the resolution of this finding.