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The authors thank Je-Min Son and Hwa-Young Kim for their valuable support and technical assistance.

<ol>
	<li>Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976). 2000;25(3):389-394.</li>
	<li>Genevay S, Atlas SJ. Lumbar spinal stenosis. Best Pract Res Clin Rheumatol. 2010;24(2):253-265.</li>
	<li>Weinstein JN, et al. Surgical versus nonoperative treatment for lumbar spinal stenosis: four-year results of the Spine Patient Outcomes Research Trial. N Engl J Med. 2008;358(8):794-810.</li>
	<li>Deyo RA, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259-1265.</li>
	<li>F&#246;rsth P, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413-1423.</li>
	<li>Ghogawala Z, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):1424-1434.</li>
	<li>L&#248;nne G, et al. Lumbar spinal stenosis: comparison of surgical practice variation and clinical outcome in three national spine registries. Spine J. 2019;19(1):41-49.</li>
	<li>Ahn Y, et al. Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery. 2014;75(2):124-133.</li>
	<li>Yeung A, Lewandrowski KU. Five-year clinical outcomes with endoscopic transforaminal foraminoplasty for symptomatic degenerative conditions of the lumbar spine: a comparative study of inside-out versus outside-in techniques. J Spine Surg. 2020;6(Suppl 1):S66-S83.</li>
	<li>Knight MT, et al. Transforaminal endoscopic lumbar decompression and foraminoplasty: a 10-year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery. Int J Spine Surg. 2014;8:21.</li>
	<li>Jasper GP, et al. A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients. Pain Physician. 2013;16(3):225-229.</li>
	<li>Chung J, et al. Percutaneous endoscopic lumbar foraminoplasty for lumbar foraminal stenosis of elderly patients with unilateral radiculopathy: radiographic changes in magnetic resonance images. J Neurol Surg A Cent Eur Neurosurg. 2019;80(4):302-311.</li>
	<li>Hofstetter CP, et al. AOSpine consensus paper on nomenclature for working-channel endoscopic spinal procedures. Global Spine J. 2020;10(2 Suppl):111S-121S.</li>
	<li>Lewandrowski KU. &#8220;Outside-in&#8221; technique, clinical results, and indications for transforaminal endoscopic decompression. Int J Spine Surg. 2014;8:21.</li>
	<li>Krzok G. Transforaminal endoscopic surgery: outside-in technique. Neurospine. 2020;17(Suppl 1):S44-S57.</li>
	<li>Ahn Y, Rhee DY. Transforaminal endoscopic lumbar foraminotomy for iatrogenic foraminal stenosis following vertebroplasty. Neurospine. 2024;21(4):1137-1140.</li>
	<li>Giordan E, et al. Full-endoscopic transforaminal lumbar foraminotomy: a systematic review and meta-analysis. Neurospine. 2021;18(4):829-845.</li>
	<li>Ruetten S, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective randomized controlled study. Spine (Phila Pa 1976). 2008;33(9):931-939.</li>
	<li>Telfeian AE, Jasper GP, Francisco GM. Transforaminal endoscopic treatment of lumbar radiculopathy after instrumented lumbar spine fusion. Pain Physician. 2015;18(2):179-184.</li>
	<li>Morgenstern R, et al. The learning curve in foraminal endoscopic discectomy: experience needed to achieve a 90% success rate. SAS J. 2007;1(3):100-107.</li>
	<li>Ahn Y, Park HB, Son S, Yoo BR. Clinical efficacy of extended transforaminal endoscopic lumbar foraminotomy compared with the conventional technique. J Clin Med. 2025;14(18):6446.</li>
	<li>Gadjradj PS, et al. Percutaneous transforaminal endoscopic discectomy versus open microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2021;46(8):538-549.</li>
	<li>Gadjradj PS, et al. Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022;376:e065846.</li>
	<li>Gray CM, Kumar S. Complete resolution of chronic pain, sensory impairment, and motor dysfunction following percutaneous transforaminal endoscopic decompression in a failed back surgery syndrome patient: a case report. J Spine Surg. 2020;6(3):613-619.</li>
	<li>Telfeian AE, et al. Transforaminal endoscopic surgical treatment for postlaminectomy lumbar radiculopathy: case series. World Neurosurg. 2021;150:e577-e584.</li>
</ol>

The authors declare no competing financial interests or other conflicts of interest related to this work.

This protocol describes a structured and reproducible technique for circumferential TELF. Radiculopathy caused by lumbar foraminal stenosis is common and often debilitating. Despite open surgery and minimally invasive procedures, incomplete decompression remains a common cause of persistent or recurrent symptoms. Therefore, circumferential decompression of the ENR is important for achieving reliable clinical outcomes19,21. Although C-TELF evolved from previously ...

Lumbar foraminal stenosis is a common cause of intractable radiculopathy, particularly in older adults and patients who have undergone previous lumbar surgery1,2. This condition often leads to persistent leg pain, functional disability, and reduced quality of life3,4. Degenerative changes, including disc collapse, facet hypertrophy, and ligament thickening, contribute to the progressive narrowing of the neural foramen5. Although conventional open decompression and fusion surgery can relieve symptoms, these procedures are associated with significant tissue injury, perioperative morbidity, and the risk of adjacent segment degeneration6,7. Minimally invasive spinal surgery techniques have been developed to overcome these limitations. Among them, transforaminal endoscopic lumbar foraminotomy (TELF) has emerged as an effective surgical option for lumbar foraminal stenosis8,9. This technique allows direct decompression of the exiting nerve root (ENR) through a transforaminal route while preserving normal anatomical structures10. In addition, TELF can be performed under local anesthesia, which may reduce surgical risk in older or medically compromised patients11,12. The development of TELF has been supported by advances in surgical instrumentation, visualization systems, and operative strategies13. The introduction of outside-in approaches and progressive foraminal unroofing techniques has enabled safer and more effective access to the stenotic zone14,15. These advances have expanded the indications for endoscopic spine surgery and improved clinical outcomes in selected patient populations16.
Despite these advances, conventional TELF techniques may provide only partial decompression and may not fully address complex or multifactorial compression, particularly in cases involving severe bony stenosis, fibrosis, or postoperative anatomical changes17,18. In patients with a history of lumbar fusion, foraminal stenosis may result from a combination of disc collapse, scar tissue formation, and hardware-related irritation19. In such cases, incomplete decompression may contribute to persistent or recurrent symptoms20. To address these limitations, an extended form of TELF has been developed to achieve circumferential decompression of the ENR. This technique emphasizes the complete removal of compressive structures, including bone, ligament, and soft tissue, under direct endoscopic visualization (Figure 1 and Figure 2)8,16. Compared with conventional TELF techniques, this approach is intended to provide more comprehensive neural decompression in selected cases21. Although C-TELF evolved from previously described extended TELF techniques, the focus of the procedure extends beyond wider bony decompression alone. Extended TELF was developed to create larger decompression margins and reduce the risk of residual or recurrent foraminal stenosis. In contrast, C-TELF places additional emphasis on meticulous release of the ENR through the removal of fibrotic tissue, scar tissue, and residual compressive structures surrounding the nerve root. This approach aims to achieve adequate decompression and free neural mobilization under direct endoscopic visualization. The overall goal of this method is to achieve 360° decompression of the ENR through a reproducible, landmark-based endoscopic technique. This study describes a detailed protocol for C-TELF and provides guidance for its application in patients with complex lumbar foraminal stenosis. C-TELF is particularly useful in patients with severe bony stenosis, foraminal fibrosis, postoperative foraminal stenosis, and recurrent radiculopathy. These complex conditions often require more extensive neural decompression and neural release than can be achieved using conventional decompression techniques. Detailed inclusion criteria, exclusion criteria, and patient selection guidelines are provided in the Protocol section.
<img alt="Spinal decompression diagram, sequential process of nerve root decompression via surgical tool usage." class="xfigimg" src="/files/ftp_upload/71862/71862fig1.jpg" data-altupdatedat="1790654420000" data-alt="Figure 1"> 
Figure 1. Lateral-view schematic of circumferential transforaminal endoscopic lumbar foraminotomy (C-TELF). (A) Lumbar foraminal stenosis causing compression of the exiting nerve root (ENR). (B) Initial bony decompression beginning at the lower pedicle wall. (C) Progressive bony unroofing toward the facet joint cleft, allowing exposure of the proximal and axillary portions of the ENR. (D) Extension of bone resection to the isthmus and upper pedicle wall to expose the shoulder portion of the ENR. (E) Final schematic demonstrating complete circumferential (360°) decompression of the ENR. <a href="https://www.jove.com/files/ftp_upload/71862/71862fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Vertebrae anatomy diagram; procedural steps A-E for disc removal using surgical tools." class="xfigimg" src="/files/ftp_upload/71862/71862fig2.jpg" data-altupdatedat="1790654420000" data-alt="Figure 2"> 
Figure 2. Axial-view schematic of C-TELF. (A) Lumbar foraminal stenosis causing compression of the ENR. (B) Undercutting of the superior articular process during initial bony decompression. (C) Landmark-based foraminal unroofing focused on identification of the facet joint cleft. (D) Removal of ligamentous soft tissues to expose the dural sac and ENR. (E) Final schematic demonstrating complete decompression from the proximal foraminal zone to the lateral exit zone with an adequate bony decompression margin. <a href="https://www.jove.com/files/ftp_upload/71862/71862fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

<table><tbody><tr><td>4K Camera Head</td><td>Olympus</td><td>CH-S400-XZ-EB</td><td>Endoscopic visualization</td></tr><tr><td>Biopsy Forceps, Blakesley</td><td>Joimax</td><td>BFS323061</td><td>Forceps</td></tr><tr><td>Biopsy Forceps, Spoon</td><td>Joimax</td><td>THF322541</td><td>Forceps</td></tr><tr><td>Biopsy Forceps, Spoon, angled</td><td>Joimax</td><td>THF322041</td><td>Forceps</td></tr><tr><td>Closing Cap for Joimax Endoscopes</td><td>Joimax</td><td>TCC150700</td><td>Working-channel endoscope accessory</td></tr><tr><td>Computed tomography scanner</td><td>GE HealthCare (Korea)</td><td>Revolution Frontier</td><td>Used for assessing bony stenosis, osteophytes, and pedicle morphology</td></tr><tr><td>Conscious sedation medication</td><td>Bukwang R&amp;amp;D</td><td>Midazolam 5 mg/5 mL</td><td>Used during the procedure while preserving patient feedback</td></tr><tr><td>Dynamic X-ray system</td><td>Philips</td><td>Zenition 70</td><td>Used for evaluating segmental instability</td></tr><tr><td>Endo-Flexprobe, standard</td><td>Joimax</td><td>TEFP32020</td><td>Steerable probe</td></tr><tr><td>Endo-Kerrison-Shaft, 40&amp;deg;</td><td>Joimax</td><td>EKS32351540</td><td>Endoscopic punch</td></tr><tr><td>Endo-Kerrison-Shaft, 90&amp;deg;</td><td>Joimax</td><td>EKS32351590</td><td>Endoscopic punch</td></tr><tr><td>Endoscopic burr tip</td><td>NSK</td><td>PDS-1CD330-35</td><td>Straight coarse diamond burr, special long, 3.5 mm; used with Primado2 drill system</td></tr><tr><td>Endoscopic probe</td><td>Joimax</td><td>TEFH45025</td><td>Used for nerve root and dural sac dissection</td></tr><tr><td>Fluoroscopy unit/C-arm</td><td>Philips</td><td>Zenition 70</td><td>Used for target-level localization, needle placement, and working-sheath position verification</td></tr><tr><td>Floseal Hemostatic Matrix</td><td>Baxter</td><td>ADS201844 (5 mL Kit)</td><td>Hemostasis</td></tr><tr><td>Grasper Forceps, Spoon</td><td>Joimax</td><td>THG323555</td><td>Forceps</td></tr><tr><td>Guidewire</td><td>Mantiz</td><td>A1B-1037</td><td>Used for sequential dilation and working-sheath placement</td></tr><tr><td>Guiding Rod, conical with center and eccentric bore</td><td>Joimax</td><td>GRD226315</td><td>Access instrument</td></tr><tr><td>Guiding Tube, conical, green</td><td>Joimax</td><td>GTC232838</td><td>Access instrument</td></tr><tr><td>Guiding Tube, conical, red</td><td>Joimax</td><td>GTC215363</td><td>Access instrument</td></tr><tr><td>Guiding Tube, conical, yellow</td><td>Joimax</td><td>GTC224353</td><td>Access instrument</td></tr><tr><td>Local anesthetic</td><td>Huons</td><td>Lidocaine 2%</td><td>Used at the skin entry site</td></tr><tr><td>Lumbar magnetic resonance imaging scanner</td><td>Philips</td><td>MR7700</td><td>Used for identifying foraminal or extraforaminal nerve root compression</td></tr><tr><td>Metal Hammer</td><td>Joimax</td><td>TMH200170B</td><td>Instrument advancement</td></tr><tr><td>NiTi Nerve Hook, superelastic</td><td>Joimax</td><td>TNH322533</td><td>Nerve hook</td></tr><tr><td>Palm Handle</td><td>Joimax</td><td>TRPH25100</td><td>Instrument handle</td></tr><tr><td>Postoperative magnetic resonance imaging scanner</td><td>Philips</td><td>MR7700</td><td>Used when postoperative imaging is required to evaluate decompression or suspected complications</td></tr><tr><td>Pressure-controlled irrigation pump</td><td>CONMED Corporation</td><td>10K</td><td>Pressure maintained at 30&amp;ndash;60 mmHg</td></tr><tr><td>Primado2 Drill System</td><td>Nakanishi</td><td>P200-CU-100</td><td>Endoscopic burr system; operated with a straight 3.5-mm coarse diamond burr at approximately 80,000 rpm</td></tr><tr><td>Primado2 Foot Controller</td><td>Nakanishi</td><td>FC-73</td><td>Endoscopic burr system controller</td></tr><tr><td>Primado2 Slim Motor Handpiece</td><td>Nakanishi</td><td>P200-SMH-HS</td><td>Endoscopic burr system handpiece</td></tr><tr><td>Reamer Push-Ejector, green</td><td>Joimax</td><td>RPE280380</td><td>Bone reamer system</td></tr><tr><td>Reamer Push-Ejector, red</td><td>Joimax</td><td>RPE280600</td><td>Bone reamer system</td></tr><tr><td>Reamer Push-Ejector, yellow</td><td>Joimax</td><td>RPE280500</td><td>Bone reamer system</td></tr><tr><td>Scope Working Tube Distance Ring for TESSYS, iLESSYS, MultiZYTE Scopes</td><td>Joimax</td><td>SWTDR6312</td><td>Working-tube accessory</td></tr><tr><td>Selective nerve root block needle</td><td>BD</td><td>408360</td><td>Used for diagnostic selective nerve root block</td></tr><tr><td>Semi-Flexible Grasper Forceps</td><td>Joimax</td><td>TFG322522U</td><td>Steerable forceps</td></tr><tr><td>Sequential dilator (2.5 mm OD)</td><td>Joimax</td><td>GRC221025</td><td>Length: 220 mm; inner diameter: 1.0 mm; outer diameter: 2.5 mm</td></tr><tr><td>Sequential dilator (3.9 mm OD)</td><td>Joimax</td><td>GTC202838</td><td>Length: 205 mm; inner diameter: 2.6 mm; outer diameter: 3.9 mm</td></tr><tr><td>Sequential dilator (5.2 mm OD)</td><td>Joimax</td><td>GTC194353</td><td>Length: 195 mm; inner diameter: 4.2 mm; outer diameter: 5.2 mm</td></tr><tr><td>Sequential dilator (6.3 mm OD)</td><td>Joimax</td><td>GTC185363</td><td>Length: 185 mm; inner diameter: 5.3 mm; outer diameter: 6.3 mm</td></tr><tr><td>Silicone Sealing Cap for Luer-Lock, blue</td><td>Joimax</td><td>JMSDL001</td><td>Sealing cap</td></tr><tr><td>Skin closure materials</td><td>Ethicon</td><td>VCP311</td><td>Vicryl 3-0 subcutaneous suture; Steri-Strip skin closure; Neodressing (9 &amp;times; 7 cm)</td></tr><tr><td>Spinal needle</td><td>TaeChang Industrial Co., Ltd.</td><td>SP.QB 21G &amp;times; 90 mm</td><td>Used for transforaminal access to the foraminal zone</td></tr><tr><td>Stopper</td><td>Joimax</td><td>JFST061427</td><td>Accessory</td></tr><tr><td>TESSYS Cleaning Wire</td><td>Joimax</td><td>TCW40010</td><td>Cleaning accessory</td></tr><tr><td>TESSYS Endo-Flexprobe Handle</td><td>Joimax</td><td>TEFH45025</td><td>Probe handle</td></tr><tr><td>TESSYS Foraminoscope, combo</td><td>Joimax</td><td>FS6342181C</td><td>Working-channel endoscope; 30&amp;deg; viewing angle; 4.7-mm working channel</td></tr><tr><td>TESSYS Foraminoscope, ocular</td><td>Joimax</td><td>FS6342181O</td><td>Working-channel endoscope; 30&amp;deg; viewing angle; 4.7-mm working channel</td></tr><tr><td>TESSYS Guiding Rod, blunt, green</td><td>Joimax</td><td>GRB251025</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod, blunt, red</td><td>Joimax</td><td>GRB252050</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod, blunt, yellow</td><td>Joimax</td><td>GRB251540</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod, conical, green</td><td>Joimax</td><td>GRC241025</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod, conical, red</td><td>Joimax</td><td>GRC242050</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod, conical, yellow</td><td>Joimax</td><td>GRC241540</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod, curved, green</td><td>Joimax</td><td>GRT241025S</td><td>Access instrument</td></tr><tr><td>TESSYS Guiding Rod Forceps</td><td>Joimax</td><td>GRF182500</td><td>Access instrument</td></tr><tr><td>TESSYS Reamer Handle XT, cannulated Quick-Lock-System, pull-release</td><td>Joimax</td><td>RHC108590</td><td>Reamer handle</td></tr><tr><td>TESSYS Steel Ruler</td><td>Joimax</td><td>TSR25010</td><td>Measurement tool</td></tr><tr><td>TESSYS XT Working Tube with Handle, fenestrated</td><td>Joimax</td><td>WTS217500</td><td>Working sheath</td></tr><tr><td>TESSYS XT Working Tube with Handle, fenestrated, 45&amp;deg;</td><td>Joimax</td><td>WTS217503</td><td>Working sheath</td></tr><tr><td>Trigger-Flex</td><td>Elliquence</td><td>DTF-40</td><td>Hemostasis/tissue ablation; power setting: 1&amp;ndash;60 W; foot-switch activation</td></tr><tr><td>Tweezers</td><td>Joimax</td><td>JAF180023</td><td>Tissue handling</td></tr><tr><td>Vaporflex Bipolar</td><td>Joimax</td><td>JVP32024</td><td>Hemostasis/tissue ablation; power setting: 1&amp;ndash;60 W; foot-switch activation</td></tr><tr><td>VISERA 4K UHD 31-inch LCD Monitor</td><td>Olympus</td><td>LMD-X310S</td><td>Endoscopic visualization</td></tr><tr><td>VISERA 4K UHD Camera Control Unit</td><td>Olympus</td><td>OTV-S400</td><td>Endoscopic visualization</td></tr><tr><td>VISERA 4K Xenon Light Source</td><td>Olympus</td><td>CLV-S400</td><td>Endoscopic illumination</td></tr></tbody></table>

circumferential transforaminal endoscopic lumbar foraminotomy for 360&#176; exiting nerve root decompression in patients with lumbar foraminal stenosis

Circumferential Transforaminal Endoscopic Lumbar Foraminotomy for 360&#176; Exiting Nerve Root Decompression in Patients with Lumbar Foraminal Stenosis

Lumbar foraminal stenosis is a common cause of intractable radiculopathy that may require surgical treatment when conservative management is ineffective. Transforaminal endoscopic lumbar foraminotomy (TELF) has been developed as a minimally invasive alternative to conventional open surgery, offering reduced tissue disruption and faster recovery. However, conventional TELF techniques may provide limited decompression in complex cases involving severe bony stenosis, fibrosis, or postoperative anatomical changes. This protocol describes circumferential TELF (C-TELF), an advanced endoscopic decompression technique designed to achieve 360&#176; decompression of the exiting nerve root (ENR) in patients with lumbar foraminal stenosis. The goal of this protocol is to provide a reproducible, step-by-step method for achieving circumferential neural decompression through a landmark-based transforaminal approach. The technique incorporates sequential bony unroofing, soft-tissue removal, and complete neural mobilization within the foraminal zone. The procedure is performed using a percutaneous transforaminal approach under fluoroscopic guidance and endoscopic visualization. Decompression is conducted sequentially from the lower pedicle to the upper pedicle to enlarge the neural foramen and establish an adequate safety margin around the ENR. By achieving circumferential decompression, this technique aims to minimize residual neural compression and facilitate durable decompression. This protocol provides detailed procedural guidance to support the safe and reproducible implementation of C-TELF, particularly in patients with complex or refractory lumbar foraminal stenosis.

The overall workflow of C-TELF is illustrated schematically in the lateral view (Figure 1A&#8211;1E) and axial view (Figure 2A&#8211;2E). These schematics demonstrate the progression from foraminal stenosis with ENR compression (Figures 1A and 2A), through stepwise bony decompression and foraminal unroofing (Figures 1B&#8211;1D and 2B&#8211;2D</...

This protocol describes circumferential transforaminal endoscopic lumbar foraminotomy for 360&#176; decompression of the exiting nerve root in patients with lumbar foraminal stenosis using a step-by-step, landmark-based approach to achieve adequate bony and soft-tissue decompression.

Lumbar foraminal stenosis is a common cause of intractable radiculopathy that may require surgical treatment when conservative management is ineffective. ...

circumferential-transforaminal-endoscopic-lumbar-foraminotomy-for-360

Research

JoVE Journal

Medicine

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Presented here is a novel technique of C-arm free transtubular posterolateral decompression for lumbar foraminal stenosis and lateral disc herniation under O-arm navigation.

Transtubular Endoscopic Posterolateral Decompression for L5-S1 Lumbar Lateral Disc Herniation

Technical advances and increased experience in full-endoscopic spinal surgeries enable these procedures to be performed with minimal incision, muscle retraction, and bone removal.

Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis

The present protocol describes the full-endoscopic transforaminal approach for lumbar discectomy, which is a safe technique that does not require muscle retraction or bone removal.

Full-Endoscopic Transforaminal Approach for Lumbar Discectomy

This protocol provides a step-by-step guide for performing transforaminal full-endoscopic foraminotomy under local anesthesia. This motion-preserving technique is presented as a minimally invasive surgical alternative to fusion extension for treating L5/S1 foraminal stenosis in patients with adjacent segment disease.

Transforaminal Full-Endoscopic Lumbar Foraminotomy Under Local Anesthesia for L5/S1 Adjacent Segment Foraminal Stenosis

Intervertebral disc degeneration is a significant contributor to back pain and a leading cause of disability worldwide. Numerous animal models of intervertebral disc degeneration exist. We demonstrate an ovine model of intervertebral disc degeneration, utilizing a drill bit, which achieves a consistent disc injury and reproducible level of disc degeneration.

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

We present a protocol for selective chemical lumbar sympathectomy (CLS), which inactivates only gray rami communicantes and not the sympathetic trunk. Selective CLS can help achieve therapeutic efficacy in vasodilation, sweat reduction, and pain relief that are comparable to conventional CLS, and serious complications, particularly ureteropelvic damages, can be reduced.

Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy

Here, we present a protocol to analyze the posture and the gait of patients after lumbar fusion surgery by means of high-resolution video rasterstereography and a treadmill equipped with an integrated sensor mat. Allowing critical functional postoperative evaluation on a less subjective level may enhance accuracy and reliability of indication for surgery.

Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis

This study aims to create a 3D-printed model of a patient-specific lumbar vertebra, which contains both the vertebra and spinal nerve models fused from high-resolution computed tomography (HRCT) and MRI-Dixon data.

3D Printing Model of a Patient's Specific Lumbar Vertebra

Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine.  This protocol describes circumferential transforaminal endoscopic lumbar foraminotomy for 360° decompression of the exiting nerve root in patients with lumbar foraminal stenosis using a step-by-step, landmark-based approach to achieve adequate bony and soft-tissue decompression.

Circumferential Transforaminal Endoscopic Lumbar Foraminotomy for 360° Exiting Nerve Root Decompression in Patients with Lumbar Foraminal Stenosis

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