Full Endoscopic Interlaminar Contra-Lateral Lumbar Foraminotomy

Foraminal stenosis is often underestimated due to difficulties in approaching the region surgically. The evolution of the transforaminal approach allowed safe surgical exploration of foraminal pathology under direct vision. Postoperative Dysesthesia (POD) due to irritation of the dorsal root ganglion (DRG) of lumbar nerve roots at the surgical level is a common sequela associated with the transforaminal approach. Minimal dorsal root ganglion (DRG) retraction is critical to prevent POD. Full endoscopic interlaminar contra-lateral lumbar foraminotomy consists of a sublaminar approach or translaminar approach. It is followed by contralateral foraminotomy and extraforaminal decompression. The contralateral approach's principle is to create a safe path to the contralateral foramen, preserving the ipsilateral anatomy. It allows simultaneous lateral recess, contra-lateral foramen, and extraforaminal decompression along the nerve root with minimal nerve root manipulation in the foramen. However, the learning curve for the technique is steep compared to the transforaminal technique

Keywords: Dorsal root ganglion, Foraminal stenosis, Postoperative dysesthesia, Transforaminal approach