Percutaneous endoscopic lumbar laminectomy

Aim: Percutaneous endoscopic lumbar laminectomy or laminotomy (PELL) is a minimally invasive surgical technique to treat lumbar canal stenosis. The procedure is undertaken using a single port endoscope, as with percutaneous endoscopic lumbar discectomy (PED). PED has become popular with spinal surgeons in Japan as a suitable surgery for lumbar disc herniation patients. Because PED has the powerful advantage of structural preservation, it allows for short hospital stays and early recovery of the patient. PELL and PED are conceptually very similar, in that they are both minimally invasive. PELL is not as popular as PED, however. The aim of the current study was to explore the reasons why. Methods: The current study reports the early experiences of surgeons at this institution in using the PELL technique, and its limitations. Results: The goal of PELL is total flavectomy and decompression of the bony structure. Currently, there are difficulties and limitations in achieving decompression using PELL with small tools. Conclusion: PELL requires much more skill than PED and the learning curve is not steep. PELL is minimally invasive for the patient, but further developments of the endoscope or procedures are required to achieve widespread use.