PELF procedure is similar to percutaneous laser discectomy for the lumbar and cervical spine, and aims to widen the lumbar exit route foramina for lateral stenosis and disc protrusion.
A side-firing laser is inserted through the endoscope and used along with manual punches to clear disc protrusions into the epidural space. The procedure is used to relieve back pain caused by multilevel disc disease. Its claimed benefit are that it may prevent or delay the necessity of spinal fusion. The procedure is intended for patients with multilevel disease with pain radiating through the buttocks and legs. Approximately 2% to 5% of people suffer acute back pain per year, while 0.5% of these will require surgery. A total of nine endoscopic laser foraminoplasty (ELF) studies were identified in 11 papers, of which none were randomised controlled trials and three were nonrandomized comparative studies. The remainders were reports of case series. The quality of evidence is consequently poor. There are no data comparing pain outcomes between patients treated with conventional surgery and those treated with ELF. Several studies reported significant postoperative improvements in pain and disability following ELF. One comparative study reported a significantly lower complication rate for ELF (1.6%) when compared with conventional surgery (11.8%).
Endoscopic laser foraminoplasty is an endoscope-assisted laser technique, designed to treat pain by widening the lumbar exit route foramina in the spine. The procedure has been used since 1995. Under direct vision and within the protection of saline solution, epidural scarring, extruded and sequestrated disc protrusions and/or osteophytes are removed by holmium laser ablation.
Neuroleptic anaesthesia is used because patient feedback is essential. A cannulated probe is advanced into the patient.s back. The probe is replaced with a guide wire and under X-ray control a 4.6 mm dilator tube is railroaded to the exit root foramen. The trocar is removed and an endoscope with eccentrically placed 2.5 mm working channel and irrigation channel is inserted. A side firing 2.2 mm diameter laser probe is inserted through the endoscope. Disc protrusion in the epidural space is cleared by laser ablation and manual punches. The standard intervention appears to be minimal intervention fenestrectomy and open surgical undercutting for predominantly unisegmental and unilateral recess stenosis. The claimed benefits of endoscopic laser foraminoplasty are that it may prevent or delay the necessity of spinal fusion.