Foraminal and lateral recess stenosis is a common condition that is often under treated and not completely addressed by traditional surgical decompression.
Recently, new surgical tools such as Boxano’s iO-Flex, developed by traditional spine surgeons to address this condition, has hopes of facilitating lateral recess decompression, but still has pitfalls due to reliance on non-visualized decompression and relying to a surgical tool to decompress the lateral recess without direct visualization. Transforaminal endoscopic decompression in experienced hands overcomes this pitfall. the surgeon factor and experience plays an important role in the success of this procedure.
With T-Lif and complete removal of the facets, this condition is mitigated, but the destabilization of facet removal causes instability that require a much more invasive , surgically expensive and surgically morbid procedure requiring surgical stabilization and general anesthesia.
These two case presentations on iO-Flex failure provides additional information on the anatomic complexities of patho-anatomy causing symptoms of foraminal and lateral recess causing radiculopathy or sciatica and numbness. It can be safely performed as outpatient surgery in an ASC with the patient completely awake of only minimally sedated.