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To counter this disadvantage, a modified TESSYS procedure-“U” route PELD-was developed recently in which the ventral articular joint was resected using a trephine under a visual endoscope to obtain enough exposure and the nucleus forceps was navigated ventrally to resect the anterior compressions after removing hypertrophied LF thoroughly, and this technique is catching more attention from spinal surgeons. Surgeons successfully decompressed the anterior nucleus pulposus under TESSYS with foraminoplasty but cannot remove posterior hypertrophic LF to achieve a fully dorsal decompression. TESSYS was applied to treat LSS favorably. Upon the improvement of PELD procedure performance and development of surgical instruments, the indications of PELD are being explored. As a further development of minimally invasive spinal surgery, transforaminal endoscopic spine system (TESSYS) procedure was introduced and has been demonstrated feasible and effective for lumbar disc herniation (LDH) treatment. During the last decades, LSS can be treated via a unilateral approach to achieve bilateral decompression and spinal canal enlargement with microendoscopic discectomy (MED) however, the complications of MED, delayed postoperative recovery, and reduced satisfaction rate were reported.

Traditionally, the decompression plus fusion surgery is regarded as the standard procedure for LSS treatment. The treatment aims to alleviate symptoms and improve life quality however, surgery should be considered after conservative treatment is gone through and failed. The mechanical compression on the nerve root, cauda equina, and/or vascular structure leads to symptoms including low back pain, intermittent neurogenic claudication and radiculopathy in lower extremities, and sensory and motor disturbances. There are a large part of LSS patients with disc protrusion, resulting in spinal canal narrowing and dural sac constriction. The major causative factors of LSS include hypertrophied faceted joints, osteophyte formation, and ligamentum flavum (LF) hypertrophy. Lumbar spinal stenosis (LSS) and disc herniation (DH) are two of the most common etiologies in chronic pain patients. Chronic pain is defined as the pain that persists beyond normal healing time.

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