ABSTRACT
BACKGROUND: Various full-endoscopic techniques have been developed to reach the lateral recess of the lumbar spine. However, specialized surgical tools, including expensive spinal endoscopic systems, and a steeper learning curve to mastering the technique are required. METHOD: We present a novel target-addressed unilateral biportal endoscopic technique to reach directly the lumbar lateral recess, particularly useful at L4-L5 and L5-S1. The technique follows an inclined-ipsilateral trajectory to preserve the lateral extension of ligamentum flavum and the facet joint as much as possible. CONCLUSION: This technique was associated with all the advantages of minimally invasive decompressive procedures and outstanding outcomes.
Subject(s)
Endoscopy , Ligamentum Flavum , Humans , Learning Curve , Ligamentum Flavum/diagnostic imaging , Ligamentum Flavum/surgery , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/surgery , Lumbosacral Region/surgeryABSTRACT
BACKGROUND: Lumbar burst fractures (complete or incomplete) of L5 have a low incidence, accounting for 1.2% of all spinal burst fractures. Treatment for these fractures remains controversial. Decompression of neural elements and stabilization of the spine to preserve lordosis and avoid kyphotic deformity are recommended when a patient has a neurological deficit and an unstable fracture. Otherwise, the fracture could be managed conservatively. METHODS: We report a detailed step-by-step unilateral biportal endoscopy technique used in a patient with an L5 incomplete burst fracture and neurological deficit. RESULTS: The patient had an acceptable immediate postoperative course; lower back pain and radicular symptoms improved significantly after surgery. CONCLUSIONS: Our unilateral biportal endoscopy technique for L5 incomplete burst fractures offers the capability to perform enough decompression of neural elements and assist other procedure-related maneuvers under direct endoscopic visualization. This technique could be considered another minimally invasive spine surgery option for treating selected patients with L5 incomplete burst fractures.
Subject(s)
Decompression, Surgical/methods , Lumbar Vertebrae/surgery , Neuroendoscopy/methods , Spinal Cord Injuries/surgery , Spinal Fractures/surgery , Vertebroplasty/methods , Adult , Decompression, Surgical/instrumentation , Humans , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/injuries , Male , Neuroendoscopy/instrumentation , Spinal Cord Injuries/diagnostic imaging , Spinal Cord Injuries/etiology , Spinal Fractures/complications , Spinal Fractures/diagnostic imaging , Treatment Outcome , Vertebroplasty/instrumentationABSTRACT
BACKGROUND: The principal advantage of intraoperative spinal navigation is the ease of screw placement. However, visualization and the integration of navigation can be explored with the use of navigation-guided full-endoscopic techniques. OBJECTIVE: To describe the stepwise intraoperative navigation-assisted unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) technique and to present our preliminary results in a Mexican population. METHODS: A 10-step summary of the UBE-TLIF operative technique was described, and the clinical and radiological results are presented and analyzed. RESULTS: A total of 7 patients were treated. We observed the value of integrating navigation and endoscopic visualization when decompression had to be performed. CONCLUSION: Together, intraoperative navigation and direct visualization through the endoscope may be a useful surgical tool for surgeons with experience in endoscopic spinal surgery.
