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Clin Orthop Surg. 2018 Dec;10(4):508-512. doi: 10.4055/cios.2018.10.4.508. Epub 2018 Nov 21.

Unilateral Biportal Endoscopic Spinal Surgery Using a 30° Arthroscope for L5-S1 Foraminal Decompression.

Author information

1
Department of Orthopedic Surgery, Andong Hospital, Andong, Korea.
2
Department of Spine Surgery, Barun Hospital, Jinju, Korea.

Abstract

Foraminal decompression using a minimally invasive technique to preserve facet joint stability and function without fusion reportedly improves the radicular symptoms in approximately 80% of patients and is considered one of the good surgical treatment choices for lumbar foraminal or extraforaminal stenosis. However, proper decompression was not possible because of the inability to access the foramen at the L5-S1 level due to prominence of the iliac crest. To overcome this challenge, endoscopy-based minimally invasive spine surgery has recently gained attention. Here, we report the technical skills required in unilateral extraforaminal biportal endoscopic spinal surgery using a 30° arthroscope to enable foraminal decompression at the L5-S1 level. Two 0.8-cm portals were created 2 cm lateral from the lateral border of the pedicles at the L5-S1 level. After sufficient working space was made, half of the superior articular process (SAP) in the hypertrophied facet joint was removed using a high-speed burr and a 5-mm wide osteotome, whereas the remaining inside part of the SAP was removed using a Kerrison punch and pituitary punch. The foraminal ligamentum flavum should be removed to inspect the conditions of the L5 exiting root and disc. Removing of the extruded disc could decompress the L5 root. The extraforaminal approach using a 30° arthroscope is considered a minimally invasive alternative technique for decompressing foraminal stenosis at the L5-S1 level that preserves facet stability and provides symptomatic relief.

KEYWORDS:

Arthroscope; Endoscopes; Lumbosacral region; Spinal stenosis

PMID:
30505421
PMCID:
PMC6250961
DOI:
10.4055/cios.2018.10.4.508
[Indexed for MEDLINE]
Free PMC Article

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