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

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Minimally Invasive Spine Surgery

Background:

• Lumbar foraminal stenosis causes radicular symptoms, often treated with minimally invasive decompression.
• Traditional techniques face challenges at the L5-S1 level due to iliac crest prominence, hindering access.
• Endoscopic spine surgery offers a potential solution for challenging lumbar decompression cases.

Purpose of the Study:

• To describe the technical skills for unilateral extraforaminal biportal endoscopic spinal surgery at L5-S1.
• To demonstrate effective foraminal decompression at L5-S1 using a 30° arthroscope.
• To evaluate this technique's ability to preserve facet joint stability.

Main Methods:

• Utilized a unilateral extraforaminal biportal endoscopic approach with a 30° arthroscope.
• Created two 0.8-cm portals lateral to the L5-S1 pedicles.
• Performed decompression by removing the superior articular process (SAP) and ligamentum flavum, addressing disc extrusion.

Main Results:

• Successfully achieved foraminal decompression at the L5-S1 level, previously difficult due to iliac crest anatomy.
• Preserved facet joint stability and function during the decompression procedure.
• Reported symptomatic improvement in radicular symptoms, consistent with previous studies on decompression efficacy.

Conclusions:

• Endoscopic extraforaminal decompression is a viable minimally invasive option for L5-S1 foraminal stenosis.
• This technique overcomes anatomical limitations posed by the iliac crest.
• It offers facet joint preservation and symptomatic relief for patients with lumbar stenosis.