Utility of Computed Tomography-Guided Navigation for Full-Endoscopic Pars Crisscross Decompression: A Technical Note

Area of Science:

• Spine surgery
• Minimally invasive techniques
• Endoscopic spinal decompression

Background:

• Full-endoscopic pars crisscross decompression (FE-PCD) for L5 isthmic spondylolisthesis is challenging due to complex anatomy and limited endoscopic visualization.
• These limitations increase risks of incomplete decompression or iatrogenic injury.

Purpose of the Study:

• To describe a novel navigation-assisted FE-PCD technique.
• The technique aims to overcome anatomical challenges in endoscopic spinal decompression.

Main Methods:

• The navigation-assisted FE-PCD technique was applied to 3 patients with L5 isthmic spondylolisthesis.
• An O-arm-based navigation system provided real-time 3D guidance and "virtual probing" for precise anatomical identification.

Main Results:

• All procedures were completed successfully without complications.
• Navigation effectively compensated for limited endoscopic views, enabling clear differentiation of structures and precise resection of the impinging ragged edge.

Conclusions:

• Navigation-assisted FE-PCD appears feasible and safe for L5 isthmic spondylolisthesis.
• The technique provides a 3D roadmap, mitigating disorientation and ensuring adequate decompression and facet resection.