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Objective Uniportal full endoscopic thoracic endoscopic surgery can be performed through transforaminal and interlaminar approaches. The interlaminar approach is commonly described as thoracic endoscopic unilateral laminotomy for bilateral decompression (TE-ULBD), which is typically indicated for pathologies such as ossified ligamentum flavum and other posteriorly based compressive pathologies. TE-ULBD decompresses the central and lateral recesses of the thoracic spinal canal. Both the outside-in (over the top of ligamentum flavum) and inside-out (under the ligamentum flavum) approaches can decompress the thoracic spinal canal through the uniportal interlaminar endoscopic route. Methods A retrospective clinical cohort evaluation of patients who underwent TE-ULBD was performed from January 2018 to December 2021 Results A cohort of 50 cases of TE-ULBD with a mean age of 65 years old were evaluated. The complication rate was 5.4% and the reoperation rate was 2%. Statistically significant mean VAS improvements were found at 1 week, 6 months, and the final follow-up, with changes of 3.95±1.49, 4.95±1.7, and 5.2±1.8 points, respectively. Likewise, the mean Oswestry Disability Index improvements at 1 week, 3 months, and the final follow-up were 33.8±9.05, 40.12±10.38, and 41.92±11.26, respectively (p

Complex anatomy, difficult access, and low tolerance of cord manipulation in the cervical and thoracic spine are some of the most challenging aspects of spine surgery. Open cervical and thoracic spinal surgery incurs substantial morbidity, with significant postoperative pain, blood loss, and risk of infection in open cervical and thoracic wounds. With the evolution of endoscopic surgical techniques and increasing familiarity with how to handle endoscopic equipment, the indications of endoscopic spine surgery have expanded to include cervical and thoracic spinal decompression in the surgical armamentarium for treating cervical and thoracic spinal pathologies to provide the maximal benefit zone of endoscopic spine surgery.

Objective Predicting the gross anatomy of the inner ligament flavum and surrounding interlaminar window is essential for sufficient neural decompression because endoscopic spine surgery is performed in a limited, narrow surgical corridor. This article aims to analyze the anatomical data of inner LF and interlaminar window on the 3D lumbar computed tomography (CT) for easy application to the endoscopic decompression surgery. Methods We measured nine parameters indicating the contour of inner LF and interlaminar window on 3D CT from 100 patients who were diagnosed with lumbar spinal stenosis or disc herniation. Inner LF angle, inner LF distance, inner LF volume, and inner foraminal ligament distance for inner LF contour; height, width, and lateral corner angle of interlaminar window contour were measured in five age groups consisted of twenty individuals from the 30s to the 70s. We then compared two age groups(ages 30–49 years, n=40; ages 60–79 years, n=40). Results In the old age group, the interlaminar window was changed to a smaller triangle shape representing decreased width and height and increased lateral corner angle. Inner LF volume, inner LF angle, inner LF distance were also reduced in the old age group. But these parameters have variations in levels with a significant difference. Uniportal endoscopic docking point has moved according to changed interlaminar window features more caudal and lateral direction. Inner LF angle could have used to decide the approach angle for endoscopic contralateral foraminotomy. Conclusion We found the changing features of these structures correlated with age and levels to help with endoscopic decompression surgery has a limited surgical corridor. The present study results may help the endoscopic surgeons decide the endoscopic docking site, the extent of bone drilling at the medial facet joint part, and the approach angle for contralateral lumbar foraminotomy.

Objective The implement of endoscopic spinal surgery has minimized the requirement of fusion procedures. However, certain patients still require fusion surgery such as instability. We performed a full-endoscopic transforaminal lumbar interbody fusion (eTLIF) through a conventional paraspinal approach. Methods eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through paraspinal approach. Their clinical outcomes were evaluated with visual analog scale (VAS), Oswestry Disability Index (ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis (SLA), global lumbar lordosis (LLA), disc height (DH) on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. intra operative and post-operative complications noted. Results Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. In the X-ray result, mean SLA improved in pre-operative/post-operative/follow-up period 9.87±2.740/11.79±3.74 0/10.56±3.690 (p>0.01); mean LLA improved 37.1±7.040/39.2±7.130/35.7±7.250 (p>0.01). Mean DH improved from 8.97±1.49 mm/12.34±1.39 mm/11.44±1.98 mm(p

Post lumbar laminotomy anatomical changes can be disorienting to uniportal spinal endoscopist. This which led to many open conversionconversion to open surgery to verify landmarks. Isthmus tends not to be violated inis usually preserved in laminotomy and it can be used as a useful landmark for endoscopic fusion surgery. Unlike tubular microscopic surgery, endoscope possess more mobility; conveniently navigating through the identifiable anatomical landmarks in revision surgery with minimal fluroscopy. Uniportal Endoscopic Lateral to Medial Direction Transforaminal Lumbar Interbody Fusion, is a useful revision surgery technique with isthmus as reference point, it had not been described in literature. Case Presentation A 66 years old lady with two previous lumbar decompressive surgery to left L4/5 presented with neurogenic claudication and instability. She was diagnosis was to have L4/5 post-surgical spondylolisthesis with stenosis. She Informed consent was obtained consented for left L4/5 revision uniportal endoscopic lateral to medial direction transforaminal lumbar interbody fusion, Endo (LM)-TLIF. Procedure started with drilling isthmus with from lateral to medial direction using exploratory bone drilling dissection technique to decompress and explore residual bony anatomical landmark. With proper definition of anatomical margins of intervertebral disc space, endoscopic guided discectomy, end plate preparation, cage and percutaneous pedicle screws insertion were done with aid of fluoroscopy and endoscopy to perform spinal fusion. Patient did well post operatively without any intraoperative complication.Conclusion Endo (LM)-TLIF is a viable, safe and efficacious method to explore a potentially challenging post-surgical anatomy around spinal canal in revision lumbar fusion

Neglected stress related fracture of superior articular process fracture leading to disability is not commonly reported. Intravertebral foraminal ligament attachment to superior articular process is well described but its repetitive stress related avulsion injury was not reported. The presence of abundant sensory and nociceptive nerve endings around the facet joint can cause significant symptoms in this uncommon condition. We hereby present 2 cases of superior articular process tip fracture. First case is a 53 years old business who presented with intractable chronic back and right gluteal pain for many years worsened with golf games with the diagnosis of nonunion of right L2 superior articular facet and second case is a 74 years old lady who had intractable left buttock and left calf radicular pain with neglected left L5 superior articular facet tip fracture after vertebroplasty treatment on L4 compression fracture; both underwent uniportal endoscopic contralateral approach for decompression and resection of the Superior Articular Process, SAP tip fragment with its attached foraminal ligament with good symptoms relief on one year follow up. Consideration can be made for endoscopic decompression SAP tip fracture in comparison to open decompression or fusion surgery in these symptomatic patients.

Objective Thoracolumbar disc herniation is an uncommon disabling spine condition. Methods There is relatively large dura expansion to lateral recess in the thoracolumbar junction leading to potential hazard in docking and execution of endoscopic transforaminal discectomy. Mobile outside in technique had been executed successfully in lumbar disc herniation, we modified the technique to allow safe docking and execution of discectomy in thoracolumbar junction. Herein, we report a case of thoracic twelve lumbar one disc paracentral disc herniation treated with floating transforaminal endoscopic discectomy under local anesthesia. Results A 46-year-old man with a 3-months of severe back and radicular pain on the right groin. A diagnosis of right T12/L1 paracentral disc herniation was made, based on clinical and radiological investigations. He underwent percutaneous transforaminal endoscopic thoracolumbar discectomy with floating technique. Over a follow-up of 6 months, a favorable outcome was noted. Conclusion Floating technique of transforaminal endoscopic thoracolumbar junction discectomy is a safe and an effective surgical approach for the treatment of thoracolumbar disc herniation. In patients with thoracolumbar disc herniation, careful patient selection and evaluation neural elements anatomy in relation to bony anatomy is important in preparation for endoscopic decompression.

Advancement of technology and surgical skills act in synergy to lead to exploration of new solutions in spine surgery. One of the key areas of spine innovation is endoscopic spine surgery and its application to a broader spectrum of conditions with the aim of reducing perioperative morbidities, soft tissue and bony conservation and yet achieving long term target outcomes of gold standard traditional open spine surgery. Twenty first century marks the new century of opportunities and challenges, in the face of threat of Coronavirus pandemic and difficult circumstances in hospital bed management and limitation in medical resources, minimally invasiveness is evolving from individual patients’ benefits to public interest.

There is increasing trend of spine surgeries performed with uniportal and biportal endoscopic spine surgery. Despite its good outcomes and supportive literature, the proportion of spine surgeons regularly doing endoscopic spine surgeries is relatively low. The main limitation is the steep learning curve in the early phase of endoscopic spine surgeries practice. There is paucity of literature in discussion of tips in overcoming these 2 schools of endoscopic spine surgery practice. In this tips and tricks overview, the authors highlights the key differences these 2 main school of endoscopic spine surgeries practice with specific discussions pertaining to “BIPORTALS”: the areas of basic medium of surgery, instruments for visualization and working, placement of portal(s), outflow of fluids, route of approach, technical challenges, anatomical challenges, location of lens and light source and start point to work. A ladder of progression of endoscopic spine surgery is proposed to effectively ease into the practice of endoscopic spine surgery.

Uniportal Lumbar Endoscopic decompression can be performed through transforaminal and interlaminar route. Interlaminar lumbar endoscopic unilateral laminotomy for bilateral decompression allows good decompression of central and lateral recess of the stenotic lumbar spine region. Both over the top decompression approach and under the ligamentum flavum decompression approach method has been recently described with differing principles and approaches despite achieving the same target in decompression of spinal canal through uniportal interlaminar endoscopic route. The authors aim to share their experience and thoughts on the 2 described approaches. Retrospective clinical cohort evaluation of patients who underwent LEULBD were performed from January 2018 to December 2019 The cohort of 278 cases of LEULBD with mean age of 64 years old were evaluated. Complication rate is 3.6% and reoperation was 3.6%, mean VAS improvement at 1 weeks, 3 months and final follow up were 3.06±0.66, 2.50±0.86 and 2.17±0.91 respectively, p