O-Arm Navigation-Guided Unilateral Biportal Endoscopic Decompression of Far-Out Syndrome

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Abstract

The main aim of this video article is to demonstrate the combined use of O-arm navigation and unilateral biportal endoscopy (UBE) to manage far-out syndrome (FOS). In FOS there is entrapment and compression of the fifth lumbar nerve beyond the foramen and between L5 transverse process and the sacral ala at the lumbosacral junction. Conventional microscopic decompression using a paraspinal approach had been the gold standard for its management. However, the surgery is technically challenging due to the deep location of the pathology and intricate anatomy of extraforaminal space. There have been some published reports of unsatisfactory outcomes with microscopic decompression for FOS. We decided to integrate navigation with UBE to increase precision for the management of FOS. A 70-year-old female presented to us with chief complaint of left lower limb radiculopathy since 1 year. She also complained of numbness and paresthesias in her left leg and foot. She was unable to walk for more than 10 minutes due to pain. Her magnetic resonance imaging scan revealed compression of left L5 nerve root in the extraforaminal region. UBE decompression via paraspinal approach was performed for her under O-arm navigation. She experienced immediate relief of her symptoms in the postoperative period. O-arm-navigation-guided UBE is an effective and safer alternative to microsurgical decompression for the management of FOS. This video demonstrates the step-by-step implementation of O-arm navigation with endoscopy and its precise execution.

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Most cited references 15

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New uses and refinements of the paraspinal approach to the lumbar spine.

L L Wiltse, Rebecca M. C. Spencer (1988)

The paraspinal approach was described by our group in 1968. It differs from the approach described by Melvin Watkins in 1953 in that it is a longitudinal separation of the sacrospinalis group between the multifidus and longissimus, and not between the lateral border of the entire sacrospinalis group and quadratus lumborum. Also, Watkins removed a flake of the iliac crest with muscles attached, which he swung cranially and medially. This article also describes several refinements not mentioned in the original article and gives several new uses for the approach. Specifically, its use for removing a far lateral disc, decompressing a far out syndrome, inserting pedicle screws, and for decompressing the opposite side from inside the vertebral canal is described.

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Extraforaminal approach of biportal endoscopic spinal surgery: a new endoscopic technique for transforaminal decompression and discectomy.

Jae-Sung Ahn, Ho-Jin Lee, Dae-Jung Choi … (2018)

This study was performed to describe the extraforaminal approach of biportal endoscopic spinal surgery (BESS) as a new endoscopic technique for transforaminal decompression and discectomy and to demonstrate the clinical outcomes of this new procedure for the first time. Twenty-one patients (27 segments) who underwent the extraforaminal approach of BESS between March 2015 and April 2016 were enrolled according to the inclusion and exclusion criteria. The operative time (minutes/level) and complications after the procedure were recorded. The visual analog scale (VAS) score was checked to assess the degree of radicular leg pain preoperatively and at the time of the last follow-up. The modified Macnab criteria were used to examine the clinical outcomes at the time of the last follow-up. The mean duration of the follow-up period was 14.8 months (minimum duration 12 months). The mean operative time was 96.7 minutes for one level. The mean VAS score for radicular leg pain dropped from a preoperative score of 7.5 ± 0.9 to a final follow-up score of 2.5 ± 1.2 (p < 0.001). The final outcome according to the modified Macnab criteria was excellent in 5 patients (23.8%), good in 12 (57.2%), fair in 4 (19.0%), and poor in 0. Therefore, excellent or good results (a satisfied outcome) were obtained in 80.9% of the patients. Complications were limited to one dural tear (4.8%). The authors found that the extraforaminal approach of BESS was a feasible and advantageous endoscopic technique for the treatment of foraminal lesions, including stenosis and disc herniation. They suggest that this technique represents a useful, alternative, minimally invasive method that can be used to treat lumbar foraminal stenosis and disc herniation.

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Technique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion

Dong Heo, Young Ho Hong, Dong Chan Lee … (2020)

Biportal endoscopic transforaminal lumbar interbody fusion (TLIF) may have advantages of minimally invasive fusion surgery as well as those of endoscopic surgery. The purpose of this study was to present the biportal endoscopic TLIF technique along with video presentations and a review of the literature on this technique. Basically, the biportal endoscopic TLIF technique is similar to minimally invasive TLIF with a tubular retractor. There were 2 options in the biportal endoscopic TLIF procedures. The first was the insertion of one long TLIF cage and the other was the insertion of 2 short posterior lumbar interbody fusion (PLIF) cages. After the interbody fusion procedures, percutaneous pedicles screw fixation was performed. Biportal endoscopic TLIF achieved complete neural decompression through laminectomy and facetectomy like conventional TLIF. Endplate preparation was performed completely under a clear and magnified endoscopic view. It was also feasible to insert a large TLIF cage or 2 cages for PLIF without exiting nerve root injury. Biportal endoscopic TLIF might have the advantages of endoscopic surgery as well as minimally invasive fusion surgery. Direct neural decompression, endplate preparation under endoscopic guidance, and the insertion of a large TLIF cage or 2 PLIF cages may be the merits of biportal endoscopic lumbar fusion procedures.

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Author and article information

Journal

Journal ID (nlm-ta): Neurospine

Journal ID (iso-abbrev): Neurospine

Journal ID (publisher-id): NS

Title: Neurospine

Publisher: Korean Spinal Neurosurgery Society

ISSN (Print): 2586-6583

ISSN (Electronic): 2586-6591

Publication date (Print): December 2024

Publication date (Electronic): 31 December 2024

Volume: 21

Issue: 4

Pages: 1149-1153

Affiliations

[1 ]Asha Nursing Home, Pune India, Pune, India

[2 ]Department of Neurosurgery, Spine Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

[3 ]Orthopaedic Hospital of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China

Author notes

Corresponding Author Jin-Sung Kim Department of Neurosurgery, Spine Center, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Email: mdlukekim@ 123456gmail.com , md1david@ 123456catholic.ac.kr

Author information

Rohit Akshay Kavishwar http://orcid.org/0000-0002-1482-5623

YiHao Liang http://orcid.org/0009-0004-5674-4241

Dongeon Lee http://orcid.org/0009-0005-5149-9467

Jaehwan Kim http://orcid.org/0000-0001-6954-8187

Maria Pedraza http://orcid.org/0009-0003-0974-0451

Jin-Sung Kim http://orcid.org/0000-0001-5086-0875

Article

Publisher ID: ns-2449140-570

DOI: 10.14245/ns.2449140.570

PMC ID: 11744545

PubMed ID: 39765258

SO-VID: d0218fd0-2cbb-4284-9a48-fd81ffb378fd

License:

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 23 October 2024

Date revision received : 15 November 2023

Date accepted : 16 November 2024

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O-arm navigation-based transforaminal unilateral biportal endoscopic discectomy for upper lumbar disc herniation: an innovative preliminary study
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