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Contralateral sublaminar approach for decompression of the combined lateral recess, foraminal, and extraforaminal lesions using biportal endoscopy: a technical report

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Abstract

Background

The development of specialized instruments and surgical techniques has enabled the biportal endoscopic system to access the foraminal and extraforaminal area using the contralateral sublaminar approach at the lumbar level.

Methods

Biportal endoscopic contralateral sublaminar approach was used to resolve the contralateral foraminal, and extraforaminal stenosis at the lumbar level. Prominent syndesmophytes and herniated disc compression of the exiting nerve root were successfully removed, and the distorted nerve root was restored to a smooth downward angulation in the far-out area.

Conclusion

We successfully utilized biportal endoscopy to decompress the combined lumbar lateral recess, foraminal, and extraforaminal lesions using a contralateral sublaminar approach.

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Author information

Authors and Affiliations

  1. Neurosurgery, Spine center, Leon Wiltse Memorial Hospital, Anyang, South Korea

    Ji Yeon Kim

  2. Neurosurgery, Endoscopic Spine Surgery Center, Seoul Bumin Hospital, 389, Gonghang-daero, Gangseo-gu, 7590, Seoul, South Korea

    Dong Hwa Heo

Authors
  1. Ji Yeon Kim
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  2. Dong Hwa Heo
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Correspondence to Dong Hwa Heo.

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Key points

1. The main advantage of this technique is effective decompression of the entrapped ENR in the foraminal and extraforaminal areas and traversing nerve roots in the lateral recess with a single approach while preserving the facet joint.

2. Prominent syndesmophytes and herniated disc, compressing of the ENR from the ventral part, can be removed without retraction of the dorsal root ganglion.

3. Prior foraminal discectomy reduces intracanal pressure and enables a more relaxed and safe approach to the extraforaminal area.

4. Endpoint decompression in the far-out area restores a smooth downward angulation of the ENR, which may enhance the relief of radicular pain.

5. Preoperative CT investigation is crucial to plan the extent of bony removal of the SAP, prominent syndesmophytes, and sublaminar structures for successful nerve root decompression and preservation of the facet joint.

6. This technique may not be suitable for the L5–S1 level, which has a wide facet joint and inclination of the disc space.

Supplementary Information

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Video clip 1. Video clip of the biportal endoscopic contralateral sublaminar approach for lumbar foraminotomy and decompression. We performed a left-sided approach for right contralateral lateral recess and foraminal and extraforaminal decompression at the L4–L5 level. LF, ligamentum flavum; SAP, superior articular process; HNP, herniated nucleus pulposus (MP4 91426 kb)

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Kim, J.Y., Heo, D.H. Contralateral sublaminar approach for decompression of the combined lateral recess, foraminal, and extraforaminal lesions using biportal endoscopy: a technical report. Acta Neurochir 163, 2783–2787 (2021). https://doi.org/10.1007/s00701-021-04978-x

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  • DOI: https://doi.org/10.1007/s00701-021-04978-x

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