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We present a novel technique to approach far lateral lumbar pathologies using a bitubular, biportal endoscopic system and a paramedian approach. Background: Conventional approaches for lumbar far lateral discectomy range from open approaches to newer minimally invasive approaches such as tubular discectomy and single portal endoscopic discectomy. We present a case of a patient suffering with a left L3–4 and left L4–5 extraforaminal disc herniation who was treated successfully with a left sided bitubular, biportal endoscopic 2 level far lateral discectomy. A paramedian ‘bitubular’ biportal endoscopic approach is safe and effective for far lateral lumbar pathologies with excellent visualisation due to good outflow of irrigation fluid.

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Endoscopic Transforaminal Thoracic Decompression for Removal of a Giant Calcified Thoracic Disc Herniation

Mazda FARSHAD ; Christoph Johannes LAUX ; Lukas ZINGG ; Florian WANIVENHAUS

Neurospine.2024;21(4):1116-1118. doi:10.14245s.2449064.532

To demonstrate the preoperative workup, surgical planning and execution of transforaminal endoscopic thoracic discectomy (TETD) for a giant calcified disc herniation. Surgeries for symptomatic thoracic disc herniations are rare and challenging. The main goal is to achieve sufficient decompression with minimal manipulation of the spinal cord. Conventional surgical techniques may have significant approach-related morbidities and often require additional stabilization. The full endoscopic transforaminal technique is the least invasive approach so far. A 73-year-old female patient with progressive gait disturbance and paraparesis received radiological imaging which revealed a giant calcified thoracic disc herniation at the level T11–12. The preoperative workup, planning and execution of TETD is demonstrated in detail. This report represents a typical educational case of a giant calcified thoracic disc herniation, treated by TETD.

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Full-Endoscopic J-Shaped Transforaminal L5 Nerve Decompression in Bertolotti Syndrome

Chang-Il JU ; Pius KIM ; Jong Hun SEO

Neurospine.2024;21(4):1131-1136. doi:10.14245s.2449112.556

This case report and video demonstrate the technique of full-endoscopic J-shaped transforaminal L5 exiting nerve decompression in Bertolotti syndrome. Bertolotti syndrome, characterized by a congenital lumbosacral transitional vertebra, often results in mechanical lower back pain and nerve root compression. A 69-year-old male presented with progressive radiating pain in the right leg and tingling in the L5 dermatome. Lumbar spine MRI revealed a right foraminal disc herniation at the L5–S1 level, with calcification and foraminal stenosis. The patient was also diagnosed with Castellvi type I Bertolotti syndrome, featuring a large L5 transverse process and a high iliac crest. These anatomical variations complicated the transforaminal approach, creating a narrow safety zone for conventional methods. The approach began with docking on the L5 transverse process. Endoscopic drilling was performed in a J-shaped configuration to partially resect the transverse process and alar wing, facilitating endoscope insertion into Kambin’s triangle. Foraminal decompression was achieved by removing the tip of the superior articular process (SAP), thereby decompressing the L5 exiting nerve root. Full-endoscopic spine surgery offers a safe and effective alternative to traditional open techniques for L5 nerve decompression in Bertolotti syndrome. This video presentation illustrates the intraoperative endoscopic approach, detailing the decompression techniques and highlighting the minimally invasive advantages of this method.

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