Spine surgery has evolved tremendously over the last 2 decades, moving from conventional open spine surgery to minimally invasive spine surgery. Minimally invasive spine surgery prevents damage to the paraspinal muscles, reduces intraoperative blood loss, shortens the surgical time, and avoids traditional open surgery. Thus, in the majority of cases, recovery is much quicker and patients have less back pain after surgery. Previous literature has proven the advantages of uniportal full-endoscopic spine procedures and unilateral biportal endoscopy (UBE) procedures. However, a steep learning curve is a critical barrier for most endoscopic procedures. Recently, biportal endoscopic spine surgical methods have been developed to make it easier for aspiring spine surgeons to learn and implement. UBE utilizes 2 portals—namely, a working portal and a viewing portal—to perform spinal decompression. A right-handed surgeon stands on the left side of a prone and anesthesia induced patient to plan the working and viewing portals under C -arm fluoroscopy. The working portal is marked caudally on the medial pedicle line (caudal pedicle) targeting the spinolaminar junction of the cranial vertebra of the involved level, and the viewing portal is marked cranially, targeting the same spot on the same line on the cranial pedicle. A problem arises when the spinal pathology is located on the right side of the patient’s spine. Therefore, the authors describe a technique through which a right-handed surgeon can tackle a right-sided spinal pathology through a right-sided approach.

Objective: Kyphoscoliosis is the most common deformity seen in patients with neurofibromatosis type 1 (NF1), occurring in 10%–60% of cases. These dystrophic curves often exhibit severe deformities that require surgical intervention. Various procedures have been evaluated and studied; however, there is no consensus, and these are also associated with a higher rate of morbidity. Therefore, this study aimed to evaluate the clinical and radiological outcomes of apical spinal osteotomy (ASO) in NF1 patients with dystrophic curves who exhibited thoracic, thoracolumbar, or lumbar kyphoscoliosis. Methods: We conducted a retrospective analysis of prospectively collected data involving 21 children with dystrophic NF1 curves who underwent ASO at a single tertiary care center from November 2009 to June 2017. The efficacy of ASO for correcting coronal and sagittal deformities was assessed. Clinical outcomes (visual analogue scale [VAS], Oswestry Disability Index [ODI], and Frankel grade) and radiological outcomes (Cobb angle correction, fusion, and complications) were evaluated. Results: The study included 21 patients (11 males, 10 females) with a mean age at surgery of 9.33 years. The mean kyphotic Cobb angle improved significantly from 98.33° to 36.52°. The mean sagittal vertical axis also improved significantly from 7.40 cm to 4.21 cm, along with significant improvements in VAS and ODI scores. Conclusion This study describes a technique using a posterior approach for single-level ASO in the treatment of severe dystrophic NF1 curves. The technique can be effective in children with mild to moderate curves, yielding good clinicoradiological outcomes and satisfactory correction rates.