The growth of minimally invasive techniques in spine surgery has accelerated in recent years, leading to development of new techniques and technology such as robotic-assisted spine surgery and full-endoscopic surgery. While robotic spine surgery offers the potential of increased precision and accuracy in instrumentation, endoscopic techniques are beneficial in reducing collateral tissue damage and allowing patients a faster return to function. We describe a case where we combine a robotic guidance system with a full-endoscopic technique, the trans-superior articular process decompression. We aim to share our experience as well as an overview of the surgical technique.

The growth of minimally invasive techniques in spine surgery has accelerated in recent years, leading to development of new techniques and technology such as robotic-assisted spine surgery and full-endoscopic surgery. While robotic spine surgery offers the potential of increased precision and accuracy in instrumentation, endoscopic techniques are beneficial in reducing collateral tissue damage and allowing patients a faster return to function. We describe a case where we combine a robotic guidance system with a full-endoscopic technique, the trans-superior articular process decompression. We aim to share our experience as well as an overview of the surgical technique.

The growth of minimally invasive techniques in spine surgery has accelerated in recent years, leading to development of new techniques and technology such as robotic-assisted spine surgery and full-endoscopic surgery. While robotic spine surgery offers the potential of increased precision and accuracy in instrumentation, endoscopic techniques are beneficial in reducing collateral tissue damage and allowing patients a faster return to function. We describe a case where we combine a robotic guidance system with a full-endoscopic technique, the trans-superior articular process decompression. We aim to share our experience as well as an overview of the surgical technique.

The growth of minimally invasive techniques in spine surgery has accelerated in recent years, leading to development of new techniques and technology such as robotic-assisted spine surgery and full-endoscopic surgery. While robotic spine surgery offers the potential of increased precision and accuracy in instrumentation, endoscopic techniques are beneficial in reducing collateral tissue damage and allowing patients a faster return to function. We describe a case where we combine a robotic guidance system with a full-endoscopic technique, the trans-superior articular process decompression. We aim to share our experience as well as an overview of the surgical technique.

The growth of minimally invasive techniques in spine surgery has accelerated in recent years, leading to development of new techniques and technology such as robotic-assisted spine surgery and full-endoscopic surgery. While robotic spine surgery offers the potential of increased precision and accuracy in instrumentation, endoscopic techniques are beneficial in reducing collateral tissue damage and allowing patients a faster return to function. We describe a case where we combine a robotic guidance system with a full-endoscopic technique, the trans-superior articular process decompression. We aim to share our experience as well as an overview of the surgical technique.

Patients with degenerative lumbar spinal stenosis and double crush syndrome often require decompression of the nerve root at multiple levels. Traditional approaches are limited by the need for extensive bony resection and the risk of iatrogenic instability. The endoscopic contralateral approach offers a minimally invasive alternative, but has primarily been applied to single-level decompressions. This study evaluated the feasibility of an "extended" biportal endoscopic contralateral approach for 2-level decompression in a patient with double crush syndrome, detailing the surgical technique and outcomes. A 69-year-old female patient presented with bilateral leg pain and numbness attributed to severe stenosis at L4–5 and L5–S1. The patient underwent a single biportal endoscopic procedure utilizing an extended contralateral approach to decompress the L4–5 central canal, lateral recess, and the L5–S1 foramen. The technique involved careful planning of incision placement, sublaminar drilling, and decompression of the L5 nerve root across both levels. The second illustrative case is a patient with L4 double crush syndrome who was managed similarly. Postoperative imaging demonstrated successful decompression of the L4–5 central canal and L5–S1 foramen, with preservation of the L5 pars interarticularis. The patient experienced complete symptom resolution. The approach resulted in minimal soft tissue dissection and bony preservation, enhancing surgical efficiency. The extended biportal endoscopic contralateral approach effectively addresses double crush root syndrome through a single minimally invasive approach. This technique improves operating room efficiency, while still achieving good neural decompression without causing iatrogenic instability, and may be a viable surgical option for selected cases.

The introduction of endoscopic spine surgery has led to a paradigm shift in the treatment of spinal disorders. In particular, biportal endoscopic surgery has gained traction for its wider visual field and improved the maneuverability of instruments, familiar anatomy, and costeffectiveness. In this study, we describe our en bloc removal of the ligamentum flavum using a “butterfly” technique. This approach had several advantages: (1) The flavum serves as a protective barrier for the dura during drilling. (2) There is less epidural bleeding, which provides (3) better visualization. (4) In an inadvertent durotomy, this usually occurs later in the procedure, which is more manageable than the early stages of decompression. Biportal decompression for spinal stenosis can be performed using an en bloc ligamentum flavum removal technique that is safe, reproducible, and efficient. A systematic approach will help early adopters overcome the steep learning curve.

Single-position lateral interbody fusion surgery has gained traction over the years because of reduced surgical time and improved operating theater workflow. With the introduction of robotics in spine surgery, surgeons can place pedicle screws with a high degree of accuracy and efficiency; moreover, the robot allows us to localize the disk space and perform endplate preparation accurately with minimal radiation. In this study, we discuss the potential synergistic benefits of integrating robotic-assisted spine surgery and singleposition prone lateral surgery. We share our technique and provide the operative nuances of using the Mazor X Stealth Edition system (Medtronic, Minneapolis, MN, USA). We highlighted the potential synergistic benefits of integrating both the prone lateral and robotic-assisted surgical techniques, including the challenges encountered. This approach is not meant to replace other techniques or be used in all patients. Instead, it adds to our arsenal for managing spine fusion.