Objective: Cervical foraminotomy is a critical surgical intervention for addressing foraminal stenosis. Traditional magnetic resonance imaging may be insufficient for diagnosing transcanal stenosis. This lacuna is efficiently solved by using 2-dimensional sagittal-oblique multiplanar reconstruction computed tomography (CT) scans (2D-SOMPR). Standard medial facetectomy is insufficient if pathology extends to the outer foramen. This study investigates a combined approach, utilizing unilateral biportal endoscopy with CT scan-aided imaging, to achieve decompression in complex foraminal stenosis. Methods: A cohort of 23 patients with severe transcanal foraminal stenosis underwent the combined foraminotomy technique. Thirteen patients received single-level decompression, while 4 underwent multilevel procedures. Three patients with bilateral root involvement underwent hemilaminectomy for cervical myelopathy. Results: All patients reported complete neurological symptom relief at a mean follow-up of 12 months. Visual analogue scale and Neck Disability Index scores showed significant improvements, with 22 patients achieving excellent outcomes. Minor transient irritation of the exiting nerve root was observed in 8 patients, resolving within 8 weeks. One patient with preoperative C5–6–7 root palsy experienced partial recovery. No permanent neurological deficits, infections, or surgical complications were noted. Conclusion The combined standard and inclinatory foraminotomy approach is a safe and effective solution for complex cervical foraminal stenosis. This technique ensures complete neural decompression while preserving facet joint function.

Objective: The management of hidden zone lumbar disc herniation has been considered technically challenging due to its difficult surgical exposure. Paraspinal unilateral biportal endoscopy (UBE) is a minimally invasive surgical procedure that has recently gained popularity and has several advantages. Therefore, the authors describe their novel technique of paraspinal UBE for the treatment of upmigrated lumbar disc herniations in the hidden zone of MacNab and present clinical outcomes. Methods: Twelve patients underwent paraspinal UBE to retrieve the upmigrated disc herniation from under the axilla of the exiting nerve root. The operation duration, blood loss, complications, and recurrences were recorded. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores. Patient satisfaction was evaluated using the modified MacNab criteria. Results: After a mean follow-up period of 12.9 months, all patients experienced complete relief from neurological symptoms. VAS and ODI scores significantly improved at the final follow-up. According to the modified MacNab criteria, 11 patients achieved an excellent outcome, while one patient had a good outcome due to transient exiting nerve root irritation that resolved with medication after 8 weeks. No major complications were noted. Conclusion The paraspinal UBE procedure ensures adequate visualization and removal of the herniated disc with minimal bony resection. In conclusion, paraspinal UBE is a safe and effective surgical procedure for managing disc herniations in the hidden zone of MacNab, particularly at higher lumbar levels.

Methods: Twenty-four patients with AIS (Cobb >65°) underwent surgery at a single center between January 2014 and December 2021. The first 10 patients underwent surgery using only IOT (T group), whereas the subsequent 14 patients underwent surgery with a combination of IOT and PO (TP group). Results: The mean preoperative Cobb angles in the T and TP groups were 89.35°±6.05° and 92.32°±9.28°, respectively (p=0.59). The mean flexibility index (FI) of the T and TP groups were 0.31±0.016 and 0.36±0.03, respectively (p=0.41). The mean postoperative Cobb angle in the T and TP groups were 40.25°±5.95° and 19.1°±3.20°, respectively (p=0.041). Apical vertebral rotation improved from mean grade 3.2 (2–4) to grade 2.6 (1–3) in the T group and from mean grade 3.6 (2–4) to mean grade 1.8 (1–3) in the TP group. Postoperatively, the mean thoracic kyphosis was 13.84°±2.10° and 21.02°±1.68° in T and TP groups (p=0.044). Transient signal-loss intraoperatively was noted in two patients, one in each group. No episodes of postoperative neurological deficits were reported. No incidences of pseudarthrosis/implant-related complications were reported at the end of 2 years in either group. Conclusions IOT and PO complement one another and can be safely combined without an attributable risk of neurological injury.

Methods: Twenty-four patients with AIS (Cobb >65°) underwent surgery at a single center between January 2014 and December 2021. The first 10 patients underwent surgery using only IOT (T group), whereas the subsequent 14 patients underwent surgery with a combination of IOT and PO (TP group). Results: The mean preoperative Cobb angles in the T and TP groups were 89.35°±6.05° and 92.32°±9.28°, respectively (p=0.59). The mean flexibility index (FI) of the T and TP groups were 0.31±0.016 and 0.36±0.03, respectively (p=0.41). The mean postoperative Cobb angle in the T and TP groups were 40.25°±5.95° and 19.1°±3.20°, respectively (p=0.041). Apical vertebral rotation improved from mean grade 3.2 (2–4) to grade 2.6 (1–3) in the T group and from mean grade 3.6 (2–4) to mean grade 1.8 (1–3) in the TP group. Postoperatively, the mean thoracic kyphosis was 13.84°±2.10° and 21.02°±1.68° in T and TP groups (p=0.044). Transient signal-loss intraoperatively was noted in two patients, one in each group. No episodes of postoperative neurological deficits were reported. No incidences of pseudarthrosis/implant-related complications were reported at the end of 2 years in either group. Conclusions IOT and PO complement one another and can be safely combined without an attributable risk of neurological injury.

Methods: Twenty-four patients with AIS (Cobb >65°) underwent surgery at a single center between January 2014 and December 2021. The first 10 patients underwent surgery using only IOT (T group), whereas the subsequent 14 patients underwent surgery with a combination of IOT and PO (TP group). Results: The mean preoperative Cobb angles in the T and TP groups were 89.35°±6.05° and 92.32°±9.28°, respectively (p=0.59). The mean flexibility index (FI) of the T and TP groups were 0.31±0.016 and 0.36±0.03, respectively (p=0.41). The mean postoperative Cobb angle in the T and TP groups were 40.25°±5.95° and 19.1°±3.20°, respectively (p=0.041). Apical vertebral rotation improved from mean grade 3.2 (2–4) to grade 2.6 (1–3) in the T group and from mean grade 3.6 (2–4) to mean grade 1.8 (1–3) in the TP group. Postoperatively, the mean thoracic kyphosis was 13.84°±2.10° and 21.02°±1.68° in T and TP groups (p=0.044). Transient signal-loss intraoperatively was noted in two patients, one in each group. No episodes of postoperative neurological deficits were reported. No incidences of pseudarthrosis/implant-related complications were reported at the end of 2 years in either group. Conclusions IOT and PO complement one another and can be safely combined without an attributable risk of neurological injury.