371 - Endoscopic Approaches and Applications for Lumbar Spinal Procedures

Abstract

Full-endoscopic spine surgery has gained popularity during the past decade given its minimal approach-related morbidities and favorable patient outcomes. Full-endoscopic spine surgery is carried out via a working channel endoscope and requires generation of an artificial working space assisted by a tubular retractor. Recent advances in surgical tools, high-speed drills, and radiofrequency technology allow for safe dissection of tissue planes and decompression of neural elements. Given the minimal exposure during full-endoscopic spine surgery, intraoperative-efficient progression relies on radiographic imaging, palpation, and visualization of anatomic target areas, which are defined for all procedures. Intraoperative identification of neural structures is aided by bony principal anatomic landmarks. Transforaminal access utilizes the intervertebral foramina caudal to the exiting nerve root as the surgical corridor. Interlaminar approaches are comparable to traditional posterior surgical approaches and utilize the space between the laminae. With the help of several modifications of transforaminal and interlaminar techniques, full-endoscopic spine surgery allows the surgeon to address the vast majority of degenerative pathology. However, the use of traditional surgery should always be considered, particularly in cases of moderate to severe deformity or instability.