Minimally Invasive Spine Surgery Research Articles

“New Beginning of JMISST as an International Journal with MISSAB” and the First Publication of the “Special Issues Section”

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Full-endoscopic Trans-Kambin’s Triangle Lumbar Interbody Fusion: Technique and Review of Literature

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Expanded Indications of Full Endoscopic Spine Sugery

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Current Status of Biportal Endoscopic Decompression for Lumbar Central Stenosis

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Learning Curve of Minimally Invasive C1-C2 Trans-articular Screw Fixation (MIS-TAS): Over A Period of Five Years

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Anatomical Importance of Inner Ligamentum Flavum Parameters for Successful Endoscopic Lumbar Decompression Surgery

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

Recent Trends and Changes in the Endoscopic Spinal Surgery

Recent Trends and Changes in the Endoscopic Spinal Surgery

Diagnosis, treatment and etiology analysis of nerve compression by bone fragment after lumbar spine surgery

To explore the diagnosis, treatment, cause and prevention of nerve compression by bone fragment after lumbar spine surgery. The clinical data of 23 patients with nerve compression by bone fragment after lumbar spine surgery from February 2012 to March 2019 were collected retrospectively, including 9 males and 14 females, aged 42 to 81 years with an average of (62.60±5.70) years. The surgical methods included lumbar interbody fusion in 20 cases and spinal endoscopy in 3 cases. All 23 patients experienced radiating pain on the decompression side or the contralateral limb after operation. The time of occurrence was from immediately after operation to 2 weeks after operation, with an average of (3.2±1.7) days. All patients underwent postoperative examination of lumbar spine CT or MRI to confirm residual ectopic bone fragments, and at the same time, bilateral lower extremity color Doppler ultrasound excluded thrombosis. Sources of ectopic bone fragments:14 cases of residual bone fragments caused by intervertebral fusion bone graft loss or fenestration fusion, 6 cases of fractured upper articular process head, and 3 cases of upper articular process bone remaining during spinal endoscopic surgery. The patient's hospital stay was 10 to 37 (23.4±6.2) days. All patients were followed up for 6 to 25 (13.6±3.4) months. Three patients underwent posterior open nerve root exploration for removing bone fragments on the same day or the second day after surgery, and the symptoms were relieved. Twenty patients underwent conservative treatment firstly, and 13 patients were discharged after pain relieved by conservative treatment, 7 patients failed conservative treatment, the 2 cases of failed 7 cases had undergone nerve root block surgery during conservative treatment. Two patients underwent spinal endoscopy nerve root exploration and bone mass removal, and five patients underwent posterior open nerve root exploration and bone fragmentation removal. All postoperative pain symptoms were relieved. Preoperative CT, MRI and intraoperative bone fragment removal confirmed the shape and location of the bone fragments. The most likely source of bone fragments was the loss of intervertebral fusion bone grafts or residual bone fragments resulting from fenestration fusion (14 cases), fractured upper articular process head (6 cases), and upper articular process bones remaining in endoscopic surgery (3 cases). According to the Macnab criteria in evaluating clinical outcome, 20 cases got excellent results and 3 good. After the lumbar spine surgery, the nerve compression by bone fragments is treated with appropriate treatments, and good clinical results can be obtained. Timely removal of residual bone fragments during operation and careful exploration of nerve roots before closing incision can avoid such complications.

Comparison of Minimally Invasive Total versus Subtotal Resection of Spinal Tumors: A Systematic Review and Meta-Analysis

With the advent of minimally invasive techniques, minimally invasive spine surgery (MISS) has become a realistic option for many spine cases. This study aims to evaluate the operative and clinical outcomes of MISS for total versus subtotal tumor resection from current evidence. A literature search was performed using the search term (Minimally invasive surgery OR MIS) AND (spine tumor OR spinal tumor). Studies including both minimally invasive total and subtotal resection cases with operative or clinical data were included. Seven studies describing 159 spinal tumor cases were included. Compared with total resection, subtotal resection showed no significant differences in surgical time (mean difference (MD), 9.44 minutes; 95% confidence interval [CI], -47.66 to 66.55 minutes; P= 0.37), surgical blood loss (MD, -84.72 mL; 95% CI, -342.82 to 173.39 mL; P= 0.34), length of stay (MD, 1.38 days; 95% CI, -0.95 to 3.71 days; P= 0.17), and complication rate (odds ratio, 9.47; 95% CI, 0.34-263.56; P= 0.12). Pooled analyses with the random-effects model showed that neurologic function improved in 89% of patients undergoing total resection, whereas neurologic function improved in 61% of patients undergoing subtotal resection. Our analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Patients undergoing total resection showed slightly better improvement in neurologic outcomes compared with patients undergoing subtotal resection. Overall, this study suggests that both total and subtotal resection may result in comparable outcomes for patients with spinal tumors. However, maximal safe resection remains the ideal treatment because it provides the greatest chance of long-term benefit.

Automatic tip detection of surgical instruments in biportal endoscopic spine surgery

BackgroundRecent advances in robotics and deep learning can be used in endoscopic surgeries and can provide numerous advantages by freeing one of the surgeon's hands. This study aims to automatically detect the tip of the instrument, localize a point, and evaluate the detection accuracy in biportal endoscopic spine surgery (BESS). The tip detection could serve as a preliminary study for the development of vision intelligence in robotic endoscopy. MethodsThe dataset contains 2310 frames from 9 BESS videos with x and y coordinates of the tip annotated by an expert. We trained two state-of-the-art detectors, RetinaNet and YOLOv2, with bounding boxes centered around the tip annotations with specific margin sizes to determine the optimal margin size for detecting the tip of the instrument and localizing the point. We calculated the recall, precision, and F1-score with a fixed box size for both ground truth tip coordinates and predicted midpoints to compare the performance of the models trained with different margin size bounding boxes. ResultsFor RetinaNet, a margin size of 150 pixels was optimal with a recall of 1.000, precision of 0.733, and F1-score of 0.846. For YOLOv2, a margin size of 150 pixels was optimal with a recall of 0.864, precision of 0.808, F1-score of 0.835. Also, the optimal margin size of 150 pixels of RetinaNet was used to cross-validate its overall robustness. The resulting mean recall, precision, and F1-score were 1.000 ± 0.000, 0.767 ± 0.033, and 0.868 ± 0.022, respectively. ConclusionsIn this study, we evaluated an automatic tip detection method for surgical instruments in endoscopic surgery, compared two state-of-the-art detection algorithms, RetinaNet and YOLOv2, and validated the robustness with cross-validation. This method can be applied in different types of endoscopy tip detection.

Incorporation of MISS in Routine Spine Practice

Traditional open spine surgery is the gold standard procedure in spine practice. Minimally invasive spine surgery (MISS) since last two decades have tremendously improved in technique and technology improving the clinical and functional outcomes of the surgery and patients. But still MISS has steep learning curve, many challenges and hurdles to inculcate it in the routine spine practice of the surgeon who may be either a novice or even an established in spine practice. The author has tried to identify the hurdles in incorporating MISS in routine spine practice and suggested methods to overcome these hurdles to incorporate MISS in routine clinical practice. Keywords: Minimally Invasive Spine Surgery (MISS); Spine practice; Spine Surgeon.

Therapeutic effects of full endoscopic spine surgery via transforaminal approach in elderly patients with lumbar spinal stenosis: A retrospective clinical study.

This study aimed to investigate the therapeutic effects of full endoscopic spine surgery on clinical and radiological outcomes in elderly patients over 70 years with lumbar spinal stenosis, without any obvious segmental instability. A total of 47 patients (27 males, 20 females; the mean age=74.23±5.16) above 70 years who underwent a transforaminal percutaneous endoscopic decompression with the diagnosis of lumbar spinal stenosis, were included in this retrospective study. The mean follow-up was 26±2.97 months. The clinical efficacy of the surgical procedure was assessed by the Oswestry disability index (ODI) and the visual analog scale (VAS) of the leg and lower back at 1 week, 3 months, and 1 year postoperatively, and at the final follow-up examination. Modified MacNab criteria was also performed to assess the clinical efficiency of surgery at the final follow-up. An excellent outcome as per modified MacNab criteria was obtained in 9 patients (19.1%), a good outcome in 33 patients (70.2%), a fair outcome in 3 patients (6.4%), and poor results in 2 patients (4.3%). The mean ODI score significantly improved from 71.29±5.69 preoperatively to 32.05±10.71 at postoperative 1 week, 30.27±9.89 at 3 months, 27.23±8.47 at 1 year, and 23.11±9.97 at the final follow-up (p<0.05 for each evaluation point). The mean VAS score of the leg and lower back significantly decreased from 6.10±0.96 and 5.71±1.13 preoperatively to 1.69±0.96, 2.24±1.01 at postoperative 1 week, 1.69±0.84, 2.45±0.87 at 3 months, 1.71±0.81, 2.38±0.79 at 1 year, and 1.71±0.92, 2.48±0.67 at the final follow-up, respectively (p<0.05 for each evaluation term). Postoperative computed tomography or magnetic resonance imaging showed adequate decompression of the central or lateral recess and removal of combined herniated discs. The results of our preliminary study have demonstrated that full endoscopic spine surgery is a safe and efficient technique for the therapy of neurogenic claudication and radiculopathy in elderly patients with lumbar spinal stenosis. Level IV, Therapeutic Study.

Percutaneous carbon-PEEK instrumentation for spine tumors: a prospective observational study.

Minimally invasive spine surgery (MISS) has been progressively accepted as a useful approach for spine tumors. Recently released carbon-PEEK implants have been already reported as effective in open surgeries for spine tumors. This study aimed to evaluate the feasibility, surgical, clinical and radiological outcomes of a new percutaneous carbon-PEEK instrumentations for spine tumors. This is a prospective case-control observational study. Demographical, clinical, surgical, and radiological data were collected from May 2018 to August 2019. Visual Analogue Scale for back pain (VAS), the Oswestry Disability Index (ODI) Questionnaire, EORTC QLQ-C30 questionnaire for quality of life, and ASIA Impairment Scale (AIS) were collected before surgery and at 6 weeks and follow-up (FU) visits. Data were compared with the control group, a retrospective series of 23 metastatic patients that underwent titanium pedicle screw fixation. Twenty-one patients met inclusion criteria. Mean age was 59.2 years (range, 35-78) and mean FU was 14.2 months (7-22). Thoracic spine was involved in 14 (66.7%) cases, lumbar spine in 7 (33.3%). The mean length of surgery was 75 (42-185) minutes, mean blood loss was 90ml (50-215) and every patient was mobilized within 24 hours after surgery. The VAS (8.3±1.1 to 2.9±1.0, P<0.05) and ODI (54.6±11.7 to 25.1±5.4, P<0.05) scores significantly improved over follow-up. AIS improved in 7 (33.3%) patients and remained unchanged in 14 (66.7%). The EORTC QLQ-C30 global health/QoL, functional and symptomatic scales significantly improved postoperatively and at the last follow-up. Only two minor complications (9.5%) were recorded. No statistically significant difference was observed between the two groups related to clinical, radiological outcomes, complications rate and implant failure. Percutaneous Carbon/PEEK implants could be considered as alternative to standard titanium implants in oncological patients, according to their lower rate of MRI artifacts, facilitating radiological FU and adjuvant radiotherapy. Further clinical trials and biomechanical evaluations are needed to confirm our preliminary results.

Minimally Invasive Cross-link: A Cadaveric Feasibility Study with a Working Prototype

Spinal fusion involving posterior instrumentation with rods and pedicle screws has been common surgical practice for many years. Traditionally, a cross-link connecting the vertical rods can be added to the construct to increase stability in multiple planes of motion. More recently however, minimally invasive spine surgery (MISS) techniques have gained traction without accompanying technology or methodology to place a cross-link. Herein we describe a novel technique of placing a cross-link percutaneously, accommodating both open and minimally invasive spine fixation.

Результаты трансфораминального эндоскопического удаления грыжи диска пояснично- крестцового отдела позвоночника, дополненного нуклеопластикой

Introduction Herniated disks are very common. Percutaneous endoscopic lumbar spine surgery for the lumbar disc herniation facilitates minimalized access ports to the operating site with decreased risk of infection, reduced blood loss and less tissue dissection and muscle trauma. The goal was to compare the results of standard transforaminal endoscopic discectomy for lumbosacral herniation and outcomes of the procedure added by nucleoplasty. Material and methods Percutaneous transforaminal endoscopic discectomy was performed for 92 patients and added by nucleoplasty in 43 patients of group I. Preoperative and postoperative evaluation was produced with the Visual Analog Pain Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire (ODI) and the MacNab clinical outcome score. Complication and recurrence rate was reviewed. Microsoft Office Excell and Statistica 8.0 were used to complete data analysis reports. Results VAS scores decreased from 7.9 to 3.1 showing 2.5-fold decrease (p &lt; 0.05), and ODI scores decreased from 71.09 to 18.58) (p &lt; 0.001) demonstrating fourfold decrease at one-year follow-up. There were no significant differences in VAS and ODI scores between the groups preoperatively and postoperatively (p &gt; 0.05). The majority of patients of group I (41.86 %) rated their health status as excellent on the MacNab scale, and the majority of patients of group II (53.06 %) rated their health status as good. Postoperative complication rate was 11.63% in group I and 12.24% in group II (p &gt; 0.05). There was no recurrence in group I with the recurrence rate of 6.1% (p &lt; 0.001) in group II. Conclusion Endoscopic discectomy for lumbosacral herniation supplemented with nucleoplasty can reduce the recurrence rate.

Comparison of endoscopic spine surgery and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar disease: A meta-analysis

This study aimed to compare the clinical outcomes of endoscopic spinal surgery (ESS) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar disease (DLD) through meta-analysis. The Medline (via PubMed), Cochrane, Scopus, and Embase databases were searched for studies that evaluated the outcomes of ESS and MIS-TLIF in DLD, including visual analog scale (VAS) score for low back pain, VAS score for leg pain, Oswestry Disability Index (ODI), and complications published between January 2000 and August 2020. Two authors extracted the data independently. Any discrepancies were resolved by a consensus. Four comparative studies were identified. No significant differences were found between the ESS and MIS-TLIF groups in terms of VAS score for back pain, VAS score for leg pain, and ODI, except for complication rate. The complication rate was higher in the ESS than in the MIS-TLIF group. A literature review identified four comparative studies reporting the clinical outcomes of ESS and MIS-TLIF for DLD. Despite the heterogeneity, a limited number of meta-analyses showed that the clinical outcomes between the two groups were not significantly different except for complication rate. Hence, further large-scale multicenter studies are required to validate our results.

Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery.

Biportal endoscopic spine surgery (BESS) is extending its application to most kind of spine surgeries. Postoperative spinal epidural hematoma (POSEH) is one of the major concerns of this emerging technique. Through this study we aim to investigate the incidence of POSEH in BESS comparing to a conventional spine surgery (CSS).The patients who underwent a non-fusion decompressive spine surgery due to degenerative lumbar spinal stenosis (LSS) or herniated lumbar disc (HLD) or both between January 2015 and March 2019 were reviewed retrospectively. The incidence of clinical POSEH that demanded a revision surgery for hematoma evacuation was compared between CSS and BESS. As a second endpoint, the morphometric degree of POSEH was compared between the two groups. The maximal compression of cauda equina by POSEH was measured by 4 grade scale at the T2 axial image and the neurological state was evaluated by 5 grade scale. The indication of hematoma evacuation was more than hG3 with more than nG1. As a subgroup analysis, risk factors of POSEH in BESS were investigated.The 2 groups were homogenous in age, sex, number and level of operated segments. There was significant difference in the incidence of symptomatic POSEH as 2/142 (1.4%) in CSS and 8/95 (8.4%) in BESS (P = .016). The radiological thecal sac compression by hematoma was hG1 65 (61.3%), hG2 35 (33.0%), hG3 5 (4.7%), hG4 1 (0.9%) cases in CSS and hG1 33 (39.8%), hG2 25 (30.1%), hG3 22 (26.5%), hG4 3 cases (3.6%) in BESS. The difference was significant (P < .001). In BESS subgroup analysis, the risk factor of high grade POSEH was bilateral laminectomy (OR = 8.893, P = .023).The incidence of clinical and morphometric POSEH was higher in BESS. In BESS, POSEH developed more frequently in bilateral laminectomy than unilateral laminectomy.

Water Dynamics in Unilateral Biportal Endoscopic Spine Surgery and Its Related Factors: An In Vivo Proportional Regression and Proficiency-Matched Study

Stable water dynamics during endoscopic spine surgery improves the surgeon's comfort and patient's outcomes. We aimed to measure the water dynamics during spinal surgery and identify the factors that facilitate stable water dynamics. This open-label, prospective, proficiency-matched, invivo study included patients with single-level degenerative spinal disease. After assessing their heights and balancing the matched instrument, we measured the irrigation fluid pressure in various situations. We performed multiple regression analysis based on odds ratio(OR), confidence interval (CI), and relationships (proficiency-matched) with possible instrumental and physical characteristics. The instrumental factors were the presence and length of a rigid cannulation, and the physical characteristics were body mass index (body mass index [BMI]), skin-to-dura depth, height (interaction with BMI), and body weight (interaction with BMI). Of the 36 patients, 29 were included. The mean pressure of the operation cavity was 16.66 ± 9.12 cm H2O (12.25 ± 6.71 mm Hg). Water pressure with the rigid cannulation (9.41 ± 2.94 cm H2O [6.92 ± 2.16 mm Hg]) was significantly lower than that without cannulation (23.43 ± 7.57 cm H2O [17.26 ± 5.57 mm Hg], P < 0.01). Water pressure correlated with cannular length (OR=-1.08, CI=-1.79,-0.37, P < 0.01) and BMI (OR= 0.56, CI= 0.12, 0.99, P < 0.01). BMI showed a proportional relationship (r=0.84, P < 0.01). During biportal endoscopy, we suggest maintaining water pressure between 4.41 cm H2O (2.41 mm Hg) and 31.00 cm H2O (22.83 mm Hg). Compared to physical characteristics, placement of the cannula and appropriate cannula length are important factors that affect water dynamics.

Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis.

Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6±3.4 and 7.5±2.3 to 1.8±1.3 and 1.8±1.6, respectively (P<.001). The mean Oswestry Disability Index improved from 59.9±21.2 preoperatively to 18.2±8.5 postoperatively (P<.001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.

Early Outcomes: A Comparison between Biportal Endoscopic Spine Surgery and Open Lumbar Discectomy for Single-Level Lumbar Disc Herniation

Objective: To compare early outcomes between biportal endoscopic spine surgery (BESS) and open lumbar discectomy (OLD) for treating single-level lumbar disc herniation. Materials and Methods: A retrospective cohort study was conducted in 80 cases of single-level lumbar disc herniation that underwent either BESS or OLD. The author compared the perioperative data between BESS and OLD, including operative time (OT), level, side, estimated blood loss (EBL), surgical drain output, hospital stay (HS), hospital costs, visual analogue scale (VAS) scores, morphine consumption, complication, and McNab’s satisfaction outcome. Results: Forty-three patients underwent BESS and 37 underwent OLD. There was 55% female and 45% male. The mean age was 37.8±9.5 years. The BESS group showed significantly (a) lower median morphine consumption than the OLD group (five mg versus nine mg, p&lt;0.001), (b) lower postoperative pain (VAS) at 2-, 4-, 12-, 24-, 48- (p&lt;0.001), and 72-hours post-surgery (p=0.017), and (c) shorter HS (4.8±2.9 days versus 7.4±4.6 days, p=0.003). McNab’s satisfaction outcome of a good or excellent result was comparable between BESS and OLD group (97.7% versus 86.5%, p=0.090). The BESS group, however, had a longer OT than the OLD group (100.4±28.5 versus 67.9±23.2 minutes, p&lt;0.001), and had a higher hospital cost (1,256±360.9 USD versus 910.6±269.8 USD, p&lt;0.001). Complications were not significantly different between the BESS and OLD groups. Conclusion: BESS for single-level lumbar discectomy had less postoperative pain for up to 72 hours, less opioid consumption, and shorter HS, but longer OT and higher hospital costs than OLD. Patient satisfaction outcomes were comparable between the two groups. Keywords: Biportal endoscopic spine surgery, Unilateral biportal endoscopic discectomy, Open lumbar discectomy, Single-level lumbar disc herniation