Unilateral Biportal Endoscopic Spine Surgery: Basic and Advanced Technique

✍ Scribed by Dong Hwa Heo; Cheol Woong Park; Sang Kyu Son; Jin Hwa Eum

• Publisher: Springer Nature
• Year: 2022
• Tongue: English
• Leaves: 225
• Category: Library

✦ Synopsis

Biportal endoscopic spine surgery has been rapidly developed recently, and Unilateral biportal endoscopic spine (UBE) surgery may be new stream in spine surgery. UBE surgery is a new concept of surgery that is different from the existing one portal endoscopic surgery, and has the advantage of being familiar with spinal surgeons as the surgical anatomy is similar to a general surgical method, and the learning curve period is short. The 4mm diameter endoscope provides a very clear image, and it can be safely operated under magnified and clear endoscopic view. It is also available to use general surgical instruments in addition to endoscopic surgical instruments during UBE approaches. Currently it is being performed not only in the lumbar spine, but also in the cervical and thoracic spine. In addition, simple laminectomy, disc removal, and spinal fusion are possible. With the advancement of UBE surgery, spinal surgeons from various countries have been performing UBE in recent years, and it is gradually spreading to the world. This will be the first book summarizing from basic to advanced techniques with abundant illustrations and video aid for easy understanding.

✦ Table of Contents

Preface
Preface
Unilateral Biportal Endoscopic Spine Surgery: A New Paradigm in Endoscopic Spine Surgery
Preface
Preface
Congratulatory Address
Publishing UBE Textbook
Acknowledgement
Contents
Part I: Introduction
1: A Brief History of Unilateral Biportal Endoscopic Spine Surgery
1.1 Introduction
1.2 History
1.2.1 Innovations and the Initiation of UBE Spine Surgeries
1.3 Brief UBE History in Korea
1.4 Future of UBE
References
2: The Basics and Concepts of Unilateral Biportal Endoscopy
2.1 All Endoscopic Procedures Require a Working Space
2.2 UBE Is Fluid-medium Surgery, Not Air-based
2.3 The General UBE System
2.4 UBE Should Be Performed with a Complete Understanding of the Eight Basic Concepts
References
3: Instruments and Settings of Unilateral Biportal Spinal Endoscopic Surgery
3.1 Introduction
3.1.1 Anesthesia and Position
3.1.2 UBE Instrument Settings
3.1.3 Startup Process After Initial Setting
Part II: Lumbar Disc Herniation
4: Unilateral Biportal Endoscopy for Herniated Lumbar Disc
4.1 Introduction
4.2 Indications and Contraindications
4.3 Special Instruments
4.4 Anesthesia and Positioning of the Patient
4.5 Surgical Steps
4.5.1 Skin Mark and Incision
4.5.2 Creation of Two Portals
4.5.3 Working Space Preparation
4.5.4 Laminectomy and Flavectomy (Video 4.2)
4.5.5 Discectomy (Video 4.2)
4.5.6 Drainage and Closure
4.6 Illustrated Cases
4.6.1 Case 1 (Left Side Axillar Approach, Video 4.3)
4.6.2 Case 2 (Left-sided Shoulder Approach, Video 4.4)
4.6.3 Case 3 (Left-sided Contralateral Approach to Right Foramen, Video 4.5)
4.7 Complications and Their Management
4.7.1 Bleeding
4.7.2 Traction Injury and Dural Tear
4.7.3 Learning Curve and Important Points
4.7.4 Surgical Tips and Pitfalls
References
5: Foraminal and Extraforaminal HNP (Paraspinal Approach)
5.1 Introduction
5.2 Indications and Contraindications
5.3 Special Instruments
5.4 Anesthesia and Positioning
5.5 Surgical Steps
5.6 Illustrated Cases
5.7 Management of Complications
5.8 Surgical Tips and Pitfalls
References
6: Unilateral Biportal Endoscopy Via Contralateral Sublaminar Approach for Surgical Management of Lumbar Disc Herniation
6.1 Introduction
6.2 Indications and Contraindications
6.3 Special Instruments
6.4 Anesthesia and Position
6.5 Surgical Steps
6.5.1 Creation of Two Channels
6.5.2 Bone Work
6.5.3 Removal of Ligamentum Flavum and Exposure of Nerve Root
6.5.4 Removal of Ruptured Disc Particles
6.5.5 Bleeding Control
6.6 Illustrated Cases
6.6.1 Case 1: Foraminal Up-migrated Disc (Fig. 6.7 and Video 6.1)
6.6.2 Case 2: Upper Lumbar Disc Herniation, Down Migration (Fig. 6.8 and Video 6.2)
6.6.3 Case 3. Dual Roots Decompression. Foraminal HNP with Lateral Recess Stenosis (Fig. 6.9 and Video 6.3)
6.7 Management of Complications
6.8 Surgical Tips and Pitfalls
References
7: Unilateral Biportal Endoscopy for Revision Lumbar Discectomy
7.1 Introduction
7.2 Indications and Contraindications
7.3 Anesthesia and Position
7.4 Surgical Steps
7.5 Illustrated Cases
7.6 Complications and Its Management
7.7 Surgical Tips and Pitfall
References
Part III: Lumbar Stenosis
8: Lumbar Stenosis: Central and Lateral Recess Stenosis
8.1 Introduction
8.2 Indications & Contraindications
8.2.1 Indications
8.2.2 Relative Contraindications
8.2.3 Contraindications
8.3 Surgical Instruments
8.4 Anesthesia & Positions
8.5 Surgical Steps
8.5.1 Skin Entry Points and Making Two Holes (Working and Endoscopic Port)
8.5.2 Soft-tissue Dissections
8.5.3 Ipsilateral Laminotomy and Decompression
8.5.4 Contralateral Sublaminar Decompression
8.5.5 Bleeding Control and Closure
8.6 Illustrated Cases
8.6.1 Case 2 Description: L4-5 Stenosis (Right Unilateral Laminotomy Bilateral Decompression) (Video 8.2)
8.6.2 Case 1 Description: L4-5 Stenosis (Left Unilateral Laminotomy Bilateral Decompression) (Video 8.3)
8.7 Complications: Prevention & Managements
8.7.1 Incidental Durotomy
8.7.2 Epidural Hematoma
8.7.3 Nerve Root Injury
8.8 Surgical Tips & Pitfalls
8.8.1 Exposure of Distal and Medial Portion of Superior Articular Process
8.8.2 Decompression: More Is Better
8.8.3 Release of Adhesion Between Ventral Dura and Epidural Small Ligaments
References
9: The Paraspinal Approach with Unilateral Biportal Endoscopy for Lumbar Foraminal Lesions
9.1 Introduction
9.2 Indications and Contraindications
9.2.1 Indications
9.2.2 Contraindications
9.3 Anesthesia and Position
9.4 Surgical Steps
9.4.1 [L1–5 Level]
9.4.1.1 Skin Marking and Incision
9.4.1.2 Foraminotomy/Discectomy (Video 9.1)
9.4.2 [L5–S1 Level]
9.4.2.1 Skin Marking and Incision
9.4.2.2 Foraminotomy/Discectomy (Video 9.2)
9.5 Illustrated Cases
9.5.1 Case 1: Paraspinal Foraminotomy at L3–4 Right Side Approach
9.5.2 Case 2: Paraspinal Discectomy with Resection of the SAP Tip at L3–4 Left
9.5.3 Case 3: Paraspinal Discectomy at L3–4 Left Side Approach
9.5.4 Case 4: Paraspinal Foraminotomy at L5–S1 Right Side Approach (Video 9.4)
9.6 Complications and Their Management
9.6.1 Bleeding
9.6.2 Dural Tear/Root Irritation
9.7 Surgical Tips and Pitfalls
References
10: Unilateral Biportal Endoscopy for Decompression of Foraminal (Extraforaminal) Stenosis Through the Contralateral Sublaminar Approach
10.1 Introduction
10.2 Indications and Contraindications
10.3 Special Instruments (See Detailed Figures in Chapters for Instruments)
10.4 Anesthesia and Position
10.5 Surgical Steps of Lumbar Contralateral Sublaminar Approach for Foraminal-Extraforaminal Lesions (Fig. 10.1)
10.6 Surgical Steps Left-sided Approach for Right-sided Contralateral Lesions
10.6.1 Making Two Portals
10.6.2 Contralateral Sublaminar Bony Decompression until the Medial Border of Foramen (Video 10.1 and Fig. 10.3)
10.6.3 Lateral Recess Decompression and Foraminal Decompression (Video 10.1, Fig. 10.3)
10.6.4 Extraforaminal Decompression and Opening the Far-out Area (Video 10.2, Fig. 10.4)
10.6.5 End-point and Final Confirmation of Complete Decompression (Video 10.2, Fig. 10.5)
10.7 Surgical Steps Right-sided Approach for Left-sided Contralateral Foraminal-Extraforaminal Lesions
10.7.1 Making Two Portals
10.7.2 Contralateral Sublaminar Bony Drilling and Foraminal-Extraforaminal Decompression (Video 10.3 and Fig. 10.7)
10.8 Illustrated Cases
10.9 Complications and Their Management
10.10 Surgical Tips and Pitfall
References
11: Far-out Syndrome Decompression Using Unilateral Biportal Endoscopy
11.1 Introduction
11.2 Indications and Contraindications
11.3 Special Instruments
11.4 Anesthesia and Position
11.5 Surgical Steps
11.6 Illustrated Case
11.6.1 Case 1 (Left Side Approach, Video 11.1)
11.6.2 Case 2 (Right Side Approach, Video 11.2)
11.7 Complications and Their Management
11.8 Surgical Tips, and Pitfall
References
Part IV: Lumbar Interbody Fusion
12: Lumbar Interbody Fusion by Unilateral Biportal Endoscopy
12.1 Introduction
12.2 Indications and Contraindications
12.3 Special Instruments
12.4 Anesthesia and Position
12.5 Surgical Steps
12.5.1 Skin Marking and Making Portal
12.5.2 Initial Working Space and Bone Working (Fig. 12.3 and Video 12.1)
12.5.3 Partial Removal of Superior Articular Process and Identification of Disc Space (Fig. 12.5 and Video 12.2)
12.5.4 Annulotomy and Endplate Preparation (Fig. 12.6 and Video 12.2)
12.5.5 Bone Grafting and Cage Insertion (Fig. 12.7 and Video 12.3)
12.5.6 Completion of Central and Foraminal Decompression (Fig. 12.8 and Video 12.3)
12.5.7 Insertion of Postoperative Drainage and Percutaneous Pedicle Screw Fixation
12.5.8 Postoperative Care
12.6 Illustrated Cases
12.6.1 Case 1 (Fig. 12.9)
12.6.2 Case 2 (Fig. 12.10)
12.7 Complications and Management
12.7.1 Dural Tear
12.7.2 Postoperative Hematoma
12.7.3 Fluid-Induced Complications
12.7.4 Cage Subsidence/Retropulsion
12.7.5 Neural Injury
12.8 Surgical Tips and Pitfalls
References
13: Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion, Modified Techniques
13.1 Introduction
13.2 Indications and Contraindications
13.3 Special Instruments
13.4 Anesthesia and Position
13.5 Surgical Steps
13.5.1 Modified Far-lateral TLIF Using UBE (Extreme Lateral TLIF, Video 13.1)
13.5.2 Modified UBE TLIF Two-cage Insertion Technique (Video 13.2)
13.6 Case Reports
13.7 Complications and Management
13.8 Surgical Tips and Pitfalls
13.8.1 Modified Far-lateral UBE TLIF (Extreme Lateral UBE TLIF)
13.8.2 Two-cage Insertion Technique
References
14: Lumbar Interbody Fusion Extension for Symptomatic Adjacent Segment Disease by Unilateral Biportal Endoscopic Approach
14.1 Introduction
14.2 Indication and Contraindication
14.3 Anesthesia and Positions
14.4 Special Preparations Before Surgery
14.5 Surgical Steps in Cases of L4-5 Interbody Fusion with Rod Extension at L4-L5-S1
14.5.1 Interbody Cage Insertion for ASD
14.5.2 Previously Inserted “Set Pedicle Screws” Removal
14.5.3 Previously Inserted “Rods” Removal
14.5.4 Previously Inserted “Pedicle Screws” Removal
14.5.5 Insert New Pedicle Screws and Rods Using Percutaneous Pedicle Screw Systems
14.6 Complications and Management
14.7 Illustrated Cases
14.8 Discussion
References
15: Hybrid Surgery Combining Unilateral Biportal Endoscopy and Lateral Lumbar Interbody Fusion
15.1 Introduction
15.2 Indications and Contraindications
15.3 Anesthesia and Position
15.4 Surgical Steps: LLIF
15.5 Surgical Steps: UBE and Percutaneous Pedicle Screw Fixation
15.6 Illustrated Cases
15.6.1 Case 1: LLIF + UBE Decompressive Laminectomy for Adult Scoliosis with Multilevel Spinal Stenosis
15.6.2 Case 2: LLIF + UBE Foraminotomy for Osteoporotic Vertebral Collapse with Far-lateral Ruptured HNP
15.7 Complications and Their Management
15.8 Surgical Tips and Pitfalls
References
Part V: Cervical and Thoracic Lesion
16: Cervical Posterior: Foraminotomy and Discectomy
16.1 Introduction
16.2 Indications and Contraindications
16.3 Equipment
16.4 Anesthesia and Position
16.5 Surgical Steps
16.6 Posterior Cervical Foraminotomy (Videos 16.1, 16.2, and 16.3)
16.6.1 Skin Marking and Incision
16.6.2 Laminectomy and Flavectomy
16.6.3 Nerve Root Decompression
16.7 Posterior Cervical Inclinatory Foraminotomy (Videos 16.4 and 16.5)
16.7.1 Skin Marking and Incision
16.7.2 Foraminotomy and Flavectomy
16.7.3 Discectomy
16.8 Illustrated Cases
16.8.1 Case 1: PCF C5–6 Right
16.8.2 Case 2: PCIF C3–4, C4–5 Right
16.8.3 Case 3: PCIF C5–6 Left
16.9 Complications and Their Management
16.9.1 Bleeding
16.9.2 Dura Tear
16.10 Surgical Tips and Pitfalls
References
17: Unilateral Biportal Endoscopy for Cervical Decompressive Laminectomy
17.1 Introduction
17.2 Indications and Contraindications
17.3 Special Instruments (See Detailed Figures in Chapters for Instruments)
17.4 Anesthesia and Position
17.5 Surgical Steps of Laminectomy with Bilateral Decompression (Video 17.1)
17.5.1 Making Two Portals
17.5.2 Soft Tissue Dissection and Expose the Targeted Lamina and Interlaminar Area
17.5.3 Ipsilateral Hemilaminectomy and Contralateral Sublaminar Bony Drilling
17.5.4 Partial Laminotomy to Detach the LF from the Adjacent Laminas
17.5.5 Neural Decompression
17.6 Surgical Steps of Unilateral Laminotomy with Bilateral Decompression (Video 17.2)
17.6.1 Midline Bony Drilling and Expose the Bilateral Interlaminar Area
17.6.2 Partial Laminotomy along the Superior and Inferior Border of the Interlaminar Area
17.6.3 Neural Decompression
17.7 Illustrated Cases
17.8 Complications and Their Management
17.9 Surgical Tips and Pitfall
References
18: Thoracic Unilateral Laminetomy for Bilateral Decompression by Unilateral Biportal Endoscopy
18.1 Introduction
18.2 Indications and Contraindications
18.3 Special Instruments
18.4 Anesthesia and Position
18.5 Surgical Steps
18.5.1 Skin Marking and Making Portal
18.5.2 Bone Working (Video 18.1)
18.5.3 Removal of LF (Video 18.2)
18.5.4 Removal of OLF (If Present) (Videos 18.3 and 18.4)
18.5.5 Postoperative Drain
18.5.6 Postoperative Care
18.6 Illustrated Cases
18.6.1 Case (1): Thoracic Spinal Stenosis
18.6.2 Case (2): OLF
18.7 Complications and Their Management
18.7.1 Dural Tear (Video 18.5)
18.7.2 Cord Injury
18.7.3 Postoperative Hematoma
18.8 Surgical Tips and Pitfall
References