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KMID : 1148120170070020061
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Journal of Advanced Spine Surgery
2017 Volume.7 No. 2 p.61 ~ p.66
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Floating Technique for L5-S1 Foraminal Approach by Biportal Endoscopic Spine Surgery
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Choi Dae-Jung
Jung Je-Tea
Kim Yong-Sang
Jang Han-Jin
Yoo Bang
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Abstract
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The foramen of L5-S1 can develop several degenerative diseases such as extraforaminal lumbar disc herniation, foraminal stenosis with disc height collapse, degenerative or spondylolytic spondylolisthesis, and far-out syndrome. The floating technique in biportal endoscopic spine surgery (BESS) keeps a certain distance between instruments and spinal structures.1) This key point makes the floating technique different from conventional endoscopic surgery, which uses the Kambin’s safe triangle as a work zone. The floating view can enable the surgeon to see the structures panoramically, under high magnification: consequently, fine discrimination of their margin and safe manipulation of neural structures can be guaranteed. A certain gap between the floating scope and lesion can permit various instruments, generally used in open spine surgery, to be inserted from the sides with fewer limitations. Extraforaminal or foraminal lesions under the lamina can be reached by avoiding the iliac crest, and total facetectomy, which has the potential of iatrogenic instability, is not required to explore the foraminal structures. However, the floating view can be obstructed by small bleeds from laminectomized bone and/or surrounding vessels. This present article describes the technique and provides tips on how to perform BESS with floating technique safely and successfully for various lesions at the L5-S1 foramen.
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KEYWORD
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Stenosis, Lumbar, Spine surgery, Endoscopic, Floating technique
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