12.4. Bone Resection
@ProfFishchenkoThe extent of bone resection in BELIF/UBE-LIF includes complete removal of the inferior articular process of the cranial vertebra and resection of the superior articular process of the caudal vertebra, usually approximately half in the coronal plane.
We perform bone resection with an arthroscopic cutting burr or an orthopedic osteotome (chisel). While learning the technique, we recommend a 5 mm cutting burr, barrel-shaped or round. Osteotome use requires appropriate surgical experience.
We begin resection at the lamina and inferior articular process of the cranial vertebra. In my practice, I usually prepare a surface with the burr and perform the main resection with an osteotome. We collect bone fragments for use as autograft: the material from the removed articular processes is usually sufficient to fill the interbody cage.
After removing the inferior articular process, we visualize the articular surface of the superior articular process (SAP). To access the intervertebral disc using the described technique, resection of 5–8 mm from the medial SAP border is usually sufficient. If additional foraminal decompression is needed, we remove the SAP completely. For convenience, we resect the SAP in fragments.
After the necessary SAP resection, we must clearly visualize:
• the traversing nerve root;
• the exiting nerve root;
• the lateral portion of the intervertebral disc.
References
1. Heo DH, Hong YH, Lee DC, Chung HJ, Park CK. Technique of biportal endoscopic transforaminal lumbar interbody fusion. Neurospine. 2020;17(Suppl 1):S129–S137. DOI: 10.14245/ns.2040178.089.
2. Park HJ, Shin JI, You KH, Yang JI, Kim N, Kim YH, et al. Biportal endoscopic transforaminal lumbar interbody fusion: how to improve fusion rate? Int J Spine Surg. 2024;18(5):582–588. DOI: 10.14444/8648.
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