13.1. Indications and contraindications
@ProfFishchenkoIndications
We use posterior biportal endoscopic foraminotomy with discectomy for lateral, foraminal, and selected paramedian herniations when nerve root compression corresponds to the clinical presentation and the fragment is accessible without spinal cord retraction.
When these conditions are met, we consider protrusions, extrusions, and sequestered herniations.
• Cranially and caudally migrated herniations — when the fragment is accessible without spinal cord retraction.
• Lateral or foraminal location; selected paramedian herniations — according to the criteria above.
• Recurrent intervertebral disc herniations.
• Calcified or ossified herniations — with assessment of the feasibility of safe access.
Contraindications
• General contraindications to the planned type of anesthesia.
• Central herniations requiring spinal cord decompression.
Segmental instability requiring stabilization and deformity requiring correction also need a different surgical strategy.
References
1. Broekema AEH, Simões de Souza NF, Soer R, Koopmans J, van Santbrink H, Arts MP, et al; FACET investigators. Noninferiority of posterior cervical foraminotomy vs anterior cervical discectomy with fusion for procedural success and reduction in arm pain among patients with cervical radiculopathy at 1 year: the FACET randomized clinical trial. JAMA Neurol. 2023;80(1):40–48. DOI: 10.1001/jamaneurol.2022.4208.
2. Jung SB, Kim N. Biportal endoscopic spine surgery for cervical disk herniation: a technical notes and preliminary report. Medicine (Baltimore). 2022;101(27):e29751. DOI: 10.1097/MD.0000000000029751.
3. Kang MS, You KH, Han SY, Park SM, Choi JY, Park HJ. Percutaneous full-endoscopic versus biportal endoscopic posterior cervical foraminotomy for unilateral cervical foraminal disc disease. Clin Orthop Surg. 2022;14(4):539–547. DOI: 10.4055/cios22050.
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