4.4. Bone resection
@ProfFishchenkoExtent of bone resection
In my practice, I determine the extent of bone resection for removal of an intracanal disc herniation according to its level, the anatomy of the interlaminar space, and the direction and extent of fragment migration. The aim is to provide access to the herniation and adequate decompression while preserving the segment’s supporting structures as much as possible. Features of work at individual levels are described in the following sections.
Instruments
I perform bone resection with a burr, an osteotome, or a combination of both. Instrument selection depends on the resection zone, available working space, and proficiency with the technique.
When learning BESS/UBE, I recommend starting with an arthroscopic cutting burr, barrel-shaped or spherical, 4–5 mm in diameter. In my practice, I use a 5 mm cutting burr with the Stryker CORE 2 system.
Safety during the bony stage
Regardless of the selected instrument, I ensure direct visualization and protection of adjacent neural structures. I work under clear endoscopic visualization, keeping the working part of the instrument and anatomical landmarks in view. If visibility is lost, I stop resection until visualization is restored.
References
1. Park DK, Weng C, Zakko P, Choi DJ. Unilateral Biportal Endoscopy for Lumbar Spinal Stenosis and Lumbar Disc Herniation. JBJS Essent Surg Tech. 2023;13(2):e22.00020. doi:10.2106/JBJS.ST.22.00020.
2. Zhang Q, Wei Y, Wen L, Tan C, Li X, Li B. An overview of lumbar anatomy with an emphasis on unilateral biportal endoscopic techniques: A review. Medicine (Baltimore). 2022;101(48):e31809. doi:10.1097/MD.0000000000031809.
3. Kim SK, Kang SS, Hong YH, Park SW, Lee SC. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res. 2018;13(1):22. doi:10.1186/s13018-018-0725-1.
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