9. Contralateral Endoscopic Decompression for Foraminal Stenosis
@ProfFishchenkoHypertrophy of the superior articular process, thickening of the ligamentum flavum, and intervertebral disc bulging may narrow the intervertebral foramen and compress the spinal nerve root. Asymptomatic narrowing alone requires no treatment. In symptomatic foraminal stenosis, we determine management according to the clinical presentation; some patients require surgery.
Biportal endoscopic decompression (BESS/UBE) is a surgical method for decompression of the intervertebral foramen. In this chapter, I describe a contralateral approach from within the spinal canal: we decompress the intervertebral foramen by resecting the hypertrophied ligamentum flavum and the tip of the superior articular process. An alternative posterolateral approach is described in Chapter 8.
References
1. Akbary K, Kim JS, Park CW, Jun SG, Hwang JH. Biportal endoscopic decompression of exiting and traversing nerve roots through a single interlaminar window using a contralateral approach: technical feasibilities and morphometric changes of the lumbar canal and foramen. World Neurosurg. 2018;117:153-161. doi:10.1016/j.wneu.2018.05.111.
2. Tian D, Zhu B, Liu J, Chen L, Sun Y, Zhong H, et al. Contralateral inclinatory approach for decompression of the lateral recess and same-level foraminal lesions using unilateral biportal endoscopy: a technical report. Front Surg. 2022;9:959390. doi:10.3389/fsurg.2022.959390.
3. Bui AT, Trinh GM, Wu MH, Hoang TT, Hu MH, Pao JL. Indications for and outcomes of three unilateral biportal endoscopic approaches for the decompression of degenerative lumbar spinal stenosis: a systematic review. Diagnostics (Basel). 2023;13(6):1092. doi:10.3390/diagnostics13061092.
4. Yeung YK, Park CW, Jun SG, Park JH, Tse ACY. Comparative cohort study for expansion of lateral recess and facet joint injury after biportal endoscopic ipsilateral decompression and contralateral decompression. Asian Spine J. 2022;16(4):560-566. doi:10.31616/asj.2020.0656.
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