The Paraspinal Approach with Unilateral Biportal Endoscopy for Lumbar Foraminal Lesions

Abstract

There have been many reports describing various surgical approaches for pathologies in the foramen or extra-foramen areas. Among these approaches, Watkins introduced the paraspinal approach for posterior–lateral fusion in 1953, which was later modified and established by Wiltse and Spancer. This approach has definitely improved the treatment outcomes. The paraspinal approach has improved the surgical results because of the reduced amount of facet resection, less retraction of the paraspinal muscles, appropriate handling of the exiting nerve root, and adequate decompression of the dorsal root ganglion.

As the value of minimally invasive spinal surgery becomes more and more acknowledged and accepted by spine surgeons, the application of paraspinal approach surgery using the endoscope is rapidly expanding. The most important advantage of the endoscopic paraspinal approach is direct visualization of the nerve root and its surrounding structures in a minimally invasive way. However, compared to the more frequently used posterior approach, fewer spine surgeons are familiar with the paraspinal approach. Therefore, the goal of this chapter is to describe the anatomical and technical details to help overcome the learning curve.