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Papers of the Week

2021 Jun 07

Oper Neurosurg (Hagerstown)

Endoscopic Interlaminar Approach for Lumbar 4/5 Ipsilateral and Contralateral Decompression: 2-Dimensional Operative Video.


Lumbar radiculopathy often results from direct compression of the exiting nerve roots. This may be caused mainly by spondylotic changes with any contribution from components like a herniated disc, facet overgrowth, and ligamentum flavum hypertrophy, or any combination of them. There are a wide range of surgical treatments directed at decompressing the neural elements. Over the last decade, endoscopic spine surgery has gained popular interest because of potential benefits, including decreased bony removal, less muscle disruption, and enhanced visualization.1 A unilateral endoscopic surgical approach can accomplish an effective bilateral decompression using the ipsilateral-contralateral technique.2 This method allows for addressing both central and bilateral recess stenoses. We present a case of a 48-yr-old female with persistent bilateral lower extremity radicular pain worse on the left side with severe lumbar 4/5 stenosis and a left-sided synovial cyst causing significant foraminal narrowing. This 2-dimensional video illustrates the technique used for an endoscopic interlaminar approach for lumbar 4/5 ipsilateral and contralateral decompression. We highlight key elements regarding the positioning, workflow, and surgical technique to successfully perform this approach. Patient consented to the procedure.