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Objective: Spinal endoscopic surgery is increasingly adapted as a minimal invasive technique, however, significant facet joint violation may be developed after ipsilateral laminectomy. The aim of this study is to introduce surgical technique of contralateral keyhole biportal endoscopic surgery (CKES) for ruptured lumbar disc and report it is early surgical outcomes with facet joint violation. Methods: Between January to December 2019, 27 patients with ruptured lumbar disc were underwent CKES. Simple radiographs were obtained to investigate development of iatrogenic instability or spondylolisthesis. Magnetic resonance imaging scan was checked about 8 hours after surgery to evaluate successful removal of ruptured disc and existence of facet joint violation. Clinical outcomes were assessed by modified MacNab criteria, visual analogue scale (VAS) scores of back and radicular pain. Results: The mean age of the patients was 62.8 ± 12.48 years. The average operative time and mean follow-up period were 57.1 ± 21.36 minutes and 8.1 ± 3.78 months, respectively. Compared to preoperative scores, the VAS scores of back and radicular pain were significantly improved. Modified MacNab outcome grade was good to excellent in 96.3% (26 out of 27 patients) of patients. The reduction rate of facet joint plane was about 4.9% after contralateral approach. Conclusion: CKES may be considered as an excellent surgical option to treat ruptured lumbar disc without the development of iatrogenic instability. Low rate of facet joint reduction, good visualization of lateral recess, and identification of accurate midline of central spinal canal are advantages of the procedure.

Object The purpose of this study was to determine whether anterior lumbar interbody fusion (ALIF) followed by percutaneous translaminar facet screw fixation is effective in elderly patients with degenerative spinal disease. Methods Twenty-nine patients > 60 years old who underwent ALIF with percutaneous translaminar facet screw fixation from January to June 2004 were studied. The radiological and clinical data of these patients were collected and analyzed. The mean follow-up period was 14.6 months (range 12–17 months). Results The mean preoperative, immediate postoperative, and 6- and 12-month postoperative posterior disc heights were 7.1, 11.6, 9.8, and 9.8 mm, respectively. Subsidences of posterior disc height > 20% developed in 9 patients (30%). The significant risk factor for subsidence was found to be 2-level operations (p = 0.023). The mean preoperative Oswestry Disability Index score and visual analog scale scores for the back and leg were 24.4, 6.6, and 7.5, respectively, and improved postoperatively to 14.2, 1.5, and 1.8, respectively. Conclusions Minimally invasive ALIF followed by percutaneous translaminar facet screw fixation was performed as a minimally invasive surgical technique in elderly patients. However, in certain circumstances such as multilevel operations or in patients with severe osteoporosis, significant cage subsidence can develop.

Objective: With the latest advances and innovations in field of spine surgery, the new generation of spine surgeons has been increasingly preferring the endoscopic lumbar interbody fusion technique to treat the pathology of lumbar degenerative disease. The aim of this study was to elucidate the clinical and radiologic outcomes of biportal endoscopic lumbar interbody fusion with a long polyetheretherketone (PEEK) cage.Methods: This study included 40 patients treated by biportal endoscopic lumbar interbody fusion with a long PEEK cage between January 2020 and December 2021. The clinical evaluation was conducted using improvements in visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores. Radiological outcomes were evaluated by changes in disc height and segmental and lumbar lordosis. Fusion was assessed based on computed tomography scans using the Bridewell criteria. Surgical parameters (e.g., operative duration, blood loss and complications) were noted.Results: Of the 40 patients in this study, 13 were male and 27 were female. Most patients had significant clinical improvement as indicated by improvements in VAS and ODI scores (p < 0.05). Disc height, segmental lordosis, and lumbar lordosis showed significant improvements (p < 0.05). The mean surgical duration was 180 minutes, and the mean blood loss was 80 mL. All patients had grade 1 or 2 fusion.Conclusion: Biportal endoscopic fusion using a long PEEK cage is an excellent option for achieving good interbody fusion when indicated. A long-term follow-up study would be needed to fully clarify the effectiveness of this procedure.