Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

Abstract

There is increasing trend of spine surgeries performed with uniportal and biportal endoscopic spine surgery. Despite its good outcomes and supportive literature, the proportion of spine surgeons regularly doing endoscopic spine surgeries is relatively low. The main limitation is the steep learning curve in the early phase of endoscopic spine surgeries practice. There is paucity of literature in discussion of tips in overcoming these 2 schools of endoscopic spine surgery practice. In this tips and tricks overview, the authors highlights the key differences these 2 main school of endoscopic spine surgeries practice with specific discussions pertaining to "BIPORTALS": the areas of basic medium of surgery, instruments for visualization and working, placement of portal(s), outflow of fluids, route of approach, technical challenges, anatomical challenges, location of lens and light source and start point to work. A ladder of progression of endoscopic spine surgery is proposed to effectively ease into the practice of endoscopic spine surgery.

Prospective Cohort Study with a 2-Year Follow-up of Clinical Results, Fusion Rate, and Muscle Bulk for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion

“…Despite the minimally invasive nature and potential benefit to soft tissue in EPTLIF, there are some potential pitfalls in EPTLIF. Firstly, there is a steep learning curve in EPTLIF, as described by Wu et al [ 7 ], EPTLIF is a quaternary level of endoscopic surgery which requires a surgeon to be familiar with endoscopic decompression and usage of an endoscopic drill. Performance bias can be a confounding factor in this study.…”

“…Lumbar degenerative spinal conditions which require spinal decompression and/or discectomy had been described in the literature [ 6 ]. There is a corresponding increase in describing endoscopic fusion [ 7 , 8 ]. There are two routes of endoscopic fusion, Trans-Kambin and posterolateral as described by Heo et al [ 8 ] in their review of endoscopic fusion.…”

Remodeling of Epidural Fluid Hematoma after Uniportal Lumbar Endoscopic Unilateral Laminotomy with Bilateral Decompression: Comparative Clinical and Radiological Outcomes with a Minimum Follow-up of 2 Years

“…The use of an arthroscope in biportal endoscopic spine surgery (BESS) and an endoscope in uniportal endoscopic spine surgery is not a standard curriculum in spinal residency [ 21 , 22 ]. Although the literature supporting the use of irrigation fluid in surgery in arthroscopic orthopedic limb surgeries is well established, the literature in spinal endoscopy is still evolving [ 3 ].…”

Comparative Cohort Study Of Paraspinal Muscle Volume Change Between Uniportal Full Endoscopic And Minimamally Invasive Open Posterolateral Transforaminal Lumbar Interbody Fusion

“…[7][8][9][10] Endoscopic fusion is one of the latest technique being described in the endoscopic literature with a relatively steep learning curve. 11,12 .Two types of endoscopic lumbar interbody fusion were described in the literature, the rst type described earlier in the literature used the safe corridor of Kambin's Triangle ventral to the facet joint with or without foraminoplasty using small diameter transforaminal endoscope for disc preparation and cage insertion. Several authors had good clinical results with this technique of uniportal endoscopic trans-kambin facet sparing approach for transforaminal lumbar interbody fusion.…”