Bi portal butterfly lumbar decompression: https://pmc.ncbi.nlm.nih.gov/articles/PMC11366563/?utm_source=perplexity
For endoscopic uniportal do vertical 90 deg to floor x-ray vs tubular do angled x-ray
For uniportal The target is the flavum and docked on AP view. Dock it at the inferior border of the L4 lamina for a L4/5 disc. The aim is to see as much of the flavum as possible so that the drilling that is required is less.
Drill the medial facet to get as lateral to the nerve root to prevent never root injury
Biportal rishi
Cut the fascia almost to the other portal to allow better flexibility
UBE fusionleft side for right hand surgeon
Prof Edmond Jonathan:
- two lines forming a triangle must cut through the pedicle. Cranial incision made 5mm from midline and at where the superior endplate. caudal incision made one phalanx distal to the cranial incision
- Make the incision horizontal (parallel to the end plate
- Make sure fascial cut enough so that the two incisions are communicating (can see light from the other). Make the fascia incision cruciate
- remove muscle attachment from spinous process down to the spinal laminar junction. The posterior edge of the spino-laminar junction will look like a C. When drilling down the spinolamina junction towards the midline and crossing the midline, the base of the spinous process and the lamina becomes like a cave. drill cranially until the attachment of the flavum. The first sign of the attachment will look like a V shaped. This V is where the there will be fat peering through the midline of the V. For all drilling use a matchstick drill. Can use a purposefully made match stick drill or use a midas rex
Right side for right hand surgeon (more difficult)
- For L4/5 because the camera on the left hand is looking at the under surface of L4, although this makes the drilling the L4 lamina easy as you can see the flavum attachment under the L4 lamina, drilling or removing the L5 is more difficult as the camera is not directed at C5 it is directed at C4 so the removal of C5 can be blind
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