Uniportal Endoscopic Techniques for Lumbar Decompression: Interlaminar Microdiscectomy, Interlaminar Laminectomy, and Transforaminal Microdiscectomy

Summary

Here, we present three uniportal endoscopic protocols for lumbar decompression. These techniques include interlaminar microdiscectomy, interlaminar laminectomy, and transforaminal microdiscectomy.

Abstract

Endoscopic spine surgery enables targeted neural decompression with the least amount of tissue disruption to paraspinal structures compared to other spine surgery techniques. Though with minimal visualization, endoscopic spine surgery can be challenging. This article presents a stepwise overview of three key uniportal lumbar endoscopic techniques: interlaminar microdiscectomy, interlaminar laminectomy, and transforaminal microdiscectomy. Through integrated operative footage, the videos demonstrate indications, portal trajectory, and critical anatomic landmarks unique to each approach. 

The interlaminar microdiscectomy technique is illustrated for median and paramedian disc herniations, emphasizing safe ligamentum flavum separation, dural protection, and direct fragment removal under endoscopic visualization. The interlaminar laminectomy segment details the management of central and lateral recess stenosis, highlighting stepwise bone removal, decompression of traversing and exiting roots, and controlled hemostasis within a limited corridor. The transforaminal microdiscectomy sequence demonstrates access through Kambin's triangle, foraminoplasty, and targeted fragment excision without violating the spinal canal. Operative tips focus on portal alignment, irrigation control, and avoidance of nerve injury, supplemented by discussion of ergonomic hand positioning and intraoperative troubleshooting.  

Together, these video demonstrations provide a comprehensive visual reference for surgeons transitioning to endoscopic lumbar surgery. By standardizing procedural steps and emphasizing anatomical orientation, this method article aims to enhance reproducibility, expand technical proficiency, and promote the safe adoption of endoscopic decompression for lumbar disc and canal pathology. 

Introduction

Endoscopic disc surgery was founded in the 1970s and represents a trend toward minimally invasive surgical approaches¹. Neurosurgery has been at the forefront of technological advancement, with each generation introducing new tools that improve surgical accuracy, efficiency, and clinical outcomes². The combination of endoscopic visualization with external monitors has expanded the adoption of this surgical approach from lumbar to thoracic and cervical pathologies³.

Endoscopic spine surgery continues to gain popularity due to its precision and minimally invasive approach....

Protocol

This protocol follows the guidelines of the human research ethics committee of the University of California and was conducted in accordance with the Declaration of Helsinki.

1. Interlaminar Laminectomy (Figure 1) 

1. Find the intralaminar space. 
   1. Identify the inferior edge of the cranial lamina. This is the starting point for the procedure. 
2. Perform Ipsilateral laminotomy of L4. 
   1. Drill the inferior edge of the cranial lamina, proceeding laterally-to-medially and extending cranially while undercutt....

Results

The study includes three patients who underwent a minimally invasive, endoscopic approach to achieve lumbar decompression secondary to disc herniation. All three patients experienced relief of symptoms as documented in progress notes. Intraoperative visualization via the endoscope confirmed decompression of the thecal sac and/or nerve root.

For the interlaminar laminotomy, the interlaminar space was identified, followed by laminotomy. The ligamentum flavum was detached and subsequently removed.......

Discussion

Lumbar disc herniation accounts for 5% of lower back disorders and remains one of the most common indications for spine surgery⁷. In patients with radicular pain and no severe neurological deficits, conservative management is advised for 4–6 weeks. For patients with progressive or persistent symptoms despite conservative non-operative therapy, microdiscectomy is indicated. Microdiscectomy is traditionally performed via an open approach, but can now be done via a tubular or endoscopic approac.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
C-arm mobile fluoroscopy unit (OEC)	GE HealthCare	https://www.gehealthcare.com/products/surgical-imaging	Intraoperative lumbar fluoroscopy; OEC model per institution
ChloraPrep	BD (Becton Dickinson)	930815	Skin antiseptic; Chlorhexidine gluconate and isopropyl alcohol surgical prep
Dermabond Advanced	Ethicon (Johnson & Johnson)	DNX12	Tissue adhesive; Topical skin closure
Diamond burr, ball tip (abrasor)	Joimax	JSBDA323534C	Endoscopic bone removal; 3.5 x 320 mm, also 4.5 x 265 mm (JSBDA274544C)
Endoscopic camera head (1788) with coupler	Stryker	1788	Endoscopic video
High-speed drill and shaver handpiece (Shrill)	Joimax	https://www.joimax.com/en/shrill/	Bone and soft-tissue removal; drives the diamond burr
iLESSYS Pro	Joimax	https://www.joimax.com/en/ilessys/	Interlaminar endoscopic system; Working-channel endoscope and instrument set (rongeurs, Endo-Kerrison punches); interlaminar approach
Irrigation tubing set (Versicon)	Joimax	JTSB350D	Single-use; for Versicon JISP3000 irrigation pump
Jamshidi (11 G x 6 in)	BD (Becton Dickinson)	DJ6011X	Bone access needle; Percutaneous bony access
Surgiflo	Ethicon (Johnson & Johnson)	2994	Hemostatic matrix with thrombin (Flowable hemostatic matrix used with recombinant thrombin [Recothrom])
Transforaminal access kit with 3 reamers (TESSYS)	Joimax	TDAK0020	Serial dilators and reamers for foraminoplasty
Transforaminal endoscopic system (TESSYS)	Joimax	https://www.joimax.com/en/tessys/	Working-channel endoscope and instrument set (graspers, cutters, Endo-Kerrison punches); transforaminal approach
Vaporflex	Joimax	JVP32024	Bipolar radiofrequency probe; Ball tip; 320 mm and 275 mm (JVP28024); hemostasis and tissue ablation
Vicryl Plus	Ethicon (Johnson & Johnson)	VCP864D	Absorbable suture, polyglactin 910 (3-0, 18 in); Subcutaneous and skin closure