Endoscopy of the Spine: Principle and Practice

Foreword
Foreword
Preface
Acknowledgement
Contents
Part I: Basic Knowledge
	1: Practical and Applied Anatomy for Full Endoscopic Spine Surgery
		1.1	 Introduction
			1.1.1	 Overview of Spine Anatomy
			1.1.2	 Adult Spine Anatomy
			1.1.3	 Surgical Landmarks
			1.1.4	 Blood Supply
			1.1.5	 Spinal Nerve
		1.2	 Cervical Spine Anatomy
			1.2.1	 C1 (Atlas)
			1.2.2	 C2 (Axis)
			1.2.3	 Foramina Transversaria
			1.2.4	 C3-C7 (Subaxial Cervical Spine)
			1.2.5	 Cervical Disc
			1.2.6	 Cervical Spinal Nerve Roots
			1.2.7	 Role of the Cervical Nerve
			1.2.8	 Cervical Spine Blood Supply
			1.2.9	 Anterior Cervical Spine Anatomy
			1.2.10	 Application of Anterior Full Endoscopic Cervical Discectomy
			1.2.11	 Posterior Cervical Spine Anatomy
			1.2.12	 Posterior Fascia
			1.2.13	 Ligamentum Nuchae
			1.2.14	 Muscles of the Posterior Cervical Spine
			1.2.15	 Ligamentum Flavum
			1.2.16	 Interlaminar Area of Posterior Cervical Spine
			1.2.17	 Application of Posterior Full Endoscopic Cervical Discectomy/Laminoforaminotomy
		1.3	 Thoracic Spine Anatomy
			1.3.1	 Specific Characteristic Features
			1.3.2	 Thoracic Discs
			1.3.3	 Role of the Thoracic Nerve
			1.3.4	 Ligaments
			1.3.5	 Relevant Anatomy
			1.3.6	 Posterior Thoracic Spine Anatomy
			1.3.7	 Application of Posterior Full Endoscopic Thoracic Discectomy
		1.4	 Lumbar Spine Anatomy
			1.4.1	 Venous Supply
				1.4.1.1	 External Venous Plexus
				1.4.1.2	 Internal Venous Plexus
			1.4.2	 Arterial Supply
			1.4.3	 Lumbar Anatomy Base on Columns Concepts
			1.4.4	 Lumbar Disc
				1.4.4.1	 Lumbar Nerve Root and Branches
				1.4.4.2	 Dorsal Root Ganglia of Lumbar Spine
				1.4.4.3	 Lumbar Nerve Root Various Types and Anomalies
				1.4.4.4	 Pedicle Morphology
				1.4.4.5	 Neural Foramen
				1.4.4.6	 Surface Anatomy
				1.4.4.7	 Zone of the Lumbar Disc Herniation
				1.4.4.8	 Level of Migrated Disc Herniation
				1.4.4.9	 Interlaminar Space
				1.4.4.10	 Ligament Flava
				1.4.4.11	 Interlaminar Window and Width
				1.4.4.12	 Kambin’s Triangle
		1.5	 Summary
		References
	2: Role of Radiological Investigations in Diagnosis of Spinal Disorders and Surgical Planning of Endoscopic Spine Surgery
		2.1	 Introduction
		2.2	 Role of Radiology in Diagnosis of Spinal Disorders
			2.2.1	 Overview of Imaging Modalities
				2.2.1.1	 Radiographs
				2.2.1.2	 Fluoroscopy and Cone-Beam CT
				2.2.1.3	 Computed Tomography (CT) and Dual-Energy CT (DECT)
				2.2.1.4	 Magnetic Resonance Imaging (MRI)
				2.2.1.5	 Nuclear Medicine (NM)
				2.2.1.6	 Ultrasound (US)
		2.3	 Role of Radiology in Surgical Planning
			2.3.1	 General Status of the Spine
			2.3.2	 Vertebral Level Labeling
			2.3.3	 Congenital/Acquired Vertebral Defects
			2.3.4	 Spinal Canal, Cord/Cauda Equina Status
			2.3.5	 Types of Stenotic Pathology and Impact on Endoscopic Approach
			2.3.6	 Transforaminal Corridor Considerations
			2.3.7	 Interlaminar Corridor Considerations
			2.3.8	 Oblique and Lateral Corridor Considerations
		2.4	 Role of Radiology in Postsurgical Evaluation
			2.4.1	 Expected Postoperative Appearances
			2.4.2	 Spinal Implants and Related Complications
			2.4.3	 Nonimplant Complications: Early
			2.4.4	 Nonimplant Complications: Late
		2.5	 Summary
		References
	3: Instruments in Endoscopic Spinal Surgery
		3.1	 Different Surgical Access and Approaches
			3.1.1	 Thoracic/Lumbar Application
			3.1.2	 Cervical Application
		3.2	 Full and Clear Endoscopic Visualization
		3.3	 Fluid Management
		3.4	 Soft Tissue Dissection and Removal
		3.5	 Bone Issue Removal and Resection
		3.6	 Coagulation and Ablation of Soft Tissue
		3.7	 Interbody Fusion
		References
	4: Role of Navigation in Endoscopic Spine Surgery
		4.1	 Introduction
		4.2	 Navigation in Endoscopic Spine Surgery
		4.3	 Clinical Applications
		4.4	 Navigation Modalities
			4.4.1	 3D Computerized Navigation
			4.4.2	 Ultrasound
			4.4.3	 Mixed Reality
			4.4.4	 Robotic
		4.5	 Conclusion
		References
Part II: Cervical Spine
	5: Anterior Cervical Endoscopic Discectomy
		5.1	 Introduction
		5.2	 PECD Indications
		5.3	 Contradiction
		5.4	 Surgical Procedures
			5.4.1	 Positioning
			5.4.2	 Location, Anesthesia, Puncture, and Working Channel Placement
			5.4.3	 Percutaneous Endoscopic Cervical Discectomy (PECD)
			5.4.4	 Postoperative Management
			5.4.5	 The Complication of PECD and Its Surgical Outcome
		5.5	 Summary
		References
	6: Anterior Endoscopic Cervical Foraminotomy and Discectomy
		6.1	 Introduction
		6.2	 Indications and Contraindications
			6.2.1	 Indications
		6.3	 Advantages
		6.4	 Surgical Procedure
		6.5	 Postprocedural Evaluation
		6.6	 Clinical Outcome
		6.7	 Complications and Risks
		6.8	 Commentary
		6.9	 Conclusion
		References
	7: Anterior Cervical Discectomy and Interbody Fusion by Endoscopic Approach
		7.1	 Introduction
		7.2	 Advantages of Endoscopic ACDF
		7.3	 Indications [3]
		7.4	 Contraindications [3]
		7.5	 Author Preferred Technique
			7.5.1	 Patient Positioning
			7.5.2	 Portal Design
			7.5.3	 Step-by-Step Description of the Technique
			7.5.4	 Complications and Management
			7.5.5	 Outcome
		7.6	 Summary
		References
	8: Anterior Endoscopic Cervical Transcorporeal Approach
		8.1	 Introduction
		8.2	 Evolution of the Anterior Cervical Transcorporeal Tunnel Approach; From the Transuncal Microforaminotomy to the Endoscopic Transvertebral Route
		8.3	 Biomechanical Perspective
		8.4	 Rationale and Special Considerations of Anterior Transcorporeal Endoscopic Approach
		8.5	 Indications and Prerequisites for Anterior Endoscopic Transcorporeal Tunnel Approach
		8.6	 Surgical Technique
		8.7	 Perioperative Care
		8.8	 Complications Related to the Cervical Anterior Transcorporeal Approach
		8.9	 Discussion
		8.10	 Conclusion
		References
	9: Posterior Endoscopic Cervical Foraminotomy
		9.1	 Introduction
		9.2	 Indications [5]
		9.3	 Contraindications
		9.4	 Author Preferred Technique
			9.4.1	 Preoperative Planning
			9.4.2	 Patient Positioning
			9.4.3	 Portal Design
			9.4.4	 Step-by-Step Description of the Technique
			9.4.5	 Complications and Management
			9.4.6	 Postoperative Care
		9.5	 Summary
		References
	10: Posterior Endoscopic Cervical Discectomy
		10.1	 Introduction
		10.2	 Indications
		10.3	 Contraindications
		10.4	 Author Preferred Technique [4–6]
			10.4.1	 Preoperative Planning
			10.4.2	 Patient Positioning
			10.4.3	 Portal Design
			10.4.4	 Step-by-Step Description of the Technique
			10.4.5	 Complications [6, 8, 9]
			10.4.6	 Postoperative Care
			10.4.7	 Outcome
		10.5	 Summary
		References
	11: Posterior Cervical Percutaneous Endoscopic Ventral Bony Decompression
		11.1	 Introduction
		11.2	 Indications
		11.3	 Contraindications
		11.4	 Author’s Preferred Technique
			11.4.1	 Preoperative Planning
			11.4.2	 Patient Positioning
			11.4.3	 Portal Design
			11.4.4	 Step-by-Step Description of the Technique
				11.4.4.1	 Approach Planning
				11.4.4.2	 Anatomical Landmarks
				11.4.4.3	 Ventral Bony Decompression (Intraforaminal)
				11.4.4.4	 Ventral Bony Decompression (in the Lateral Spinal Canal)
		11.5	 Outcomes and Complications
		11.6	 Postoperative Care
		11.7	 Summary
		References
	12: Cervical Endoscopic Unilateral Laminotomy for Bilateral Decompression (CE-ULBD)
		12.1	 Introduction
		12.2	 Indications
		12.3	 Contraindications
		12.4	 Author’s Preferred Technique
			12.4.1	 Preoperative Planning
			12.4.2	 Patient Positioning
			12.4.3	 Portal Design
			12.4.4	 Step-by-Step Description of the Technique
				12.4.4.1	 Approach Planning
				12.4.4.2	 Incision Placement
				12.4.4.3	 Anatomical Landmarks
				12.4.4.4	 Decompression
		12.5	 Outcomes and Complications
		12.6	 Postoperative Care
		12.7	 Summary
		References
	13: Transoral Endoscopic Resection of High Cervical Osteophytes
		13.1	 Introduction
		13.2	 Indications for Transoral Endoscopic Approach
		13.3	 Contraindications
		13.4	 Author’s preferred Technique
			13.4.1	 Preoperative Planning
			13.4.2	 Patient and Medical Team Positioning
			13.4.3	 Portal Design
			13.4.4	 Step-by-Step Description of the Technique
			13.4.5	 Complications and Management
			13.4.6	 Postoperative Care
			13.4.7	 Outcome
		13.5	 Summary
		References
	14: Full Endoscopic Drainage of Cervical Epidural Abscess
		14.1	 Introduction
			14.1.1	 Spinal Epidural Abscess
		14.2	 Cervical Spinal Epidural Abscess
			14.2.1	 Recognition of SEA
			14.2.2	 Anterior or Posterior Approach to C-SEA
			14.2.3	 Surgical Procedures for C-SEA
		14.3	 Full Endoscopic C-SEA Drainage
			14.3.1	 Anterior Transcorporeal Full Endoscopic Drainage
				14.3.1.1	 Surgical Technique
			14.3.2	 Anterior Transdiscal Full Endoscopic Drainage
				14.3.2.1	 Surgical Technique
			14.3.3	 Posterior Approach Full Endoscopic C-SEA Drainage
				14.3.3.1	 Surgical Technique
		14.4	 Summary
		References
Part III: Thoracic Spine
	15: Fully Endoscopic Transforaminal Discectomy Under Local Anesthesia for Thoracic Disc Herniations
		15.1	 Introduction
		15.2	 Operative Techniques
		15.3	 Clinical Results
		15.4	 Discussion
		15.5	 Conclusion
		References
	16: Full Endoscopic Posterior Decompression for Thoracic Myelopathy Caused by Ossified Ligamentum Flavum
		16.1	 Introduction
		16.2	 Evaluation and Diagnosis
		16.3	 Treatment
			16.3.1	 Full Endoscopic Surgeries for TOLF
			16.3.2	 Technical Variations of the Endoscopic Surgeries for the Resection of TOLF
			16.3.3	 Authors’ Preferred Surgical Techniques
		16.4	 Conclusions
		References
	17: Fully Endoscopic ULBD (Unilateral Laminotomy Bilateral Decompression) for Thoracic Spinal Stenosis
		17.1	 Introduction
		17.2	 Operative Technique
		17.3	 Case Series and Results
		17.4	 Discussion
		References
	18: Endoscopically Assisted Transforaminal Thoracic Interbody Fusion
		18.1	 Introduction
		18.2	 Indications
		18.3	 Contraindications
		18.4	 Author Preferred Technique
			18.4.1	 Preoperative Planning
			18.4.2	 Patient Positioning
			18.4.3	 Portal Design
			18.4.4	 Step-by-Step Description of the Technique
			18.4.5	 Complications and Management
			18.4.6	 Outcome
		18.5	 Summary
		References
	19: Video-Assisted Thoracoscopic Surgery for Drainage of Paravertebral Abscess
		19.1	 Introduction
		19.2	 Indications
		19.3	 Contraindications
		19.4	 Author’s Preferred Technique
			19.4.1	 Preoperative Planning
			19.4.2	 Patient Positioning
			19.4.3	 Operating Room Setup
			19.4.4	 Port Placement
			19.4.5	 Step-by-Step Description of the Technique
			19.4.6	 Complications and Management
			19.4.7	 Postoperative Care
		19.5	 Summary
		References
	20: Video-Assisted Thoracoscopic Surgery (VATS) for Spinal Conditions
		20.1	 Introduction
			20.1.1	 Technology
			20.1.2	 Optical Advantage
			20.1.3	 Minimally Invasive Advantage
			20.1.4	 Anterior Spinal Surgical Approach Advantage (as Compared to Posterior Surgical Spinal Approach) for Scoliosis Deformity Correction
		20.2	 Indications
		20.3	 Contraindications
		20.4	 Surgical Anatomy and its Clinical Relevance
			20.4.1	 Approach
			20.4.2	 Disc
			20.4.3	 Rib Head
			20.4.4	 Segmental Vessels (Fig. 20.2)
			20.4.5	 Sympathetic Chain: Splanchnic Nerve
			20.4.6	 Intraoperative Spinal Level Localization
		20.5	 Author’s Preferred Surgical Technique: VATI for AIS Surgery
			20.5.1	 Anesthesia
			20.5.2	 Patient and Surgical Team Positioning
			20.5.3	 Principle of Endoscopic Portal Placements
				20.5.3.1	 Posterolateral Approach
			20.5.4	 VATS Portal Localization
			20.5.5	 VATS Portal Insertion
		20.6	 Surgical Technique
			20.6.1	 VATS Discectomy for Anterior Spinal Release and Fusion for AIS Surgery
			20.6.2	 VATS Discectomy for Spinal Cord Decompression
			20.6.3	 Spinal Instrumentation and Fusion for a Right-Sided Adolescent Idiopathic Scoliosis
				20.6.3.1	 Vertebral Screw Insertion
				20.6.3.2	 Rod Engagement and Scoliosis Deformity Reduction
				20.6.3.3	 Wound Closure and Postoperative Care
				20.6.3.4	 Case Presentation
		20.7	 VATS Complications (Table 20.2)
		20.8	 Conclusion
		References
Part IV: Lumbar Spine
	21: Transforaminal Endoscopic Lumbar Discectomy
		21.1	 Introduction
		21.2	 Indications
		21.3	 Contraindications
		21.4	 Author Preferred Technique
			21.4.1	 Preoperative Planning
			21.4.2	 Patient Positioning
			21.4.3	 Portal Design
			21.4.4	 Step-by-Step Description of the Technique
			21.4.5	 Complications and Management
			21.4.6	 Postoperative Care
		21.5	 Summary
		References
	22: Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PE-TILF)
		22.1	 Introduction
		22.2	 Indications
		22.3	 Contraindications
		22.4	 Author’s Preferred Technique
			22.4.1	 Preoperative Planning
			22.4.2	 Patient Positioning
			22.4.3	 Incision Design
			22.4.4	 Step-by-Step Description of the Technique
			22.4.5	 Complications and Management
				22.4.5.1	 Nerve Root and Dural Injury
				22.4.5.2	 Cage Displacement and Collapse of the End Plate
				22.4.5.3	 Surgical Site Infection
			22.4.6	 Postoperative Care
			22.4.7	 Outcomes
				22.4.7.1	 Clinical Efficacy Evaluation
				22.4.7.2	 Evaluation of Fusion Condition
		22.5	 Summary
		References
	23: Endoscopic Foraminotomy in Patients with Moderate Degenerative Deformity of the Lumbar Spine
		23.1	 Introduction
		23.2	 Indications
		23.3	 Contraindications
		23.4	 Author Preferred Technique
			23.4.1	 Preoperative Planning
			23.4.2	 Patient Positioning
			23.4.3	 Portal Design
			23.4.4	 Endoscopic Foraminal Decompression
			23.4.5	 Complications
			23.4.6	 Postoperative Care
			23.4.7	 Outcome
		23.5	 Summary
		References
	24: Transforaminal Endoscopic Lateral Recess Decompression
		24.1	 Introduction
		24.2	 Indications
		24.3	 Contraindications
		24.4	 Author Preferred Technique
			24.4.1	 Preoperative Planning
			24.4.2	 Patient Positioning
			24.4.3	 Portal Design
			24.4.4	 Step-by-Step Description of the Technique
				24.4.4.1	 Transforaminal Approach
				24.4.4.2	 Endoscopic View
				24.4.4.3	 Bone Work
				24.4.4.4	 Soft Tissue Work
				24.4.4.5	 Finish
			24.4.5	 Complications and management
			24.4.6	 Postoperative Care
			24.4.7	 Outcome
		24.5	Summary
		References
	25: Interlaminar Endoscopic Lumbar Discectomy
		25.1	 Introduction
		25.2	 Indications
		25.3	 Contraindications
		25.4	 Author’s Preferred Technique
			25.4.1	 Preoperative Planning
			25.4.2	 Patient Positioning
			25.4.3	 Portal Design
			25.4.4	 Step-by-Step Description of the Technique
			25.4.5	 Complications and Management
			25.4.6	 Postoperative Care
		25.5	 Summary
		References
	26: Interlaminar Endoscopic Lateral Recess Decompression
		26.1	 Introduction
		26.2	 Indications for Interlaminar Endoscopic Lateral Recess Decompression
		26.3	 Contraindications
		26.4	 Author’s Preferred Technique
			26.4.1	 Preoperative Planning
			26.4.2	 Patient Positioning
			26.4.3	 Portal Design
			26.4.4	 Step-by-Step Description of the Technique
			26.4.5	 Complications and Management
			26.4.6	 Postoperative Care
		26.5	 Summary
		References
	27: Full Endoscopic Interlaminar Contralateral Endoscopic Lumbar Foraminotomy
		27.1	 Introduction
		27.2	 Surgical Anatomical Considerations
		27.3	 Causes of Foraminal Stenosis
		27.4	 Indications and Contraindications
		27.5	 Instruments Required for Surgery (Fig. 27.2)
		27.6	 Surgical Technique
			27.6.1	 Preoperative Planning
				27.6.1.1	 Plain Radiograph
				27.6.1.2	 Magnetic Resonance Imaging (MRI) and CT Scan
			27.6.2	 Mode of Anaesthesia
			27.6.3	 Positioning and Skin Incision
			27.6.4	 Surgical Equipment
			27.6.5	 Skin Surface Marking and Docking of Endoscope
			27.6.6	 Endoscopic Anatomy and Path of Endoscopic Drilling
			27.6.7	 Foraminal and Extraforaminal Decompression
			27.6.8	 Evaluation for Adequacy of Decompression
			27.6.9	 Postoperative Rehabilitation Protocol
		27.7	 Technical Pearls
			27.7.1	 Careful Haemostasis of Intraoperative Bleeding
			27.7.2	 Prevent Dorsal Root Ganglion Manipulation
			27.7.3	 Recurrence of Foraminal Disc Herniation
			27.7.4	 Iatrogenic Instability
			27.7.5	 Representative Case (Figs. 27.5 and 27.6)
		27.8	 Conclusion
		References
	28: Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression
		28.1	 Introduction
		28.2	 Indications for Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression
		28.3	 Contraindications
		28.4	 Author’s Preferred Technique
			28.4.1	 Preoperative Planning
			28.4.2	 Patient Positioning
			28.4.3	 Portal Design
				28.4.3.1	 Surgical Instrument (Fig. 28.1)
			28.4.4	 Step-by-Step Description of the Technique
			28.4.5	 Complications and Management
			28.4.6	 Postoperative Care
		28.5	 Summary
		References
	29: Biportal Endoscopic Technique in the Treatment of Lumbar Spinal Stenosis
		29.1	 Introduction
		29.2	 Indications
		29.3	 Contraindications
		29.4	 Authors’ Preferred Technique
			29.4.1	 Preoperative Planning
			29.4.2	 Patient Positioning
			29.4.3	 Portal Design
			29.4.4	 Step-by-Step Description of the Technique
			29.4.5	 Complications and Management
			29.4.6	 Postoperative Care
		29.5	 Summary
		References
	30: Endoscopic Extraforaminal Lumbar Discectomy
		30.1	 Introduction
		30.2	 Indications
		30.3	 Contraindications
		30.4	 Author’s Preferred Technique
			30.4.1	 Preoperative Planning
			30.4.2	 Patient Positioning
			30.4.3	 Portal Design
			30.4.4	 Step-by-Step Description of the Technique
				30.4.4.1	 Insertion of Guide Needle
				30.4.4.2	 Insertion of Dilator
				30.4.4.3	 Insertion of Working Cannula
				30.4.4.4	 Removal of Herniated Disk
				30.4.4.5	 Foraminoplasty
				30.4.4.6	 Complications and Management
			30.4.5	 Postoperative Care
			30.4.6	 Outcome
				30.4.6.1	 Postoperative Dysesthesia
				30.4.6.2	 Reoperation Cases
		30.5	 Summary
		References
	31: Percutaneous Endoscopic Lumbar Discectomy: Transpedicular Approach
		31.1	 Introduction
		31.2	 Indications
		31.3	 Contraindications
		31.4	 Author’s Preferred Technique
			31.4.1	 Preoperative Planning
			31.4.2	 Patient and Medical Team Positioning
			31.4.3	 Portal Design
				31.4.3.1	 Location
				31.4.3.2	 Establishment of the Working Channel
			31.4.4	 Step-by-Step Description of the Technique
				31.4.4.1	 Expose and Observe the Spinal Canal Structures
				31.4.4.2	 Resection of the Prolapsed Nucleus Pulposus
				31.4.4.3	 Before Ending the Operation
			31.4.5	 Complications and Management
			31.4.6	 Postoperative Care
			31.4.7	 Outcomes
		31.5	 Summary
		References
	32: Extraforaminal Approach of Biportal Endoscopic Spine Surgery
		32.1	 Introduction
		32.2	 Indications
		32.3	 Contraindications
		32.4	 Author’s Preferred Procedure
			32.4.1	 Preoperative Planning
			32.4.2	 Patient Preparation
			32.4.3	 Portal Design
			32.4.4	 Step-by-Step Description of the Technique
			32.4.5	 Complications and Management
			32.4.6	 Postoperative Care
			32.4.7	 Outcomes
		32.5	 Summary
		References
	33: Trans-Sacral Endoscopic Laser Decompression for Herniated Lumbar Disc
		33.1	 Introduction
		33.2	 Indication and Contraindications
		33.3	 Anesthesia and Surgical Preparation
		33.4	 Procedure
		33.5	 Postoperative Management
		33.6	 Complications
		33.7	 Current Evidence and Pitfalls
		References
	34: Trans-Superior Articular Process Endoscopic Lumbar Approach
		34.1	 Introduction
		34.2	 Indication and Contraindication
		34.3	 Surgical Procedure
			34.3.1	 Preoperative Planning
			34.3.2	 Patient Positioning and Skin Marking
			34.3.3	 J-Needle Incision and Working Corridor Creation
			34.3.4	 Bony Landmark Identification
			34.3.5	 Decompression of the Foramen
			34.3.6	 Decompression of the Lateral Recess
		34.4	 Pearls and Pitfalls
		34.5	 Outcomes and Complications
		34.6	 Discussion and Summary
		References
	35: Endoscopic Lateral Lumbar Interbody Fusion
		35.1	 Introduction
		35.2	 Indications
		35.3	 Contraindications
		35.4	 Surgical Techniques
			35.4.1	 Patient Position
			35.4.2	 Skin Incision
			35.4.3	 Approach to Retroperitoneal Space
				35.4.3.1	 Approach to the Iliac Crest (L4/5, L5/S1)
				35.4.3.2	 Intermuscular Approach (L1/2, L2/3, L3/4)
			35.4.4	 Splitting the Psoas Major Muscle and the Exposing of the Intervertebral Disc Surface
			35.4.5	 Operation in the Intervertebral Disc
			35.4.6	 Cage Insertion
			35.4.7	 Confirmation after Cage Insertion
			35.4.8	 Wound Closure
			35.4.9	 Additional Posterior Reduction
			35.4.10 Postoperative Care
			35.4.11 ELLIF in the Prone Position
		35.5	 Cases
		35.6	 Summary
		References
	36: Endoscopic Treatment of L5-S1 Intervertebral Disc Herniation Via Trans-Iliac Approach
		36.1	 Introduction
		36.2	 Indications
		36.3	 Contraindications
		36.4	 Author’s Preferred Technique
		36.5	 Complications and Management
		36.6	 Postoperative Care
		36.7	 Summary
		References
	37: Percutaneous Endoscopic Transforaminal Decompression for Lumbar Spinal Stenosis
		37.1	 Introduction
		37.2	 Indications of Percutaneous Endoscopic Transforaminal Decompression (PETD)
		37.3	 Contraindications of PETD
		37.4	 Author’s Preferred Technique (PETD)
			37.4.1	 Preoperative Planning
			37.4.2	 Patient Positioning
			37.4.3	 Portal Design
			37.4.4	 Step-by-Step Description of the Technique
			37.4.5	 Complications and Management
			37.4.6	 Postoperative Care
			37.4.7	 Outcome
		37.5	 Summary
		References
	38: Full-Endoscopic Oblique Lateral Lumbar Interbody Fusion
		38.1	 Introduction
		38.2	 Indications
		38.3	 Contraindications
		38.4	 Author’s Preferred Technique
			38.4.1	 Preoperative Planning
			38.4.2	 Patient Positioning
			38.4.3	 Portal Design
			38.4.4	 Step-by-Step Description of the Technique
				38.4.4.1	 OLLIF
				38.4.4.2	 Full-Endoscopic Decompression
				38.4.4.3	 Percutaneous Pedicle Screw System Fixation
				38.4.4.4	 Ending the Operation
			38.4.5	 Complications and Prevention
			38.4.6	 Postoperative Care
			38.4.7	 Outcome
		38.5	 Summary
		References
	39: Endoscopic Discectomy-Assisted Oblique Lumbar Interbody Fusion
		39.1	 Introduction
		39.2	 Methods or Surgical Technique
			39.2.1	 Surgical Indication
			39.2.2	 Information for the Patient
			39.2.3	 Patient Positioning
			39.2.4	 Instruments
		39.3	 Surgical Procedure
			39.3.1	 Skin Incision
			39.3.2	 Approach
			39.3.3	 Disc Preparation
			39.3.4	 Endoscopic Discectomy
			39.3.5	 Cage Trialing
			39.3.6	 Cage Insertion
			39.3.7	 Pedicular Screw Insertion
		39.4	 Complications
		39.5	 Case Presentation
		39.6	 Discussion (Including how to Avoid Complications, Pearls, Tricks, and Tips by an Expert)
		39.7	 Conclusions
		References
	40: Laparoscopic Lumbar Discectomy and Artificial Disc Replacement
		40.1	 Introduction
		40.2	 Advantages and Disadvantages of Laparoscopic Lumbar Spinal Surgery
			40.2.1	 Advantages
			40.2.2	 Deficiencies
		40.3	 Indications
		40.4	 Contraindications
		40.5	 Surgical Procedure [2, 3]
			40.5.1	 Preoperative Planning
			40.5.2	 Patient Positioning and Anesthesia
			40.5.3	 Portal Design
			40.5.4	 Step-by-Step Description of the Technique
			40.5.5	 Complications and Management
			40.5.6	 Postoperative Care
			40.5.7	 Surgical Efficacy and Evaluation
		40.6	 Prospect
		References
	41: Endoscopic Treatment for Lumbar Infectious Spondylitis
		41.1	 Introduction
		41.2	 Indications
		41.3	 Contraindications
		41.4	 Surgical Techniques of Transforaminal FEDD
			41.4.1	 Required Instruments
			41.4.2	 Preparation before Operation
			41.4.3	 Docking the Endoscope
			41.4.4	 Full-Endoscopic Debridement
			41.4.5	 Postoperative Care
		41.5	 Complications and Management
		41.6	 Conclusion
		References
	42: Endoscopic Treatment of Spinal Tuberculosis
		42.1	 Introduction
		42.2	 Instruments
		42.3	 Indications
		42.4	 Contraindications
		42.5	 Incision
		42.6	 Procedure
		42.7	 Closure and Drainage
		42.8	 Possible Complications and Management
		42.9	 Current Evidence and Pitfalls
		42.10	 Case Presentation
		42.11	 Conclusions
		References
	43: Full-endoscopic Rhizotomy of the Sacroiliac Joint Complex for Low Back Pain
		43.1	 Introduction
			43.1.1	 Anatomy
			43.1.2	 Indications
		43.2	 Surgical Technique
			43.2.1	 Operating Room Setup
			43.2.2	 Working Cannula Docking and Endoscopic Rhizotomy
			43.2.3	 Endpoint of the Procedure
			43.2.4	 Case Illustration
		43.3	 Pitfalls and Complication Avoidance
		43.4	 Conclusion
		References
	44: Endoscopy in Pain Therapy
		44.1	 Endoscopic Approach to Low Back Pain
		44.2	 Surgical Technique
		44.3	 Sacroiliac Joint
		44.4	 Learning Curve
		44.5	 Endoscopy in Pain Therapy: Future Applications
		References
	45: Percutaneous Endoscopic Lumbar Annuloplasty and Nucleoplasty for Discogenic Low Back Pain
		45.1	 Introduction
		45.2	 Sources of Low Back Pain
			45.2.1	 Discogenic Pain
			45.2.2	 Diagnosis of Discogenic Pain
			45.2.3	 Special Findings on Lumbar MRI
		45.3	 Percutaneous Endoscopic Lumbar Annuloplasty and Nucleoplasty for Discogenic Low Back Pain
			45.3.1	 Indications and Prerequisites for PELAN
			45.3.2	 Surgical Technique
			45.3.3	 Perioperative Care
			45.3.4	 Important Considerations
		45.4	 Discussion
		45.5	 Conclusion
		References
Part V: Other Issues on Endoscopy of the Spine for Academic Search
	46: Endoscopic Revision Spine Surgery
		46.1	 Introduction
		46.2	 Indications
		46.3	 Contraindications
		46.4	 Author-Preferred Technique
			46.4.1	 Preoperative Planning
			46.4.2	 Patient Positioning
			46.4.3	 Portal Design
			46.4.4	 Step-by-Step Description of the Technique
			46.4.5	 Complications and Management
				46.4.5.1	 Dural Tears
				46.4.5.2	 Exiting Root Injury
				46.4.5.3	 Infection of the Surgical Site
				46.4.5.4	 Developing Seizure
			46.4.6	 Postoperative Care
			46.4.7	 Outcome
		46.5	 Summary
		References
	47: Robotic-Assisted Endoscopic Laminotomy
		47.1	 Introduction
		47.2	 Indications
		47.3	 Contraindications
		47.4	 Author’s Preferred Technique
			47.4.1	 Preoperative Planning
			47.4.2	 Patient and Medical Team Positioning
			47.4.3	 Portal Design
			47.4.4	 Step-by-Step Description of the Technique(S)
				47.4.4.1	 Robotic-Assisted Percutaneous Targeting Stage
				47.4.4.2	 Robotic-Assisted Endoscopic Laminotomy Stage
			47.4.5	 Complications and Management
			47.4.6	 Post-Operative Care
		47.5	 Summary
		References
	48: Endoscopic Treatment for Spinal Metastases
		48.1	 Introduction
		48.2	 Preoperative Planning
		48.3	 Contraindications
		48.4	 Patient and Medical Team Positioning
		48.5	 Step-by-Step Description of the Technique
		48.6	 Technique Limitations
		48.7	 Outcome
		48.8	 Conclusion
		References
	49: Spine Endoscopy Complications, Management, and Treatment
		49.1	 Introduction
		49.2	 Wrong Indication
			49.2.1	 Cervical Endoscopic Spine Surgery
			49.2.2	 Thoracic Endoscopic Spine Surgery
			49.2.3	 Lumbar Endoscopic Spine Surgery
		49.3	 Dural Tear
		49.4	 Nerve Root Injury
		49.5	 Postoperative Hematoma
		49.6	 Recurrences
		49.7	 Infections
		49.8	 Conclusion
		References