The main aim of this video article is to demonstrate the combined use of O-arm navigation and unilateral biportal endoscopy (UBE) to manage far-out syndrome (FOS). In FOS there is entrapment and compression of the fifth lumbar nerve beyond the foramen and between L5 transverse process and the sacral ala at the lumbosacral junction. Conventional microscopic decompression using a paraspinal approach had been the gold standard for its management. However, the surgery is technically challenging due to the deep location of the pathology and intricate anatomy of extraforaminal space. There have been some published reports of unsatisfactory outcomes with microscopic decompression for FOS. We decided to integrate navigation with UBE to increase precision for the management of FOS. A 70-year-old female presented to us with chief complaint of left lower limb radiculopathy since 1 year. She also complained of numbness and paresthesias in her left leg and foot. She was unable to walk for more than 10 minutes due to pain. Her magnetic resonance imaging scan revealed compression of left L5 nerve root in the extraforaminal region. UBE decompression via paraspinal approach was performed for her under O-arm navigation. She experienced immediate relief of her symptoms in the postoperative period. O-arm-navigation-guided UBE is an effective and safer alternative to microsurgical decompression for the management of FOS. This video demonstrates the step-by-step implementation of O-arm navigation with endoscopy and its precise execution.
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This video provides a step-by-step guide for performing the hybrid endoscopic thoracic discectomy using navigation and robotic arm for addressing high migrated calcified disc herniation. With the development of techniques, endoscopic spine surgery has emerged as a reliable treatment for thoracic myelopathy. This approach offers high-resolution, off-axis visualization of the surgical field. The field is poised to advance further as endoscopic instruments are refined, becoming less invasive and more precise through the integration of navigation and robot-assisted systems. A 62-year-old woman presented to us with chief complaints of both legs weakness. She had difficulty standing and walking after squatted due to weakness in her legs and her Oswestry Disability Index score was 66. On examination her both side knee extension and ankle dorsiflexion were grade 4 without dysesthesia. The imaging examination confirmed the diagnosis of thoracic myelopathy caused by a highly migrated calcified disc herniation at T5–6 level. The patient underwent an endoscopic thoracic discectomy using robotic arm and navigation for addressing highly migrated calcified disc herniation, resulting in an excellent outcome. The continuous development of navigation and robotic systems in endoscopic thoracic surgery enhanced accuracy in surgical incisions and instrument placement, as well as improved efficiency in locating pathology and achieving precise decompression. Endoscopic thoracic discectomy combines full-endoscopy and unilateral biportal endoscopic (UBE) techniques to leverage the benefits of both approaches, including the cross-viewing of full-endoscopy cannula and the use of larger Kerrison rongeurs under UBE.
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