Tag: Transforaminal

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Technique and outcomes of the trans-superior articular process approach for endoscopic thoracic discectomy

J Neurosurg Spine 42:775–783, 2025

The trans-superior articular process (SAP) approach for endoscopic thoracic discectomy enables safe, minimally invasive treatment of symptomatic thoracic disc herniation, particularly in challenging upper/mid-thoracic regions, with significant improvements in pain and disability, short operative time, and low complication rates in a 38-patient series.

• Trans-superior articular process (trans-SAP) approach for endoscopic thoracic discectomy is described for symptomatic thoracic disc herniation (TDH).

• This technique creates a controlled corridor through the SAP using a Jamshidi needle and manual bone drills, minimizing facet removal and neural injury.

• Study included 38 patients (mean age 48.9), mostly with central or middle thoracic herniations.

• Mean operative time was 42 minutes, hospital stay 1.3 days, and follow-up 11.5 months.

• Significant improvements in pain (VAS) and disability (ODI) scores were observed at all follow-up points.

• Only one complication (2.6%, recurrent herniation) was reported.

• Trans-SAP approach is safe, effective, and minimally invasive, but has a steep learning curve and is not suitable for hard disc, severe myelopathy, or ossified ligament cases.

• Technique enables treatment of central and paramedian TDH and can be performed under local anesthesia.

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Unilateral approach with two‑cage insertion for full endoscopic transforaminal lumbar interbody fusion: technical report

Acta Neurochirurgica (2022) 164:1521–1527

The advantages of performing a transforaminal lumbar interbody fusion (TLIF) with two cages rather than a single cage include a larger cage-bone contact area and higher interbody stability.

Methods A customized cage guide is docked in the disc space created after a total facet resection. The first cage is inserted deeply into the contralateral disc space. The second cage is then inserted using the cage guide device while protecting the exiting and traversing nerve roots.

Conclusion We successfully inserted two cages from unilateral side during full endoscopic TLIF. This technique is recommended for L4–L5 and L5–S1 levels.

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Modified far lateral endoscopic transforaminal lumbar interbody fusion using a biportal endoscopic approach

Acta Neurochirurgica (2021) 163:1205–1209

Endoscopic transforaminal lumbar interbody fusion (TLIF) has the disadvantage of the small cage size and by consequence risk for cage subsidence. We succeeded to insert a large oblique lumbar interbody fusion (OLIF) cage during biportal endoscopic TLIF.

Methods Unilateral total facetectomy was performed to expose the exiting and traversing nerve roots. The distance between the exiting and traversing nerve roots was measured before OLIF cage insertion. We inserted an OLIF cage instead of a TLIF cage.

Conclusion We successfully performed modified far lateral biportal endoscopic TLIF using large OLIF cages. Modified far lateral biportal endoscopic TLIF is usually suitable for the L4-5 and L5-S1 levels.

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Minimally invasive transforaminal lumbar interbody fusion with the ROSA Spine robot and intraoperative flat-panel CT guidance

Minimally invasive transforaminal lumbar interbody fusion with the ROSATM Spine robot and intraoperative flat-panel CT guidance

Acta Neurochir (2016) 158:1125–1128

Circumferential arthrodesis is commonly used to treat degenerative lumbar diseases. Minimally invasive techniques may enable faster recovery and reduce the incidence of postoperative infections.

Methods: We report on the surgical technique of a transforaminal lumbar interbody fusion (TLIF) procedure performed with the assistance of a new robotic device (ROSATM Spine) and intraoperative flat-panel CT guidance.

Conclusions: The combined use of this new robotic device and intraoperative CT enables accurate and safe arthrodesis in the treatment of degenerative lumbar disc diseases.

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