2025 Volume 16 Issue 8 Pages 1154-1160
Introduction: Lumbar spine decompression via unilateral biportal endoscopic spine surgery (UBE) is performed as unilateral laminotomy for bilateral decompression (ULBD). During ULBD, it is difficult to preserve the inferior articular process on the ipsilateral side of entry in the upper lumbar spine due to small facet joints. To apply UBE decompression to the upper lumbar spine, we developed biportal endoscopy-assisted bilateral contralateral laminoplasty (BE-BCL) technique, which provides contralateral decompression from the bilateral interlaminar. The techniques steps and indications are also discussed.
Technical Note: The surgery was performed by first entering from the left interlaminar osteotomy spino-laminar junction, identifying the midline of the yellow ligament, and performing an osteotomy of the contralateral lamina. On the right side, bony decompression of the contralateral side was performed, and the decompression was completed by resecting the yellow ligament on the left half from the right interlaminar region and the right half from the left interlaminar. When BE-BCL was performed in patients with facet joint angles of 20 degrees or less, the average joint preservation rate was 81%.
Conclusions: BE-BCL can prevent inferior articular process fractures even for sagittalized facet joints and can expand the indications for endoscopic lumbar decompression in the upper lumbar spine.
