Background: Far-Out Syndrome at the lumbosacral junction is caused by extraforaminal compression of the L5 nerve root, frequently involving the lumbosacral ligament (LSL). Conventional piecemeal resection of the LSL may increase the risk of postoperative dysesthesia due to repeated manipulation near the L5 dorsal root ganglion (DRG). This study introduces a novel unilateral biportal endoscopic (UBE) technique for en bloc resection of the LSL. Methods: The technique is based on an osteoclastic release strategy in which the bony attachments of the LSL, including the inferior aspect of the L5 transverse process and the sacral ala, are drilled and released before addressing the ligament itself. This maneuver elevates the LSL away from the underlying L5 DRG and achieves en bloc removal under direct endoscopic visualization. Results: En bloc resection may improve visualization within the narrow extraforaminal corridor and may reduce direct mechanical manipulation of the L5 DRG, which could potentially translate into reduced postoperative dysesthesia. The presented technique enabled effective decompression without repeated instrument insertion beneath the ligament. Conclusions: UBE-assisted en bloc resection of the LSL is a feasible and potentially neuroprotective technique for treating lumbosacral extraforaminal lesions.
Lee et al. (Thu,) studied this question.