Right-Sided Approach to a Right-Sided Lumbar Pathology by a Right-Handed Surgeon Standing on the Right Side via Unilateral Biportal Endoscopy – A Technical Report

Spine surgery has evolved tremendously over the last 2 decades, moving from conventional open spine surgery to minimally invasive spine surgery. Minimally invasive spine surgery prevents damage to the paraspinal muscles, reduces intraoperative blood loss, shortens the surgical time, and avoids traditional open surgery. Thus, in the majority of cases, recovery is much quicker and patients have less back pain after surgery. Previous literature has proven the advantages of uniportal full-endoscopic spine procedures and unilateral biportal endoscopy (UBE) procedures. However, a steep learning curve is a critical barrier for most endoscopic procedures. Recently, biportal endoscopic spine surgical methods have been developed to make it easier for aspiring spine surgeons to learn and implement. UBE utilizes 2 portals—namely, a working portal and a viewing portal—to perform spinal decompression. A right-handed surgeon stands on the left side of a prone and anesthesia induced patient to plan the working and viewing portals under C -arm fluoroscopy. The working portal is marked caudally on the medial pedicle line (caudal pedicle) targeting the spinolaminar junction of the cranial vertebra of the involved level, and the viewing portal is marked cranially, targeting the same spot on the same line on the cranial pedicle. A problem arises when the spinal pathology is located on the right side of the patient’s spine. Therefore, the authors describe a technique through which a right-handed surgeon can tackle a right-sided spinal pathology through a right-sided approach.