Abstract
A systematic review of contemporary lumbar endoscopic decompression
techniques shows that the lion’s share of lumbar endoscopic decompressions is done
via the transforaminal and interlaminar approach. Many modifications and diverse
applications for the more complex clinical applications have been described. Clinical
outcomes in well-trained, experienced hands suggest that these modified endoscopic
procedures are genuine advances. However, from the point of view of the communitybased or academic traditionally trained spine surgeon adoption of these complex
endoscopic procedures may still seem either impractical or out of reach when these
endoscopic procedures are considered for each individual patient. The surgeon will
have to figure out how to implement these procedures into their routine clinical
operations by replacing the well-tried, time-proven and reliable open or other forms of
minimally invasive spine surgeries. Recognizing a surgical technique's clinical
advantages over another is one thing, but transforming one's practice is much more
complex and depends not only on one's training or comfort level, but in most cases, the
actual experience for each surgeon that will evolve due to the feedback from their
patients. In patients who have experienced both the transforaminal and translaminar
endoscopic approach, each surgeon will likely use the approach that gives the safest,
most cost-effective, as well as the approach chosen by the surgeon for each
anatomically based and guided approach. Many additional factors could potentially
impede endoscopic spine surgery implementation, most of which will evolve, as the
surgeon circle around the anatomic limitations of each approach. The availability or
lack of equipment, trained staff, and support system also plays a role.
The institutionalized spine surgeons may encounter additional hurdles since endoscopic
spine surgery's disparate nature may disrupt well-established revenue cycles, making its
implementation difficult. The surgeon's institutions may have to shoulder the burden of
capital equipment purchases while facing lower reimbursement. To aid the prospective
endoscopic spine surgeons in overcoming these implementation hurdles, the authors
aimed to provide a systematic step-by-step comparison of the lumbar endoscopic overthe-top versus the transforaminal decompression techniques to illustrate their various
technical aspects and clinical indications to aid the reader in selecting a “preferred”
endoscopic technique
Keywords: Endoscopy, Lumbar endoscopic surgery, Over the top technique, Transforaminal approach.