Technical Note: A Protocol to Preserve the Dural Safety Margin During Simultaneous Hybrid Lumbar Unilateral Biportal Endoscopy and Cervical Laminoplasty

Simultaneous hybrid surgery makes the cervical dura susceptible to injury due to hydraulic coupling. Hydrostatic pressure from lumbar irrigation causes cervical dural bulging, increasing iatrogenic durotomy risk. Surgeons must coordinate to pause lumbar irrigation during critical cervical manipulation to ensure dural relaxation [10].