O-arm navigation-based transforaminal unilateral biportal endoscopic discectomy for upper lumbar disc herniation: an innovative preliminary study

Study Design: Technical case report.Purpose: To present a novel navigation-assisted transforaminal unilateral biportal endoscopy (UBE) lumbar discectomy technique for managing upper lumbar disc herniation. Overview of Literature: Upper lumbar disc herniation is significantly less common than lower lumbar disc herniation, accounting for only 1%–2% of cases. However, treatment is more challenging and is associated with worse outcomes. Anatomical differences between the upper and lower lumbar spine complicate the standard interlaminar approach using UBE, making it insufficient for complete removal of herniated discs. Integrating endoscopic spine surgery with intraoperative navigation provides three-dimensional computer-reconstructed visual data, thereby enhancing the feasibility of the technique.Methods: The UBE approach targeted the ventral part of the superior articular process in the transforaminal UBE setup, specifically for upper lumbar disc herniation, with an approach angle of approximately 30º on the axial plane. Intraoperative navigation was employed to improve puncture accuracy for this relatively unfamiliar surgical technique. Navigation-assisted transforaminal UBE lumbar discectomy was performed on four patients presenting with back or leg discomfort due to disc herniation at the L1–L2 or L2–L3 levels.Results: All patients experienced symptom relief and were discharged on postoperative day 2.Conclusions: Transforaminal UBE lumbar discectomy is a viable therapeutic option for upper lumbar paracentral disc herniation, which is typically associated with poor prognosis. Integrating navigation integration into this novel approach enhances precision and safety.