J Minim Invasive Spine Surg Tech.  2025 Jul;10(Suppl 2):S192-S200. 10.21182/jmisst.2025.02005.

Navigating Through Uncharted Waters: A Review of the Endoscopic Anatomy of the Lumbar Spine as Seen via the Unilateral Biportal Endoscopic Approach in Over 1,000 Operated Levels –A Technical Note

• Ketan D
• Nair V
• Fazal R
• Vasavada A
• Chaudhary N

• KMID: 2571369
• DOI: http://doi.org/10.21182/jmisst.2025.02005

Abstract

The advent of minimally invasive spine surgery has revolutionised the treatment of lumbar degenerative disorders, significantly reducing postoperative complications. This paper discusses the intricate anatomy that is crucial for successful unilateral biportal endoscopy (UBE) procedures in the lumbar spine, highlighting key observations and practical insights. The authors begin by emphasizing the importance of preoperative planning and detailed examination of the spinous process (SP), laminae, and their junctions. Specific considerations such as SP size, orientation, and tilt angles are discussed, along with their implications for surgical access and decompression efficacy. The paper further explores the anatomy of the lamina-facetal junction and facet joints, which are crucial landmarks for bone removal while preserving stability. The ligamentum flavum, its layers, attachments, lateral extensions and implications for dural protection and nerve roots during surgery receive special attention. Detailed insights into visualizing the dura, nerve roots, and suspensory ligaments are provided, highlighting challenges and strategies for safe dissection and decompression. Overall, this paper offers a comprehensive understanding of endoscopic lumbar spine anatomy, addressing challenges faced by novice endoscopic surgeons and providing valuable guidance for a smoother transition into mastering UBE procedures. This knowledge is essential for mitigating risks, improving surgical outcomes, and shortening the learning curve in this advanced surgical domain.

Keyword

Unilateral biportal endoscopy; Anatomy; Lumbar spine; Endoscopic anatomy