ASIAN ORTHOPEDIC SPINE INSTITUTE

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WUBES 2023 Tht 1st World Congress of Unilateral Biportal Endoscopic Spine Surgery WUBES2023,wubes2023,wubes,The World UBE Society

C3 & C4 right UBE Laminectomies with C3-C4 Foraminotomy-Discectomy (instead of posterior OPEN decompression and FUSION)

Patient in his 50s presenting in less than a year with radiating pain down his right shoulder and arm, with associated weakness in grip strength of both hands (R > L), and a mild decrease in balance while walking. He has no instability pain of the neck, no loss of cervical lordosis, no disc space collapse.

He was initially seen in a big city private hospital and was offered posterior OPEN decompression and instrumented FUSION (using screws & rods). He chose to seek another solution to his problem due to the fact that:

#1, the proposed open fusion surgery was over 2x more expensive than a much simpler endoscopic decompression procedure;

#2, the large open incision & long recovery time were not acceptable for him, and;

#3, he did not want metal implants to be placed in his spine and lose motion in his neck.

He was eventually referred after conservative management could no longer give him any relief. And he underwent a 2-level UBE decompression procedure using a simple endoscopic sliding technique for decompressing two cervical levels, C3 and C4, without any additional skin openings.

Less than 24 hours after the UBEss procedure, the patient was already reporting clinically significant improvement in his upper limbs & shoulders (especially with pain resolution and strength increase in his right shoulder & arm). Post-op pain level was minimal, and his main complaint was more of "stiff neck" rather than op site pain. I discharged him after just 36 hours of post-op observation.

At his clinic follow-up 2 weeks later, he continued to report upper limb improvement, as well as beginning improvement in gait stability. His port hole incisions were completely healed by then.

Res ipsa loquitur.

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Diagnostic UTZ-guided left L4-L5 facet joint block & corticosteroid injection to confirm the pain origin and relieve clinically significant left lower lumbar back pain & spasm in a 29 year old seaman who was initially advised to undergo open L4-L5 instrumented fusion surgery...

Patient has no radiculopathy, no spondylolisthesis, no degenerated discs, no foraminal stenosis -- just some degenerative changes of the left L4-L5 facet joint (which initially seemed disproportionately mild for the amount of low back pain which the patient was suffering from).

Upon intra-articular facet injection of anesthetic mixed with methylprednisolone, the patient immediately reported significantly huge relief of pain. His ability to walk/stand in a fully upright position returned. (He was pre-operatively walking with his body flexed/bent over at the waist due to pain & muscle spasm.)

Now that we've ascertained that the left L4-L5 joint is the source of his pain, I've offered him two possible treatment options:

#1 - we ablate the superior & inferior sensory nerves that supply sensation to the facet joint (i.e., rhizotomy) by percutaneously inserting an endoscopic bipolar cautery probe and burning the two said nerves...

OR

#2 - perform a biportal endoscopic total facetectomy, followed by insertion of an interbody graft + pedicle screws & rod (i.e., UBE-TLIF).

It will be up to the patient to choose which of the two definitive treatments he would prefer to get.