BACKGROUND AND IMPORTANCE: Lumbar drain placement is a common neurosurgical procedure, with several surgical and medical indications extending even beyond the specialty. One complication of placement is a fractured catheter fragment. In some circumstances, catheter retrieval is necessary which is classically performed through an open approach. Here, we present the only reported case of a retained lumbar drain catheter which was retrieved using a transforaminal endoscopic approach to the lumbar spine. CLINICAL PRESENTATION: This is a 39 year-old woman who underwent an elective craniotomy with planned perioperative lumbar drain placement for cerebrospinal fluid diversion using a 14-gauge Tuohy needle. Placement was noted to be technically challenging, and during the final attempt on removal of the system, it was noted that the distal end of the catheter had been sheared and retained in the thecal sac. Postoperatively a computed tomography scan of the lumbar spine was obtained showing the catheter fragment which entered the thecal sac dorsally at the L3-4 level but penetrated the ventral dura traveling in the epidural space caudally and terminating in the left lateral recess of L4-5. Given its presumed epidural location near the left L4-5 lateral recess and foramen, the decision was made to attempt a left transforaminal endoscopic approach for catheter retrieval before resorting to a standard open surgery. CONCLUSION: As minimally invasive spine techniques for spine surgery continue to evolve, we have highlighted the versatility of the endoscope in spine surgery as it was implemented in our case, allowing for reduced perioperative morbidity associated with retained spinal catheter retrieval.

The transforaminal (TF) and interlaminar (IL) approaches compose the two endoscopic approaches to lumbar discectomy. There is a growing tendency to utilize the TF route for higher lumbar disc herniations and the IL approach related to anatomical factors for the caudal lumbar levels. The L5-S1 level produces a particular challenge due to anatomical barriers, including the height of the iliac crest and the orientation of the facet when confronted with a lateral or far-lateral disc herniation. Traditional approaches can lead to significant joint destabilization in the effort to resect the disc fragment Here we present an operative video with technical nuances of the TF approach utilized to perform both a far-lateral and paracentral discectomy at L5-S1 to treat a 52-year-old male with two distinct and noncontiguous herniations with severe acute right-sided L5 and S1 radiculopathy. This would have otherwise required either two different endoscopic approaches or a more extensive open approach for successful discectomy

Background: The endoscopic approach to the spine has a steep learning curve, primarily due to challenges in learning how to access Kambin’s triangle, leading to significant radiation exposure. Real-time live instrument tracking using two-dimensional fluoroscopic navigation has been shown to significantly reduce the time and radiation exposure needed to perform a trans-Kambin approach; however, the impact on the learning curve for those in training has not been studied. Methods: Physicians in training (PITs) in a single program were evaluated while accessing Kambin’s triangle using a gel sawbone model. The PITs were randomized in terms of spinal level, the technology used first, and the approach side. Time to access Kambin’s triangle and radiation were recorded for each cohort. A linear regression model was used to assess associations between procedure time and radiation exposure and endoscopic experience and PGY level. Results: Seven PITs were studied with a range of prior experience, consisting of three PITs with high exposure (HE) (≥30 cases) and four with low exposure (LE) (0–20 cases, averaging 7.5). Unassisted by instrument tracking, the SE group was 63% faster and was exposed to 63% less radiation. Further, there was a moderate correlation with experience and time (R = −0.52) and radiation (R = −0.60). Using instrument tracking allowed all the PITs to be 40% faster, taking 6.6 min (range 2.9–12.4) without instrument tracking and 4.0 min (1.9–6.3) with it. Radiation also decreased by 91% (2.52 vs. 0.23 mGy with instrument tracking). Conclusions: Experience significantly enhanced the accessibility of Kambin’s triangle, reducing time and radiation exposure by about two-thirds. Regardless of experience, instrument tracking reduced radiation exposure by 90%. Additionally, familiarizing PITs with instrument location can eliminate 70% of the learning curve for those inexperienced with accessing Kambin’s triangle.

BACKGROUND: Pyogenic spondylodiscitis diminishes spinal structural integrity via disruption of the anterior and middle column, sometimes further compounded by iatrogenic violation of the posterior tension band during initial posterior decompressive surgeries. Although medical management is typically sufficient, refractory infection or progressive deformity may require aggressive debridement and reconstructive arthrodesis. Although anterior debridement plus reconstruction with posterior stabilization is an effective treatment option, existing techniques have limited efficacy for correcting focal deformity, leaving patients at risk for long-term sagittal imbalance, pain, and disability. OBSERVATIONS: The authors present a case of chronic lumbar pyogenic spondylodiscitis in a patient in whom initial surgical debridement failed and pronounced angular kyphosis and intractable low back pain developed. A novel bipedicular handlebar construct was used to achieve angular correction of the kyphosis through simultaneous anterior interbody grafting and posterior instrumentation with the patient in the lateral position. LESSONS: Leveraging both pedicle screws at the same level to transmit controlled corrective distraction forces through the segment allows for kyphosis correction without relying on long posterior constructs for cantilever reduction. Simultaneous anterior reconstruction with a posterior short lever arm, bipedicular handlebar construct is an effective technique for achieving high angular correction during circumferential reconstructive approaches to postinfectious focal kyphotic deformities.