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In this digital collection, you will find all resources given to attendees of the Endoscopic Approaches to Spine Level I course.

Endoscopic Approaches to Spine Level I Resources

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Arthrex Inc. 1370 Creekside Boulevard, Naples, Florida 34108-1945 Tel: 800-933-7001 or 239-643-5553 Fax: 239-591-6980 www.arthrex.com Thank you for including Arthrex in your evaluation to determine the best partner for your health system to launch an endoscopic spine program. As a global leader in sports medicine and surgical education, Arthrex continually strives to provide surgeons and patients with groundbreaking ultra-minimally invasive and motion-preserving procedures. Innovation in the medical device industry is largely driven by manufacturers. As a privately held company with no outside investors, we are uniquely positioned to rapidly develop new technologies and advance truly minimally invasive procedures that prioritize surgeon needs and patient outcomes over company profits. Limited, nonpermanent options for back pain mean patients must often undergo frequent treatments and invasive procedures that result in limited motion, damage to soft-tissue anatomies, and unsightly scars. Put simply, there is a gap in today’s continuum of care between conservative treatment and maximally invasive surgical procedures. Arthrex seeks to bridge that gap by leveraging more than 40 years of expertise in orthopedics to introduce our innovations in the spine space. Through our endoscopic surgical approaches and orthobiologic solutions, we aim to spare soft tissue, preserve motion, and achieve the best possible outcomes for patients. Our commitment to advancing minimally invasive spine solutions is supported by an extensive education infrastructure. Arthrex has more than 100 cadaveric surgical skills labs across the country, and we provide around 125 corporate training courses at the Naples headquarters annually, empowering surgeons worldwide. We currently train more than 50,000 orthopedic sports medicine surgeons each year and are excited to extend this value to orthopedic and neurospine surgeons. Since entering the spine market, we have trained more than 350 surgeons via our dedicated endoscopic spine courses and local agency labs. Arthrex has more than 3800 field-based representatives in the US, ensuring surgeons always have local representation whose sole focus is to support Arthrex products. Our endoscopic spine-specific curriculum pathway includes expert-led instruction, immersive hands-on training in a dedicated spine lab, and comprehensive practice support. This world-class medical education ensures that less-invasive spine surgery is accessible, safe, and reproducible. By developing our products and procedures with unwavering dedication to innovation, unmatched provider education, and scientific research, we set surgeons and facilities up for success in endoscopic spine approaches. Together, we can expand your treatment offerings, maximize practice efficiency, and help make active lifestyles a reality for millions of patients. Sincerely, Zak Kemp Director, Global Spine © 2026-04 Arthrex, Inc. All rights reserved. DOC1-001606-en-US_B

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Essential documents for office operations and account management.

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Office Forms & Reference Documents

Instrument Checklist Customer Name: For tray customization, refer to catalog and recommended instrument sets Please contact your Arthrex Technology Consultant for more information. Customized Sets Access Product Description Item Number Spine Access Kit, disposable AR-S4000K-S Guidewire, 0.7 mm × 400 mm AR-S4000-007-400 Guidewire, nitinol, 0.8 mm × 400 mm AR-S4000-008-400 Quantity Dilation Dilators Product Description Item Number Quantity 6-Step Series Dilator, 2.5 mm × 230 mm AR-S6524-025-230 Dilator, 4.1 mm × 220 mm AR-S6524-041-220 Dilator, 5.1 mm × 210 mm AR-S6524-051-210 Dilator, 6 mm × 200 mm AR-S6524-060-200 Dilator, 7 mm × 190 mm AR-S6524-071-190 Dilator, 10.1 mm × 160 mm AR-S6524-101-160 4-Step Series Dilator, 3 mm × 230 mm AR-S6524-030-230 Dilator, 6 mm × 210 mm AR-S6524-060-210 Dilator, 7 mm × 190 mm AR-S6524-070-190 Dilator, 10.1 mm × 170 mm AR-S6524-101-170 3-Step Series XL Dilator, 3 mm × 250 mm AR-S6524-030-250 Dilator, 6 mm × 235 mm AR-S6524-060-235 Dilator, 7 mm × 220 mm AR-S6524-070-220 Single-Step Dilators Product Description Item Number Switching stick, 6.3 mm × 225 mm AR-S3020-063-225 Switching stick, 6.3 mm × 265 mm AR-S3020-063-265 Switching stick, 7 mm × 225 mm AR-S3020-070-225 Switching stick, 7 mm × 265 mm AR-S3020-070-265 Switching stick, 10 mm × 185 mm AR-S3020-100-185 One-step dilator, 6.3 mm × 225 mm AR-S3025-063-225 One-step dilator, 6.3 mm × 265 mm AR-S3025-063-265 One-step dilator, 7 mm × 225 mm AR-S3025-070-225 One-step dilator, 7 mm × 265 mm AR-S3025-070-265 One-step dilator, 10 mm × 185 mm AR-S3025-100-185 02 | Instrument Checklist Quantity Cannulas 6.3 mm Scope Product Description Item Number Cannula, w/ oblique window, 7.5 mm × 125 mm, 30° AR-S3420-075-12530 Cannula, w/ oblique window, 7.5 mm × 125 mm, 40° AR-S3420-075-12540 Cannula, w/ oblique window, 7.5 mm × 125 mm, 55° AR-S3420-075-12555 Cannula, w/ elevator tip, 7.5 mm × 125 mm AR-S3420-075-125ET Cannula, w/ oblique window, 7.5 mm × 155 mm, 30° AR-S3420-075-15530 Cannula, w/ oblique window, 7.5 mm × 155 mm, 40° AR-S3420-075-15540 Cannula, w/ oblique window,: 7.5 mm × 155 mm, 55° AR-S3420-075-15555 Cannula, w/ elevator tip, 7.5 mm × 155 mm AR-S3420-075-155ET Cannula, w/ oblique window, 7.5 mm × 178 mm AR-S3420-075-178 Cannula, w/ oblique window, 7.5 mm × 178 mm, 30° AR-S3420-075-17830 Cannula, w/ oblique window, 7.5 mm × 178 mm, 40° AR-S3420-075-17840 Cannula, w/ oblique window, 7.5 mm × 178 mm, 55° AR-S3420-075-17855 Cannula, w/ elevator tip, 7.5 mm × 178 mm AR-S3420-075-178ET Cannula, w/ open tip, 7.5 mm × 178 mm AR-S3420-075-178OT Cannula, w/ oblique window, 7.5 mm × 212mm, 30° AR-S3420-075-21230 Cannula, w/ elevator tip, 7.5 mm × 212mm AR-S3420-075-212ET Cannula, w/ open tip, 7.5 mm × 212mm AR-S3420-075-212OT Quantity 7 mm Scope Product Description Item Number Cannula, w/ oblique window, 8 mm × 125 mm AR-S3420-080-125 Cannula, w/ oblique window, 8 mm × 125 mm, 30° AR-S3420-080-12530 Cannula, w/ oblique window, 8 mm × 125 mm, 40° AR-S3420-080-12540 Cannula, w/ oblique window, 8 mm × 125 mm, 55° AR-S3420-080-12555 Cannula, w/ elevator tip, 8 mm × 125 mm AR-S3420-080-125ET Cannula, w/ oblique window, 8 mm × 155 mm, 30° AR-S3420-080-15530 Cannula, w/ oblique window, 8 mm × 155 mm, 40° AR-S3420-080-15540 Cannula, w/ oblique window, 8 mm × 155 mm, 55° AR-S3420-080-15555 Cannula, w elevator tip, 8 mm × 155 mm AR-S3420-080-155ET Cannula, w/ oblique window, 8 mm × 178 mm AR-S3420-080-178 Cannula, w/ oblique window, 8 mm × 178 mm, 30° AR-S3420-080-17830 Cannula, w/ oblique window, 8 mm × 178 mm, 40° AR-S3420-080-17840 Cannula, w/ oblique window, 8 mm × 178 mm, 55° AR-S3420-080-17855 Cannula, w/ elevator tip, 8 mm × 178 mm AR-S3420-080-178ET Cannula, w/ open tip, 8 mm × 178 mm AR-S3420-080-178OT Cannula w/ oblique window, 8 mm × 212 mm, 30° AR-S3420-080-21230 Cannula w/ elevator tip, 8 mm × 212 mm AR-S3420-080-212ET Cannula w/ open tip, 8 mm × 212 mm AR-S3420-080-212OT Quantity 10 mm Scope Product Description Item Number Cannula, w/ oblique window, 11 mm × 134 mm AR-S3420-110-134 Cannula, w/ oblique window, 11 mm × 134 mm, 30° AR-S3420-110-13430 Cannula, w/ oblique window, 11 mm × 134 mm, 40° AR-S3420-110-13440 Cannula, w/ oblique window, 11 mm × 134 mm, 55° AR-S3420-110-13455 Cannula, w/ elevator tip, 11 mm × 134 mm AR-S3420-110-134ET Cannula, w/ flat tip, 11 mm × 134 mm AR-S3420-110-134FT Quantity Instrument Checklist | 03 Endoscopes Product Description Item Number Spine endoscope, 6.3 mm × 130 mm, 15° AR-S3350-6315-130 Spine endoscope, 6.3 mm × 181 mm, 15° AR-S3350-6315-181 Spine endoscope, 6.3 mm × 130 mm, 30° AR-S3350-6330-130 Spine endoscope, 6.3 mm × 181 mm, 30° AR-S3350-6330-181 Spine endoscope, 6.3 mm × 215 mm, 30° AR-S3350-6330-215 Spine endoscope, 7 mm × 130 mm, 15° AR-S3350-7015-130 Spine endoscope, 7 mm × 181 mm, 15° AR-S3350-7015-181 Spine endoscope, 7 mm × 130 mm, 30° AR-S3350-7030-130 Spine endoscope, 7 mm × 181 mm, 30° AR-S3350-7030-181 Spine endoscope, 7 mm × 215 mm, 30° AR-S3350-7030-215 Spine endoscope, 10 mm × 139 mm, 15° AR-S3350-1015-139 Quantity Instruments Pistol Grip Short - 260 mm Product Description Item Number Cup forceps, 2.5 mm × 260 mm AR-S7110-025-260 Cup forceps, 3.5 mm × 260 mm AR-S7110-035-260 Cup forceps, 4 mm × 260 mm AR-S7110-040-260 Hook scissors, 2.5 mm × 260 mm AR-S7115-025-260 Scissor punch, 2 mm × 260 mm AR-S7116-020-260 Scissor punch, 2.5 mm × 260 mm AR-S7116-025-260 Scissor punch, up angle, 3.5 mm × 260 mm AR-S7116-035U-260 Scissor punch, 4 mm × 260 mm AR-S7116-040-260 Cup grasper, serrations, 2 mm × 260 mm AR-S7121-020-260 Cup grasper, semiflexible, 3 mm × 260 mm AR-S7125-030F-260 Quantity Long - 330 mm Product Description Item Number Cup forceps, up angle, 2 mm × 330 mm AR-S7110-020U-330 Cup forceps, 2.5 mm × 330 mm AR-S7110-025-330 Cup forceps, up angle, 2.5 mm × 330 mm AR-S7110-025U-330 Cup forceps, 3 mm × 330 mm AR-S7110-030-330 Cup forceps, 3.5 mm × 330 mm AR-S7110-035-330 Cup forceps, 4 mm × 330 mm AR-S7110-040-330 Duckling punch, 2.5 mm × 330 mm AR-S7111-025-330 Duckling punch, 3.5 mm × 330 mm AR-S7111-035-330 Hook scissors, 2.5 mm × 330 mm AR-S7115-025-330 Scissor punch, 2.5 mm × 330 mm AR-S7116-025-330 Scissor punch, up angle, 2.5 mm × 330 mm AR-S7116-025U-330 Blakesley forceps, 3.5 mm × 330 mm AR-S7118-035-330 Cup grasper w/ teeth, 2.5 mm × 330 mm AR-S7120-025-330 Cup grasper w/ serrations, 2 mm × 330 mm AR-S7121-020-330 Cup grasper w/ teeth, semiflexible, 2.5 mm × 330 mm AR-S7125-025F-330 Cup grasper, semiflexible, 3 mm × 330 mm AR-S7125-030F-330 04 | Instrument Checklist Quantity WishBone™ Handle Instruments Short - 260 mm Product Description Item Number Cup forceps, 2.5 mm × 260 mm, WishBone handle AR-S7110-025-260W Cup forceps, 3.5 mm × 260 mm, WishBone handle AR-S7110-035-260W Cup forceps, 4 mm × 260 mm, WishBone handle AR-S7110-040-260W Hook scissors, 2.5 mm × 260 mm, WishBone handle AR-S7115-025-260W Scissor punch, 2 mm × 260 mm, WishBone handle AR-S7116-020-260W Scissor punch, 2.5 mm × 260 mm, WishBone handle AR-S7116-025-260W Scissor punch, up angle, 3.5 mm × 260 mm, WishBone handle AR-S7116-035U-260W Scissor punch, 4 mm × 260 mm, WishBone handle AR-S7116-040-260W Cup grasper, serrations, 2 mm × 260 mm, WishBone handle AR-S7121-020-260W Cup grasper, semiflexible, 3 mm × 260 mm, WishBone handle AR-S7125-030F-260W Quantity Long - 330 mm Product Description Item Number Cup forceps, up angle, 2 mm × 330 mm, WishBone handle AR-S7110-020U-330W Cup forceps, 2.5 mm × 330 mm, WishBone handle AR-S7110-025-330W Cup forceps, up angle, 2.5 mm × 330 mm, WishBone handle AR-S7110-025U-330W Cup forceps, 3 mm × 330 mm, WishBone handle AR-S7110-030-330W Cup forceps, 3.5 mm × 330 mm, WishBone handle AR-S7110-035-330W Cup forceps, 4 mm × 330 mm, WishBone handle AR-S7110-040-330W Duckling punch, 2.5 mm × 330 mm, WishBone handle AR-S7111-025-330W Duckling punch, 3.5 mm × 330 mm, WishBone handle AR-S7111-035-330W Hook scissors, 2.5 mm × 330 mm, WishBone handle AR-S7115-025-330W Scissor punch, 2.5 mm × 330 mm, WishBone handle AR-S7116-025-330W Scissor punch, up angle, 2.5 mm × 330 mm, WishBone handle AR-S7116-025U-330W Blakesley forceps, 3.5 mm × 330 mm, WishBone handle AR-S7118-035-330W Cup grasper, w/ teeth, 2.5 mm × 330 mm, WishBone handle AR-S7120-025-330W Cup grasper, w/ serrations, 2 mm × 330 mm, WishBone handle AR-S7121-020-330W Cup grasper, w/ teeth, semiflexible, 2.5 mm × 330 mm, WishBone handle AR-S7125-025F-330W Cup grasper, semiflexible, 3 mm × 330 mm, WishBone handle AR-S7125-030F-330W Quantity Hand Instruments Product Description Item Number Hook probe, 2.5 mm × 260 mm AR-S10030-025-260 Hook probe, 2.5 mm × 310 mm AR-S10030-025-310 Blunt dissector, 2.5 mm × 310 mm AR-S1342-025-310 Osteotome, 3 mm × 260 mm AR-S1342-030-260 Bone curette, 2 mm × 260 mm AR-S7305-020-260 Bone curette, 3.5 mm × 330 mm AR-S7305-035-330 Osteotome, 3 mm × 310 mm AR-S7323-030-310 Bone chisel, V cut, 3 mm × 310 mm AR-S7323-030V-310 Bone awl, 3 mm × 310 mm AR-S7324-030-310 Bone curette down biting, 3.5 mm × 330 mm AR-S7305-035D-330 Quantity Instrument Checklist | 05 Articulating Ball-Tip Probes Product Description Item Number Probe, articulating, 3 mm × 330 mm AR-S7310-030-330 Kerrison/ball-tip probe, handle AR-S7400-000-000H Kerrison/ball-tip probe, WishBone™ handle AR-S7400-000-000W Ball-tip probe shaft, flexible, 1.8 mm × 330 mm AR-S7405-018-330 Ball-tip probe shaft, flexible, 2.4 mm × 330 mm AR-S7405-024-330 Quantity Kerrisons Handles Product Description Item Number Kerrison/ball-tip probe, handle AR-S7400-000-000H Kerrison/ball-tip probe, w/ WishBone handle AR-S7400-000-000W Quantity Short - 260 mm Product Description Item Number Kerrison, 2.5 mm × 260 mm, 40° AR-S7440-025-260 Kerrison, 3.5 mm × 260 mm, 40° AR-S7440-035-260 Kerrison, 4 mm × 260 mm, 40° AR-S7440-040-260 Kerrison, up angle, 4 mm × 260 mm, 40° AR-S7440-040U-260 Kerrison, 5 mm × 260 mm, 40° AR-S7440-050-260 Kerrison, 6 mm × 260 mm, 40° AR-S7440-060-260 Kerrison, 3 mm × 260 mm, 90° AR-S7490-030-260 Kerrison, 4 mm × 260 mm, 90° AR-S7490-040-260 Kerrison, 5 mm × 260 mm, 90° AR-S7490-050-260 Kerrison, 6 mm × 260 mm, 90° AR-S7490-060-260 Quantity Long - 260 mm Product Description Item Number Kerrison, 2.5 mm × 360 mm, 40° AR-S7440-025-360 Kerrison, 3.5 mm × 360 mm, 40° AR-S7440-035-360 Kerrison, 4 mm × 360 mm, 40° AR-S7440-040-360 Kerrison, 3.5 mm × 360 mm, 90° AR-S7490-035-360 Kerrison, 4 mm × 360 mm, 90° AR-S7490-040-360 Quantity Rasps/Trephines Product Description Item Number Trephine handle AR-S7700-000-000H Trephine protection tube, 6 mm × 160 mm AR-S7700-060-160 Trephine protection tube, 7.5 mm × 160 mm AR-S7700-075-160 Trephine protection tube, 8.5 mm × 160 mm AR-S7700-085-160 06 | Instrument Checklist Quantity Trephines Product Description Item Number Trephine, 3.55 mm × 350 mm AR-S7705-035-350 Trephine, 5.1 mm × 225 mm AR-S7705-051-225 Trephine, 6.6 mm × 225 mm AR-S7705-066-225 Trephine, 7.6 mm × 225 mm AR-S7705-076-225 Quantity Rod Pushers Product Description Item Number Rod pusher, 2.5 mm AR-S6524-025-230P Rod pusher, 4 mm AR-S6524-040-230P Rod pusher, 5 mm AR-S6524-050-230P Quantity Rasps Product Description Item Number Rasp, 5.1 mm × 260 mm AR-S7715-051-260 Rasp, 6.6 mm × 260 mm AR-S7715-066-260 Rasp, 7.6 mm × 260 mm AR-S7715-076-260 Rasp, 8.8 mm × 260 mm AR-S7715-088-260 Quantity Accessories Endoscope Accessories Product Description Item Number Stopcock AR-S3350-000-001 Spine endoscope depth stop, 6.3 mm AR-S3350-063-DS Spine endoscope disposable depth stop, 6.3 mm AR-S3350-063-DS-S Spine endoscope depth stop, 7 mm AR-S3350-070-DS Spine endoscope disposable depth stop, 7 mm AR-S3350-070-DS-S Spine endoscope depth stop, 10 mm AR-S3350-100-DS Spine endoscope disposable depth stop, 10 mm AR-S3350-100-DS-S Quantity Cannula Accessories Product Description Item Number Cannula holder AR-S3420-CH Quantity Spare Caps Product Description Item Number Spare cap, endoscope, blue, 1 mm AR-S3375-100-BLU Spare cap, endoscope, green, 1 mm AR-S3375-100-GRE Spare cap, endoscope, yellow, 1 mm AR-S3375-100-YEL Spare cap, endoscope, blue, 2 mm AR-S3375-200-BLU Spare cap, endoscope, green, 2 mm AR-S3375-200-GRE Spare cap, endoscope, yellow, 2 mm AR-S3375-200-YEL Spare cap, cannula, blue, 3.75 mm AR-S3375-375-BLU Quantity Instrument Checklist | 07 Spare Caps (Cont.) Product Description Item Number Spare cap, cannula, green, 3.75 mm AR-S3375-375-GRE Spare cap, cannula, yellow, 3.75 mm AR-S3375-375-YEL Spare cap, endoscope, blue, sterile, 1 mm AR-S3375-100-BLU-S Spare cap, endoscope, green, sterile, 1 mm AR-S3375-100-GRE-S Spare cap, endoscope, yellow, sterile, 1 mm AR-S3375-100-YEL-S Spare cap, endoscope, blue, sterile, 2 mm AR-S3375-200-BLU-S Spare cap, endoscope, green, sterile, 2 mm AR-S3375-200-GRE-S Spare cap, endoscope, yellow, sterile, 2 mm AR-S3375-200-YEL-S Spare cap, endoscope, blue, sterile, 3 mm AR-S3375-300-BLU-S Spare cap, endoscope, green, sterile, 3 mm AR-S3375-300-GRE-S Spare cap, endoscope, yellow, sterile, 3 mm AR-S3375-300-YEL-S Spare cap, endoscope, green, sterile, 4 mm AR-S3375-400-GRE-S Spare cap, endoscope, yellow, sterile, 4 mm AR-S3375-400-YEL-S Spare cap, cannula, blue, sterile, 5 mm AR-S3375-500-BLU-S Spare cap, endoscope, yellow, sterile, 5 mm AR-S3375-500-YEL-S Spare cap, cannula, green, sterile, 5.5 mm AR-S3375-550-GRE-S Spare cap, endoscope, yellow, sterile, 6 mm AR-S3375-600-YEL-S Spare cap, cannula, yellow, sterile, 8.5 mm AR-S3375-850-YEL-S Quantity Miscellaneous Product Description Item Number Mallet AR-S4100-100-000 Extracting forceps AR-S4100-200-100 Rod removal forceps AR-S4100-200-200 Dilator Holder ML-0057 Quantity Cases Product Description Item Number Spine endoscopic case, large AR-S1000-C1 Bottom for 1/1 container height: 247 mm JK446 Full-size lid w/ retention plate blue JK486 Spine endoscopic case, small AR-S1000-C2 Bottom for 1/1 container height: 135 mm JK442 Full-size lid w/ retention plate blue JK486 Spine endoscope case AR-S1000-C3 Bottom for 3/4 container height: 120 mm JK741 3/4-size lid w/ retention plate blue JK786 Spine endoscope accessory case AR-S1000-C3-1 Spine endoscopic Trimano arm case AR-S1000-C4 Spine endoscopic case pin mat AR-S1000-C4-PM Spine endoscopic Trimano arm set AR-S1000-C4S 08 | Instrument Checklist Quantity ElectroSurgery Product Description Item Number Synergy ES console AR-S9800 Synergy ES footswitch w/ handle AR-S9800-F1 Synergy ES footswitch w/o handle AR-S9800-F2 Quantity Probes Product Description Item Number FlexTip probe, 28 cm AR-S9805-0028 FlexTip probe, 35 cm AR-S9805-0035 Quantity Synergy Tower Video Carts Product Description Item Number Monitor Cart, 55 in TP.5112.999 Monitor, 4K, 55 in, MDSC-8255 12G, BARCO K9352361 Dual-monitor video cart AR-3260-0001 Dual-monitor assembly for video cart AR-3260-1012 UHD 4K monitor, LED 32 in, black AR-3250-3211 Quantity Synergy Vision™ System Product Description Item Number Synergy Vision camera control unit AR-3200-0026 Synergy Vision tablet AR-3200-1016 Synergy Visionary™ camera head AR-3210-0034 4K C-mount coupler AR-3210-0012 Tray for camera head AR-3106C Bottom for 3/4 container height: 135 mm JK742 3/4-size lid w/ retention plate blue JK786 Quantity Light Guides Product Description Item Number Light guide, 5 mm × 274 cm, 90° distal end SS9-GYW50W108 Light Guide, 5 mm × 274 cm AR-3240-5027 Quantity Fluid Management Product Description Item Number Y-Inflow Tubing, 7 mm AR-6200 Multiport Suction Tubing, 2 port AR-S1002 Multiport Suction Tubing, 4 port AR-S1004 Quantity Instrument Checklist | 09 Bur Systems SynergyResection™ System Capital Product Description Item Number SynergyResection shaver console AR-8305 Shaver handpiece, footswitch control AR-8330F Shaver handpiece, hand control AR-8330H Synergy Resection single pedal footswitch Quantity AR-S8311 Burs Product Description Item Number Oval bur, retractable, 3 mm × 280 mm AR-SOV-R30-280 Oval bur, retractable, 3 mm × 330 mm AR-SOV-R30-330 Coarse diamond oval bur, retractable, 3 mm × 280 mm AR-SOV-R30-280CD Coarse diamond oval bur, retractable, 3 mm × 330 mm AR-SOV-R30-330CD Quantity High-Speed Drill System (NSK) Capital Product Description Item Number Primado2 control unit for 120 v P200-CU-120 Primado2 single foot control FC-73 Primado2 slim motor P200-SMH Primado2 slim motor HS P200-SMH-HS Primado2 slim motor, short P200-SMH-S Super slim handpiece 200 SPL/L P200-RA330-L Slim attachment hub, angled P300-1AHA Slim tube 240 P300-1T240 Quantity Burs - 330 mm Product Description Item Number Coarse diamond bur, special long, 2 mm PDS-1CD330-20 Coarse diamond bur, special long, 2.5 mm PDS-1CD330-25 Coarse diamond bur, special long, 3 mm PDS-1CD330-30 Coarse diamond bur, special long, 3.5 mm PDS-1CD330-35 Diamond bur, special long, 2 mm PDS-1D330-20 Diamond bur, special long, 2.5 mm PDS-1D330-25 Diamond bur, special long, 3 mm PDS-1D330-30 Diamond bur, special long, 3.5 mm PDS-1D330-35 Quantity Burs - 240 mm Product Description Item Number R Diamond Bur, 240 / 3.0 PDS-1RD240-30 R Diamond Bur, 240 / 4.0 PDS-1RD240-40 R Diamond Bur, 240 / 5.0 PDS-1RD240-50 R Coarse Diamond Bur, 240 / 3.0 PDS-1RCD240-30 R Coarse Diamond Bur, 240 / 4.0 PDS-1RCD240-40 R Coarse Diamond Bur, 240 / 5.0 PDS-1RCD240-50 R Fluted Bur, 240 / 4.0 PDS-1D330-30 10 | Instrument Checklist Quantity Trays and Accessories We recommend selecting and tallying up the instruments on the previous pages before selecting corresponding trays and accessories. Probes Product Description Item Number Spine endoscopic case, large AR-S1000-C1 Location Instrument Type Top WishBone™ handle or pistol instruments 8 Top Elevator / hook probes / bone chisel 6 Middle Guidewires 3 Middle Dilators (set 1) 4 Middle Dilators (set 2) 4 Middle Curved dilator 1 Middle Rod pusher 2 Middle Cannula 4 Middle Trephine protection tube 3 Middle Large switching stick, 10 mm 1 Middle Switching stick 2 Middle Endoscope 1 Middle Rod removal forceps 1 Middle Extracting forceps 1 Middle Trephine handle 1 Middle Rasps/trephines 4 Middle Accessory case 1 Accessory case Spare caps 3 Accessory case Unassembled stopcocks 2 Middle Scope adaptors 2 Bottom WishBone Kerrison handle 2 Bottom Mallet 1 Bottom Kerrison handle 1 Bottom Ball-tip probe shaft 1 Bottom Bone curette 1 Bottom Kerrisons 8 Max Qty Spine endoscopic case, small AR-S1000-C2 Spine endoscope case AR-S1000-C3 Spine endoscope accessory case AR-S1000-C3-1 Spine endoscopic TRIMANO arm case AR-S1000-C4 ® Quantity Instrument Checklist | 11 © 2025-07 Arthrex, Inc. All rights reserved. OF1-000455-en-US_C arthrex.com

Instrument Checklist

A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

Broschüren

Documento contendo informações sobre produtos e linhas de produtos da Arthrex.

Brochuras

Documento que contiene información sobre los productos y líneas de productos de Arthrex.

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Brochures

Join the Endoscopic Spine Evolution Table of Contents 02 | Join the Endoscopic Spine Evolution 05 Arthrex Spine 08 Visualization and Instrumentation 10 Orthobiologics Support 17 Patient Outreach and Education J oin the Endoscopic Spine Evolution | 03 Arthrex Spine As a global leader in sports medicine and surgical education, Arthrex continually strives to provide surgeons and patients with groundbreaking ultra-minimally invasive and motionpreserving procedures. Limited nonpermanent options for back pain mean patients must often undergo frequent treatments and invasive procedures that result in limited motion, damage to soft-tissue anatomies, and unsightly scars. Innovation in the medical device industry is largely driven by manufacturers. As a privately held company, we are uniquely positioned to rapidly develop new technologies and advance ultra-minimally invasive procedures that prioritize surgeon needs and patient outcomes. Put simply, there is a gap in today’s continuum of care between conservative treatment and maximally invasive surgical procedures. Backed by more than 40 years of leadership in sports medicine and surgical education, Arthrex Spine bridges that gap with endoscopic surgical approaches and orthobiologic innovations designed to help spare soft tissue, preserve motion, and provide the best possible outcomes for patients. Learn more about Arthrex Spine 04 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 05 World-class medical education offerings for health care professionals and administrators help make less-invasive surgery simpler, safer, and more reproducible. Our endoscopic spine-specific surgical curriculum pathway includes individualized and expert faculty instruction and immersive, hands-on training in our dedicated spine lab as well as practice support—all designed to help surgeons and facilities succeed with endoscopic spine techniques. We develop our products and procedures with an unwavering dedication to constant innovation, unmatched surgeon education, and world-class scientific research. Together, we can expand your treatment offerings, maximize your practice efficiency, and help make active lifestyles a reality for millions of patients. “ Arthrex is a world leader in less-invasive surgical imaging and product innovation supported by cadaveric surgical skills education and clinically trained representatives across the US to help advance your endoscopic spine proficiency. After 40 years of pioneering arthroscopic surgery, Arthrex is now focused on revolutionizing endoscopic spine surgery. Join the evolution with us. Reinhold Schmieding Arthrex President and Founder Naples, FL 06 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 07 Visualization and Instrumentation FDA-Cleared, Autoclavable 4K Video Camera and Imaging Networking System for Spine Endoscopy Arthrex offers a comprehensive endoscopic spine bur and shaver blade system via the SynergyResection™ platform. This system includes whisker shaver blades for resection and aspiration of soft tissue near neural structures, as well as a variety of bur options with retractable hoods and integrated suction for efficient bone and soft tissue removal during endoscopic spine procedures. Enhanced visualization with the Synergy 4K camera system and operative endoscope Revolutionizing ergonomics with WishBone™ rotating handle and ring-handled endoscopic instrument options Steerable electrosurgery probes designed for endoscopic spine procedures Bring it all together with a comprehensive instrumentation offering 08 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 09 Orthobiologics Support With the Most Comprehensive Orthobiologics Portfolio for Spine Arthrex offers the most extensive orthobiologics portfolio in the spine market, uniquely combining innovation, versatility, and clinical value. From advanced bone graft substitutes to next-generation cellular technologies and biologic delivery systems, Arthrex provides a full continuum of solutions designed to support spinal fusion, tissue healing, and regeneration. 1. Angel® cPRP and Bone Marrow Processing System 2. AlloSync™ Expand Demineralized Cortical Fibers 3. BoneSync™ Synthetic Bone Void Fillers 4. Vortex™ Threaded Bone Marrow Recovery Needle 5. ArthroCell™ Viable Bone Allografts 6. GraftNet™ XL Bone Collection Device 1 10 | Join the Endoscopic Spine Evolution 2 3 4 5 6 J oin the Endoscopic Spine Evolution | 11 Arthrex Graft Gun Validated to Deliver 100% Autograft Bone Chips1 Can deliver graft into the disc space for fusion procedures Designed to provide direct visibility for delivering bone graft through a decompression tube Compatible with any combination of autograft/allograft up to 100% autograft chips Reference 1. Arthrex, Inc. Data on file (APT-1022220). Naples, FL; 2025. 12 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 13 Soft-Tissue Repair and Reconstruction Spine Scorpion™ suture passer can close the fascia up to 75% faster during MIS procedures1 JumpStart® FlexEFit® dressings kill and protect against multiple grampositive and -negative bacteria2-5 The microcurrent technology of JumpStart dressings can reduce the risk of wound infection and promote healing6 References 14 | Join the Endoscopic Spine Evolution 1. Arthrex, Inc. Data on file (APT-05722). Naples, FL; 2021. 2. Banerjee J, Das Ghatak P, Roy S, et al. Silver-zinc redox-coupled electroceutical wound dressing disrupts bacterial biofilm. PLoS One. 2015;10(3):e0119531. doi:10.1371/journal.pone.0119531 3. Kim H, Makin I, Skiba J. Antibacterial efficacy testing of a bioelectric wound dressing against clinical wound pathogens. Open Microbiol J. 2014;8:15-21 doi:10.2174/1874285801408010015 4. Kim H, Izadjoo MJ. Antibiofilm efficacy evaluation of a bioelectric dressing in monoand multi-species biofilms. J Wound Care. 2015;24(Suppl 2):S10-4. doi:10.12968/ jowc.2015.24.Sup2.S10 5. Long DR, Bryson-Cahn C, Pergamit R, et al. 2021 Young Investigator Award winner: anatomic gradients in the microbiology of spinal fusion surgical site infection and resistance to surgical antimicrobial prophylaxis. Spine. 2021;46(3):143-151. doi:10.1097/BRS.0000000000003603 6. Blount AL, Foster S, Rapp DA, Wilcox R. The use of bioelectric dressings in skin graft harvest sites: a prospective case series. J Burn Care Res. 2012:33(3):354-357. doi:10.1097/BCR.0b013e31823356e4 J oin the Endoscopic Spine Evolution | 15 Patient Outreach and Education Patient Outreach Suite The Patient Outreach and Education Resource Kit provides an overview of all available tools for physicians and administrators. It includes descriptions of resources—such as clinic posters, postoperative holographic cards, patient guides—as well as step-by-step instructions for accessing each item, including the media kit and the patient-facing website featuring the Find a Doctor tool. Learn more about patient education 16 | Join the Endoscopic Spine Evolution J oin the Endoscopic Spine Evolution | 17 The Ultra-Minimally Invasive Endoscopic Spine Curriculum Pathway and the Arthrex Surgical Skills Experience Arthrex has developed a structured educational pathway to train surgeons in endoscopic spine surgery. This curriculum is designed to help them adopt endoscopic spine techniques into their practice. It includes a series of courses that begin with foundational, lower-risk procedures. Each course level adds new techniques and knowledge for a safe, step-by-step learning experience. This progressive approach to adopting endoscopic spine surgery ensures surgeons gain competence and confidence as they develop toward a more advanced skill set. Arthrex has more than 100 surgical skills labs throughout the United States. Train. Evolve. Lead. Follow a curriculum pathway, rooted in reproducibility, precision, and motion preservation. Alaska Arthrex trains more than 50,000 surgeons around the world annually. Alaska Learn more about Arthex Spine courses Canada Canada Hawaii 18 | Join the Endoscopic Spine Evolution Hawaii J oin the Endoscopic Spine Evolution | 19 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information © 2026-05 Arthrex, Inc. All rights reserved. LB1-000440-en-US_K arthrex.com

Arthrex Graft Gun Next-Generation Graft Delivery System Arthrex Graft Gun The graft gun is a revolutionary device that enables surgeons to deliver any bone graft they desire, including AlloSync™ and AlloSync Expand cortical fibers, ArthroCell™ and ArthroCell Plus cellular bone grafts, AlloSync Pure demineralized bone matrix, AlloSync gel, and various autograft chunk sizes, in a minimally invasive fashion. Engineered as an ideal graft delivery solution, the graft gun is primarily designed for minimally invasive spinal fusion procedures in both the disc space and the gutters. The graft gun consists of a reusable gun, loaders, and disposable kits, which include the delivery cannula and pushrod, making it suitable for any fusion procedure. The first of its kind, this device is also bayoneted, allowing for direct visualization of the delivery locations. FEATURES AND BENEFITS Compatible with any desired bone graft, including allograft chunks up to 5 mm in diameter 1 Single-handed ratcheting mechanism provides ergonomic ease of use and auditory confirmation Loaders can easily be packed with bone graft on the back table and used to quickly fill the cannula for delivery before being handed to the surgeon Ovular radiopaque tip for direct fluoroscopic visualization Bayoneted design allows for direct visualization Back assembly features a plunger shield to ensure the device stays within the sterile field Cannula is translucent to visualize the amount of graft implanted Disposable cannulas allow the delivery of up to 6 cc of graft with a single pass Reference 1. Arthrex, Inc. Data on file (APT-1022220). Naples, FL; 2025. 02 | Arthrex Graft Gun Historically, graft delivery has been an ongoing challenge, often limiting bone graft selection based on the graft type and surgical approach, as many bone grafts used in spinal fusion procedures are incompressible or nonflowable by nature. Current solutions to address this are limited by ease of use or graft compatibility and often include features that constrain visualization. Additionally, loading autograft chips or allograft fibers can be extremely time-consuming with many of these devices, burdening the surgeon or operating staff and potentially increasing procedure times. Cannula with a working length of 125 mm is suitable for use with even the longest posterior retractor tubes Graft gun can be fully disassembled for cleaning Disposable Cannula and Instrument Quick Guide Assembled Gun 01 Assemble the graft gun by first inserting the front assembly and aligning the laser-etched No. 1s. Rotate clockwise until fully seated. Next, insert the back assembly by aligning the laser-etched No. 2s and rotate clockwise until fully seated. Lastly, insert the gun shield by aligning the laser-etched No. 3s. 02 03 Insert the graft into the loading cartridge, then insert the cartridge into the cannula. Insert the pushrod to load the graft, then rotate the pushrod to lock it into the cartridge for removal. A rthrex Graft Gun | 03 04 05 Repeat steps 02 and 03 until the desired amount of the graft is placed in the cannula. Attach the cannula to the graft gun by aligning and rotating it clockwise to the locked position. 06 Orient the gun shield and insert the plunger (arrow side first) into the back assembly. Actuate the handle to advance the plunger. This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience, and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information © 2025-05 Arthrex, Inc. All rights reserved. LB1-000565-en-US_A arthrex.com

Arthrex Graft Gun: Next-Generation Graft Delivery System

Spine Resource Shortcuts Introduction to Arthrex Spine Video Introduces the Arthrex Spine portfolio and highlights our innovative motion- and soft–tissue-preserving endoscopic surgical options and orthobiologics, endoscopic spine-specific course, and comprehensive surgeon support. Spine Medical Education Video Surgeons share their positive experiences with the Arthrex endoscopic spine-specific course, which provides individualized education through a progressive curriculum pathway that starts with medial branch transection, progresses to interlaminar discectomies for central disc herniations, and finishes with transforaminal discectomies for posterolateral disc herniations. Spine Home Page Share this resource with your surgeons to introduce them to the Arthrex Spine portfolio, which includes endoscopic instrumentation and orthobiologic products to supplement fusions and other spine procedures. Spine Courses MedEd Web Page Visit the MedEd course calendar to view upcoming courses for spine. Patient Educational Web page ArthrexEndoscopicSpine.com is a patient-facing website with a Find a Doctor service that helps guide treatment-seeking patients in your vicinity to your practice. Patient Outreach Kit The Patient Outreach and Education Resource Kit provides an overview of all available tools for physicians and administrators. It includes descriptions of resources such as clinic posters, postoperative holographic cards, patient guides, and links to our media kit and patient-facing website, which features the find-a-doctor tool. Endoscopic Medial Branch Transection Web Page Includes resources dedicated to the medial branch transection procedure, including surgical technique guides, animations, and more. Interlaminar Endoscopic Discectomy Web Page Includes resources dedicated to the endoscopic interlaminar discectomy procedure, including surgical technique guides, animations, and more. Transforaminal Endoscopic Discectomy Web Page Includes resources dedicated to the endoscopic transforaminal discectomy procedure, including surgical technique guides, animations, and more. Spine Scorpion™ Suture Passer Web Page Includes resources dedicated to the Spine Scorpion suture passer for fascial closure, including surgical technique guides, animations, and more. JumpStart® Antimicrobial Wound Dressing Web Page Includes resources dedicated to JumpStart antimicrobial wound dressing, including surgical technique guides, animations, and more. Catalog Provides a list of product numbers and includes product and procedure descriptions and ordering information for spine and orthobiologics products. Spine Coding and Reimbursement Guidelines Get answers to common coding and reimbursement questions about spine-related and graft placement procedures completed with the products in this guide. Note: This information is shared for educational and strategic planning purposes only. Instrument Checklist Use this checklist to customize your intraoperative setup based on your surgical preferences. Digital Resource Collection View our collection of surgical techniques, patient education, product highlights, and more. Endoscopic Learning Simulations Learn the steps for endoscopic approaches through our interactive learning simulations. Spine Social Media Accounts LinkedIn, Instagram, and Twitter/X Like, share, and follow our Spine social media channels to stay up to date with our latest innovations. © 2026-04 Arthrex, Inc. All rights reserved. BR1-004430-en-US_H arthrex.com

Spine Resource Shortcuts

Ultra-Minimally Invasive Spine Procedures Endoscopic Transforaminal Approach for Herniated Disc Endoscopic Interlaminar Approach for Herniated Disc Endoscopic Medial Branch Nerve Transection 3 in 8 mm incision Antimicrobial Wound Dressing Learn More About a Patient’s Ultra-Minimally Invasive Surgery Experience Learn More at ArthrexEndoscopicSpine.com View A Patient’s Guide to Medial Branch Nerve Transection arthrex.com © 2025-09 Arthrex, Inc. All rights reserved. pFL1-000980-en-US_C View A Patient’s Guide to Endoscopic Lumbar Discectomy

Ultra-Minimally Invasive Spine Procedures

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

Operationsanleitungen

Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

Guias de técnicas cirúrgicas

Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

Guías de técnicas quirúrgicas

Surgical Technique Guides

Lumbar Transforaminal Discectomy Endoscopic Surgical Technique Endoscopic Approach to Lumbar Transforaminal Discectomy Introduction The endoscopic approach to lumbar transforaminal discectomy is an ultra-minimally invasive surgery during which an endoscope is used for access and visualization. In conjunction with ergonomic instruments, the Synergy imaging system provides innovative technology to treat this pathology. Depth stop and cannula holder allow for improved control of the endoscope and cannula WishBone™ handle combines ergonomics, efficiency, and control Synergy integration and imaging optimize visualization Premium instruments are available with a ceramic coating 02 | Lumbar Transforaminal Discectomy 1 2 Patient Positioning and OR Setup With the patient prone and their arms extended, position the C-arm across from the surgeon with the video monitor at the head and the C-arm monitor at the foot of the bed. Targeting Use AP and lateral views to target and confirm the correct level is being treated. 3 4 AP Targeting Mark the midline (A). Mark a line on the skin through the center of the disc space (B). Mark a line along the bottom of the contralateral pedicle to the top of the ipsilateral pedicle (C). Lateral Targeting Place an instrument vertically with its tip at the front of the disc space in line with the end plates. Mark a line on the instrument at the level of the dorsal skin surface (D). Lumbar Transforaminal Discectomy | 03 5 6 Incision Marking With the instrument tip on the midline, mark the distance (D) from the midline to the line on the instrument at the intersection of the oblique pedicle line (C). This is the incision point. Needle Placement Insert the needle at the incision point using AP and lateral views to avoid neural structures. Target Kambin’s triangle at the intersection of the inferior level’s superior articular process (SAP), pedicle, and the back of the inferior level’s vertebral body, making sure to not cross the medial border of the pedicle with the needle on an AP view. 7 Incision Remove the stylet, insert the guidewire, and make an incision through the skin and fascia to accommodate the outer diameter of the dilators and working cannula. 04 | Lumbar Transforaminal Discectomy 8a 8b Dilating Place the sequential dilators over the guidewire while rotating. Based on surgeon preference, trephines and rasps may be used to remove soft tissue and bone, enlarging the foramen to accommodate the diameter of the working cannula and endoscope. 9 Docking Insert the cannula over the dilators or switching stick while maintaining the opening of the bevel cranial toward the exiting nerve root. Rotate the cannula clockwise for left-sided approaches and counterclockwise for right-sided approaches, protecting the exiting nerve root with the long side of the cannula. Lumbar Transforaminal Discectomy | 05 10 11 Cannula Holder and Depth Stop With the rigid arm attached to the bed via a bed rail adapter connect the cannula holder to the cannula. Attach the light cord, camera, irrigation, and depth stop to the endoscope. Following removal of the switching stick or dilators, insert the endoscope into the cannula. Decompression Use endoscopic tools like graspers and the FlexTip RF probe to remove excess tissue, provide visualization, coagulate blood vessels, access the disc pathology, and decompress the affected elements. 12 13 Assess Use a ball-tip probe along with direct visualization to ensure all fragments have been removed and the discectomy and decompression are complete prior to removing the cannula. Complete Procedure Remove the endoscope and cannula, close the incision, and apply JumpStart® antimicrobial wound dressing over the incision site. 06 | Lumbar Transforaminal Discectomy Ordering Information Spine endoscope case AR-S1000-C3 Spine endoscope case, large AR-S1000-C1 Cannula holder AR-S3420-CH Switching stick, 7 mm × 225 mm AR-S3020-070-225 Spine endoscope, 7 mm × 181 mm, 30° AR-S3350-7030-181 Cannula w/ elevator tip, 8 mm × 178 mm AR-S3420-080-178ET Guidewire, nitinol, 0.8 mm × 400 mm AR-S4000-008-400 Dilator, 2.5 mm × 230 mm AR-S6524-025-230 Dilator, 4.1 mm × 220 mm AR-S6524-041-185 Dilator, 5.1 mm × 210 mm AR-S6524-051-170 Dilator, 6 mm × 200 mm AR-S6524-060-160 Dilator, 7.1 mm × 190 mm AR-S6524-071-185 Trephine handle AR-S7700-000-000H Trephine, 3.55 mm × 350 mm AR-S7705-035-350 Trephine, 5.1 mm × 225 mm AR-S7705-051-225 Trephine, 6.6 mm × 225 mm AR-S7705-066-225 Trephine, 7.6 mm × 225 mm AR-S7705-076-225 Rod pusher, 2.5 mm AR-S6524-025-230P Rod pusher, 4 mm AR-S6524-040-230P Rod pusher, 5 mm AR-S6524-050-230P Cup forceps, up angle, 2.5 mm × 330 mm, WB AR-S7110-025U-330W Cup forceps, 3 mm × 330 mm, WB AR-S7110-030-330W Cup forceps, 2.5 mm × 330 mm, WB AR-S7110-025-330W Scissor punch, 2.5 mm × 330 mm, WB AR-S7116-025-330W Scissor punch, up angle, 2.5 mm × 330 mm, WB AR-S7116-025U-330W Kerrison/ball-tip probe, handle, WB AR-S7400-000-000W Ball-tip probe, shaft, flexible, 1.8 mm × 330 mm AR-S7405-018-330 FlexTip RF probe, 35 cm AR-S9805-0035 Spine Access Kit, disposable AR-S4000K-S See product catalog for full product listings. Instruments dependent on surgeon preferences and pathology. TRIMANO is a registered trademark of Maquet GmbH. Lumbar Transforaminal Discectomy | 07 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information © 2026-01 Arthrex, Inc. All rights reserved. LT1-000323-en-US_C arthrex.com

Lumbar Transforaminal Discectomy

Lumbar Interlaminar Discectomy Endoscopic Surgical Technique Endoscopic Approach to Interlaminar Discectomy Introduction The endoscopic approach to interlaminar discectomies is an ultra-minimally invasive surgery ideal for patients who have been diagnosed with a paracentral lumbar disc herniation in the lower lumbar spine. During this procedure, a spine-specific endoscope is used for access and visualization. The Synergy imaging system, in conjunction with the ergonomic instruments, provides innovative new technology to treat this pathology. WishBone™ handle combines ergonomics, efficiency, and control Synergy integration and imaging optimize visualization Depth stop and cannula holder allow for improved control of the endoscope and cannula Premium instruments are available with a ceramic coating 6-Step Method 1. Target the bullseye 4. Create and identify the black hole 2. The click 5. Identify the edge 3. Clean the trampoline 6. Retract and protect The Bullseye 1 2 Patient Positioning and OR Setup With the patient prone and their arms extended, position the C-arm across from the surgeon with the video monitor at the head and the C-arm monitor at the foot of the bed. Targeting Use AP and lateral views to target and confirm the correct level is being treated. Use the switching stick to identify the entry point that is the lateral aspect of the ipsilateral interlaminar window. 02 | Lumbar Interlaminar Discectomy The Click 3a 3b Docking Make an 8 to 10 mm incision through both the skin and fascia. Insert the switching stick into the interlaminar window and on top of the ligamentum flavum. Alternatively, a needle cannula can be placed, followed by a guidewire, skin incision, and sequential dilators. Feel the Click Dock the switching stick vertically on the trailing edge of the L5 lamina (for L5-S1 discectomy). Use the switching stick to “click” between the caudal edge of the lamina and the ligamentum flavum (LF). Use tactile feedback to feel the “bounce” of the LF and confirm your location in the interlaminar window. 4 5 Cannula Holder and Depth Stop Insert the cannula over the switching stick. With the spine TRIMANO arm holder attached to the bed via a bed rail adapter, connect the cannula holder. Maintain the trajectory and location of the cannula to the anatomy while positioning and attaching the holder to the cannula. Set Up and Insert Endoscope Attach the light cord camera, irrigation, and depth stop to the endoscope. Following removal of the switching stick, insert the endoscope light cord, camera into the cannula. Lumbar Interlaminar Discectomy | 03 Cleaning the Trampoline 6 Dissect Tissue and Visualize After inserting the endoscope, insert a series of grasping instruments and the FlexTip probe through the endoscope’s working channel. Remove excess tissue and coagulate blood vessels to identify anatomical landmarks and expose the ligamentum flavum. The Black Hole 7 8 Access Spinal Canal Use both straight and angled scissor punches to resect the ligamentum flavum and gain access to the spinal canal. Maintain visibility of the working end of the instruments while incising and resecting the ligament. Orient the scissor punches with the longer, nonactuated end of the instrument medial while creating the black hole and incising through the final ligament fibers. Scissor Punches After transecting the ligament and entering the canal, pause to let the irrigation and positive pressure help create space between the ligament and the dura. Widen the ligament access by using a combination of scissor punches, Kerrison rongeurs, and downward pressure with cannula rotation to stretch and separate the ligament fibers. While accessing the canal with the cannula, maintain the orientation of the cannula so the bevel faces medial. 04 | Lumbar Interlaminar Discectomy Identify the Edge of the Nerve Root 9 10 Mobilize the Nerve Root Use instruments such as the blunt dissector, nerve hook, and articulating probe to release any adhesions that may be adhered to the dura. Continue to work and visualize the lateral margin of the nerve root. If necessary, rotate the camera 180° to use the scope lens angle to gain a more lateral view of the anatomy. After mobilizing the nerve root, advance and rotate the cannula to retract and protect the nerve root. With the nerve root protected, use a blunt instrument to apply pressure on the annulus, releasing the nucleus pulposus. Lumbar Interlaminar Discectomy | 05 Retract and Protect 11 12 Resect Use grasping forceps to extract the exposed nuclear material. Use the electrosurgery probe to ablate nuclear material and minimize the annular defect. Assess Use visualization and the ball tip probe to assess the mobility of the nerve root and ensure adequate decompression. 13 Complete Procedure Remove the endoscope and cannula, close the incision, and apply JumpStart antimicrobial wound dressing over the incision site. 06 | Lumbar Interlaminar Discectomy 6-Step Method Quick Reference 1 2 3 Target the Bullseye The Click Clean the Trampoline Place a switching stick in Dock the switching stick vertically Cauterize 360° around the cannula. the middle of the ipsilateral interlaminar window. on the trailing edge of the L5 lamina (for L5-S1 discectomy). Use a pituitary rongeur and Use a #11 or #15 blade to create an Use the switching stick to “click” incision <1 cm in length through the skin and lumbar fascia. between the caudal edge of the lamina and the ligamentum flavum (LF). Use fluoroscopy to confirm positioning. FlexTip probe to remove tissue on top of the LF. Use tactile feedback to feel the “bounce” of the LF and confirm your location in the interlaminar window. 4 5 6 Create and Identify the Black Hole Rotate the cannula, using its tip to tension the remaining LF fibers. Identify the Edge Rotate the endoscope to view the lateral edge, looking for the white stripe against the epidural fat, which is the edge of the nerve root. Retract and Protect Inside the spinal canal, wand the cannula from lateral to medial to free up adhesions to the disc herniation. Use the tissue dissector to palpate Rotate the opening of the cannula and define the edge of the nerve by dissecting the adhesions. so it faces lateral, protecting the nerve root medially and delivering the herniation into the cannula. Use endoscopic scissors to incise through the LF. After encountering the black hole, pause to allow fluid to fill the space, ensuring protection of the dura. Lumbar Interlaminar Discectomy | 07 Ordering Information Spine endoscope case AR-S1000-C3 Spine endoscope case, large AR-S1000-C1 Blunt dissector, 2.5 mm × 310 mm AR-S1342-025-310 Switching stick, 7 mm × 225 mm AR-S3020-070-225 Spine endoscope, 7 mm × 130 mm, 15° AR-S3350-7015-130 Cannula w/ elevator tip, 8 mm × 125 mm AR-S3420-080-125ET Guidwire, nitinol, 0.8 mm × 400 mm AR-S4000-008-400 Cup forceps, up angle, 2.5 mm × 330 mm, WB AR-S7110-025U-330W Cup forceps, 3 mm × 330 mm, WB AR-S7110-030-330W Cup forceps, 2.5 mm × 330 mm, WB AR-S7110-025-330W Scissor punch, 2.5 mm × 330 mm, WB AR-S7116-025-330W Scissor punch, up angle, 2.5 mm × 330 mm, WB AR-S7116-025U-330W Kerrison/ball tip probe, handle, WB AR-S7400-000-000W Kerrison, 3.5 mm × 260 mm, 40° AR-S7440-035-260 Kerrison, 4 mm × 260 mm, 40° AR-S7440-040-260 Kerrison, 4 mm × 260 mm, 90° AR-S7490-040-260 Ball tip probe, shaft, flexible, 1.8 mm × 330 mm AR-S7405-018-330 Dilator Holder ML-0057 FlexTip RF probe, 28 cm AR-S9805-010-0028 Spine Access Kit, disposable AR-S4000K-S See product catalog for full product listings. Instruments dependent on surgeon preferences and pathology. TRIMANO is a registered trademark of Maquet GmbH. This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information © 2025-09 Arthrex, Inc. All rights reserved. LT1-000322-en-US_C arthrex.com

Lumbar Interlaminar Discectomy

Medial Branch Nerve Transection Endoscopic Surgical Technique Medial Branch Transection Technique Introduction The medial branch transection (MBT) endoscopic technique allows for direct visualization to access, transect, and denervate the medial branch nerves at the junction of the dorsal transverse process and superior articular process. The Synergy imaging system, in conjunction with the ergonomic instruments, provides innovative new technology to treat this pathology. Depth stop and cannula holder allow for improved control of the endoscope and cannula WishBone™ handles combine ergonomics, efficiency, and control Synergy integration and imaging provide optimized visualization Premium instruments are available with a cermaic coating 02 | Medial Branch Nerve Transection 1 2 Set up OR and Position Patient With the patient prone and their arms extended, position the C-arm across from the surgeon with the video monitor at the head and C-arm monitor at the foot of the bed. Targeting Use AP and lateral views to target and confirm the transverse process (TP) of the level being treated. 3 4 Docking Insert the needle and stylet, followed by the guidewire. Extend the incision and insert the switching stick and cannula with the bevel orientated medially. Intermittently verify targeting and location using C-arm. Cannula Holder and Depth Stop With the TRIMANO ® arm holder attached to the bed via a bed rail adapter, connect the cannula holder. Maintain the trajectory and location of the cannula to the anatomy while positioning and attaching the holder to the cannula. TRIMANO is a registered trademark of Maquet GmbH. Medial Branch Nerve Transection | 03 5 Set up and Insert Endoscope Attach the light cord, irrigation, and depth stop to the endoscope. Following removal of the guidewire and switching stick, insert the endoscope down the cannula. 6 Dissect Tissue and Visualize Using the FlexTip probe and endoscopic instruments, dissect and identify landmarks and expose the mamillo-accessory ligament (MAL) and medial branch. 04 | Medial Branch Nerve Transection 7 8 MAL Removal Using scissor punch, hook scissors, and FlexTip probe, remove the MAL to expose the underlying nerves. Transect the Medial Branch Nerve Use the same instruments to transect the medial branch and ablate the transected nerve ends. 9 10 Debride Tissue Debride the junction of the TP and superior articular process (SAP), angling the cannula and endoscope appropriately lateral while avoiding the adjacent tissue structure of the facet capsule. Complete Procedure Remove the endoscope and cannula, close the incision, and apply JumpStart® antimicrobial wound dressing over incision site. Medial Branch Nerve Transection | 05 Ordering Information Spine endoscope case AR-S1000-C3 Spine endoscope, 7 mm × 130 mm, 30° AR-S3350-7030-130 Stopcock AR-S3350-000-001 Spine endoscopic case, large AR-S1000-C1 Guidewire, nitinol, 0.8 mm × 400 mm AR-S4000-008-400 Switching stick, 7 mm × 225 mm AR-S3020-070-225 Cannula, w/ elevator tip, 8 mm × 125 mm AR-S3420-080-125ET Cup forceps, 2.5 mm × 260 mm, WishBone™ handle AR-S7110-025-260W Cup forceps, up angle, 2 mm × 330 mm, WishBone handle AR-S7110-020U-330W Scissor punch, 2.5 mm × 260 mm, WishBone handle AR-S7116-025-260W Scissor punch, up angle, 2.5 mm × 330 mm, WishBone handle AR-S7116-025U-330W Elevator, 2.5 mm × 310 mm AR-S1342-025-310 Hook probe, 2.5 mm × 260 mm AR-S10030-025-260 Ball-tip probe, shaft, flexible, 1.8 mm × 330 mm AR-S7405-018-330 Synergy ES console AR-S9800 Synergy ES footswitch w/ handle AR-S9800-F1 FlexTip RF Probe, 28 cm AR-S9805-0035 Hook scissors, 2.5 mm × 260 mm, WishBone handle AR-S7115-025-260W See product catalog for full product listings. Instruments dependent on surgeon preferences and pathology. TRIMANO is a registered trademark of Maquet GmbH. 06 | Medial Branch Nerve Transection Medial Branch Nerve Transection | 07 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. Arthrex manufacturer, authorized representative, and importer information (Arthrex elFUs) US patent information © 2025-12 Arthrex, Inc. All rights reserved. LT1-000292-en-US_C arthrex.com

Medial Branch Nerve Transection

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Literatur zur Patientenaufklärung

Literatura para a educação do paciente

Literatura de educación para el paciente

Patient Education Literature

A Patient’s Guide to Endoscopic Lumbar Discectomy

A Patient’s Guide to Medial Branch Nerve Transection

A list of scientific articles pertaining to a product or procedure.

Eine Liste wissenschaftlicher Artikel zu einem Produkt oder Verfahren.

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Lista de artigos científicos referentes a um produto ou procedimento.

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Scientific Updates

Endoscopic Spine: Medial Branch Nerve Transection Scientific Update Lumbar facet pain, most commonly caused by facet arthropathy, accounts for 15%-45% of all lower back pain.1 An endoscopic approach to medial branch nerve transection (MBT) can lead to relief from pain caused by facet joint arthropathy. MBT has been shown to have better longterm outcomes than the traditional treatment method of radiofrequency ablation (RFA), with the median pain-free period being twice as long for MBT compared to RFA.2 Combining 4K visualization with minimally invasive techniques allows surgeons to view and treat pathology while maintaining surgical precision and reducing postoperative complications.3,4 MEDIAL BRANCH NERVE TRANSECTION Facet joint syndrome: from diagnosis to interventional management. Romain Perolat, Adrian Kastler, Benjamin Nicot, Jean-Michel Pellat, Florence Tahon, Arnaud Attye, Olivier Heck, Kamel Boubagra, Sylvie Grand, Alexandre Krainik Lumbar facet joints constitute a common source of pain, accounting for 15%-45% of lower back pain Facet arthrosis is the most frequent form of facet pathology There are no effective correlations between clinical symptoms, physical examination, and degenerative spinal changes Diagnostic positive facet joint block / medial branch block can indicate facet joints as the source of pain Takeaway: Facet joint syndrome, a common cause of lower back pain, presents challenges in diagnosis due to the lack of effective correlations between clinical symptoms and degenerative spinal changes. Facet joint blocks serve as a key diagnostic tool for identifying the source of pain for interventional management. Insights Imaging. 2018;9(5):773-789. doi:10.1007/s13244-018-0638-x Lumbar facet joint osteoarthritis: a review. Leonid Kalichman, David J Hunter The facet joints play an important role in load transmission. They provide posterior load-bearing, stabilizing motion in flexion and extension and also restricting axial movement to avoid the potential for over-rotation. Studies have shown improvement of function and decreases in pain may last 6-12 months following lumbar medial branch ablation Takeaway: Facet joints are crucial for load transmission, providing posterior loadbearing and stabilizing flexion and extension motions and limiting excessive axial rotation. Studies show that enhancements in function and pain reduction following lumbar medial branch ablation can persist for a duration of 6-12 months. Semin Arthritis Rheum. 2007;37(2):69-80. doi:10.1016/j.semarthrit.2007.01.007 01 of 04 Endoscopic rhizotomy for facetogenic back pain: a review of the history, financial considerations, patient selection criteria, and clinical outcomes. Daniel Streetman, Joshua G Fricker, Garrett L Garner, Adam L Webb, Noah Pierzchajlo, Neal A Patel, Nicholas A Howard, Ellen M Hardin, Triston E Smith, Alana J Hagley, Moshe Shalom, Nolan J Brown, Julian L Gendreau Endoscopic rhizotomy for the treatment of lumbar facet joint pain costs approximately 4 times more than traditional RFA. This is due to the cost of training, longer intraoperative time (twice that of RFA), and special equipment and instrumentation. However, long-term outcomes for rhizotomy appear to be superior to those of RFA, with a median pain-free duration twice that of RFA Some studies have based inclusion criteria on refractory lower back pain that has been resistant to physical therapy and NSAID treatment for longer than 2 months. Other studies suggest even more rigorous nonsurgical treatment, such as the use of opioids, before operative intervention. Three different studies required >80% symptom relief with steroid injections for inclusion. In two studies, MacNab scores at 12 months post-op measured 97.8% and 96.7% of patients with “excellent” or “good” outcomes, respectively. One study measured a 0% “excellent” or “good” outcome MacNab score for conservative therapy, including NSAIDs and physical therapy, while the comparison intervention was RFA, which achieved a rate of 70% of patients with “excellent” or “good” outcomes Takeaway: Endoscopic rhizotomy, though 4 times more expensive than traditional RFA for lumbar facet joint pain, exhibits superior long-term outcomes with a doubled median pain-free duration, emphasizing stringent inclusion criteria and notable success rates compared to conservative therapies. World Neurosurg. 2023;169:36-41. doi:10.1016/j.wneu.2022.10.020 Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study. Anthony Yeung, Satishchandra Gore Retrospective, nonrandomized study of 50 patients to assess the efficacy of endoscopic rhizotomy At 1-year follow-up, Visual Analog Scale (VAS) improved 6.2 to 2.5 and Oswestry Disability Index (ODI) scores improved from 48 to 28. All patients had VAS improvement that was equal to or greater than that with injection. Takeaway: In a retrospective study of 50 patients undergoing endoscopic rhizotomy for lumbar facet joint pain, significant 1-year improvements included a decrease in scores from 6.2 to 2.5, an improvement in ODI scores from 48 to 28, and all patients experiencing VAS improvement equal to or surpassing injection-based treatments. Int J Spine Surg. 2014;8:23. doi:10.14444/1023 Repeat procedures and prescription opioid use after lumbar medial branch nerve radiofrequency ablation in commercially insured patients. Jordan B Starr, Laura S Gold, Zachary McCormick, Pradeep Suri, Janna Friedly The median time to repeat RFA was about 1 year post-op (350-355 days) Found that approximately 1 in 3 patients (33.5%) who receive lumbar RFA repeat the procedure within 3 years. Nearly half (45.7%) repeat within 7 years. Takeaway: Patients undergoing lumbar facet joint treatment with RFA have a median time of approximately 1 year for repeat procedures, with 33.5% choosing to repeat within 3 years and 45.7% within 7 years. Spine J. 2020;20(3):344-351. doi:10.1016/j.spinee.2019.10.005 02 of 04 Endoscopic radiofrequency facet joint treatment in patients with low back pain: technique and long-term results. A prospective cohort study. Stefano Meloncelli, Giorgio Germani, Ignazio Urti, Marco Divizia, Maria Rosciano, Filomena Puntillo, Antonella Paladini, Giustino Varrassi 40 total patients underwent endoscopic rhizotomy to treat facet joint pain Mean age was 61.8 years (39-81), with mean preoperative numeric rating scale (NRS) and ODI scores of 7.18 and 57.95, respectively Patients whose treatment was limited to 1-2 joints had significantly better patient-reported pain scores (NRS pre-op 7.05, post-op 1.70) than those with 3 or more joints treated (NRS pre-op 7.30, post-op 3.59) Patients younger than 60 years old were found to have significantly better patient-reported postoperative pain scores (ODI pre-op 44.67, post-op 9.78) than those 60 years of age and older (ODI pre-op 68.82, post-op 37.64) Study found no clinically significant difference in patient-reported outcomes whether or not the patient had been treated with percutaneous RFA prior to treatment endoscopically Takeaway: In a study involving 40 patients undergoing endoscopic rhizotomy for facet joint pain, those treated for 1-2 joints and patients younger than 60 years of age reported significantly better postoperative pain scores, while no clinically significant difference was found in patient-reported outcomes based on prior percutaneous RFA treatment. Ther Adv Musculoskelet Dis. 2020;12:1759720X20958979. doi:10.1177/1759720X20958979 The effectiveness of endoscopic radiofrequency denervation of medial branch for treatment of chronic low back pain. Sun Yoon Jeong, Jin Sung Kim, Won Suh Choi, Jung Woo Hur, Kyoung Sik Ryu Retrospective study of 52 consecutive patients treated between October 2010 and December 2013 with endoscopic radiofrequency denervation of the medial branch nerve of the dorsal ramus VAS scores for back pain improved significantly from a pre-op mean of 7.1 to a post-op mean of 2.0 at 2-year follow-up Korean ODI improved from pre-op mean of 26.5% to a post-op mean of 7.7% at 2-year follow-up 80% of patients reported being satisfied with the procedure and had no postoperative complications Takeaway: In a retrospective study of 52 consecutive patients who underwent endoscopic radiofrequency denervation for medial branch nerve treatment between October 2010 and December 2013, significant improvements were observed in back pain VAS scores, Korean ODI, and patient satisfaction, with 80% of patients reporting satisfaction and no postoperative complications at 2-year follow-up. [published correction appears in J Korean Neurosurg Soc. 2014 Nov;56(5):454]. J Korean Neurosurg Soc. 2014;56(4):338-343. doi:10.3340/jkns.2014.56.4.338 Pain-free survival after endoscopic rhizotomy versus radiofrequency for lumbar facet joint pain: a real-world comparison study. Tao Du, Guang Lu, Junchi Li, Bing Ni, Wei Shu, Tao Sun, Dou Yang, Hongwei Zhu Both groups showed significant decreases in scores Endoscopic rhizotomy showed better efficacy than radiofrequency in NRS, ODI, and Global Impression of Change (GlOC) scores The pain-free survival curves showed that median pain-free duration was 20 months for endoscopic rhizotomy and 10 months for radiofrequency This study showed a mean cost of $3964 +/- $154.9 USD for endoscopic rhizotomy versus a mean cost of $979.1 +/$99.0 USD for RFA. Results indicated that endoscopic rhizotomy costs nearly 4 times as much as RFA and offers twice the median pain‑free duration. Takeaway: Preventing repeat RFAs could influence long‑term cost assessments, given the procedure’s tendency to recur within a year and require subsequent interventions. Pain Physician. 2022;25(1):E87-E94. 03 of 04 Factors determining the success of radiofrequency denervation in lumbar facet joint pain: a prospective study. Konrad Streitberger, Tina Müller, Urs Eichenberger, Sven Trelle, Michele Curatolo Prospective study of 41 patients who received radiofrequency denervation to treat lumbar facet joint pain between January 2006 and June 2008. Patients were followed through their 1-year post-op consultation. Success was defined as at least 50% pain reduction at 7-21 days, 6 months, and 1 year after treatment Success rate 7-21 days post-op was 76% (33 of 41 patients), 32% (13 of 41) at 6 months post-op, and 22% (9 of 41) at 1 year post-op. Median success duration was 17 weeks. Complete pain relief of at least 1-year post-op was achieved in just 4 patients (10%) 22% of patients felt significant pain reduction through their 1-year postoperative follow-up Takeaway: In a prospective study of 41 patients receiving radiofrequency denervation for lumbar facet joint pain, postoperative success rates (defined as at least 50% pain reduction) were 76% at 7-21 days, 32% at 6 months, and 22% at 1 year, with a median success duration of 17 weeks. Only 10% of patients achieved complete pain relief lasting at least 1 year, while 22% experienced significant pain reduction throughout the 1-year follow-up. Eur Spine J. 2011;20(12):2160-2165. doi:10.1007/s00586-011-1891-6 SACROILIAC JOINT DENERVATION Full-endoscopic sacroiliac joint denervation for painful sacroiliac joint dysfunction: a prospective 2-year clinical outcomes and predictors for improved outcomes. Saqib Hasan, Dia Radi Halalmeh, Yusuf-Zain Ansari, Amy Herrera, Christoph P Hofstetter Full-endoscopic sacroiliac joint denervation (FE-SJD) is a novel technique for the management of pain secondary to sacroiliac joint dysfunction 47 patients with pain secondary to sacroiliac joint dysfunction underwent uniportal FE-SJD through the posterior approach, where a retrospective analysis of perioperative parameters, complications, and clinical outcomes were obtained prospectively Significant improvement was noted in preoperative VAS (back) and ODI scores at 3, 6, 12 months, and 2 years (P < .001). Thirty-four patients (72.3%) returned to normal functioning with an average of 82% pain relief and a satisfaction rate of 78.7% at a mean follow-up of 18.2 ± 13.1 months. Takeaway: Endoscopic denervation of the dorsal rami branches supplying the sacroiliac joint represents a safe, effective, and durable option to address pain secondary to sacroiliac joint dysfunction. Neurosurgery. 2025;96(1):213-222. doi:10.1227/neu.0000000000003053 References 1. Perolat R, Kastler A, Nicot B, Pellat JM, Tahon F, Attye A, Heck O, Boubagra K, Grand S, Krainik A. Facet joint syndrome: from diagnosis to interventional management. Insights Imaging. 2018;9(5):773-789. doi:10.1007/s13244-018-0638-x 2. Streetman D, Fricker JG, Garner GL, Webb AL, Pierzchajlo N, Patel NA, Howard NA, Hardin EM, Smith TE, Hagley AJ, Shalom M, Brown NJ, Gendreau JL. Endoscopic rhizotomy for facetogenic back pain: a review of the history, financial considerations, patient selection criteria, and clinical outcomes. World Neurosurg. 2023;169:36-41. doi:10.1016/j.wneu.2022.10.020 3. Lewandrowski KU, Ransom NA, Yeung A. Return to work and recovery time analysis after outpatient endoscopic lumbar transforaminal decompression surgery. J Spine Surg. 2020;6(Suppl 1):S100-S115. doi:10.21037/jss.2019.10.01 4. Sivakanthan S, Williams JR, Feroze AH, Eaton J, Pan ZJ, Boop S, McGrath LB, Harmon K, Hofstetter CP. Endoscopic spine surgery in athletes: case series and review of literature. World Neurosurg. 2021;145:702-707. doi:10.1016/j.wneu.2020.08.211 © 2026-01 Arthrex, Inc. All rights reserved. DOC1-001333-en-US_B 04 of 04 arthrex.com

Endoscopic Spine: Medial Branch Nerve Transection

Endoscopic Discectomy and Decompression

Endoscopic Spine Learning Curve Scientific Update There is a learning curve for endoscopic spine procedures. However, it is not as significant as is often discussed. Studies have shown that mastering the learning curve can occur in as few as 15 cases.1,2 It can be decreased further through a clear education pathway and proper patient selection, as not every patient or procedure is a good candidate for endoscopic surgery.3 The benefit zone of full-endoscopic spine surgery. Saqib Hasan, Roger Härtl, Christoph P Hofstetter Full-endoscopic spine surgery employs surgical principles that aim to decrease muscle crush injuries during prolonged retraction, avoid significant soft-tissue stripping, and minimize bony resection. These principles also help prevent iatrogenic instability and lead to decreased postoperative pain and disability. To determine whether a particular patient will benefit from endoscopic spine surgery, it is best to estimate the reduction of invasiveness compared to a traditional open surgery but ensuring the same surgical goals can be achieved Endoscopic discectomy can offer a faster recovery with a highly favorable risk profile but has overall long-term outcomes similar to that of open techniques. Additionally, surgeons may not tolerate the learning curve of a new procedure that yields marginal perceived benefits despite significant decreases in overall complication rates, dural tears, and infections. Takeaway: As compared to other approaches, endoscopic spine surgery tends to have: Less need for postoperative pain medication Quicker discharge and return to work Fewer complications Similar long-term outcomes and slightly better long-term visual analog scale (VAS) scores for leg pain J Spine Surg. 2019;5(Suppl 1):S41-S56. doi:10.21037/jss.2019.04.19 Navigating the learning curve of spinal endoscopy as an established traditionally trained spine surgeon. Nicholas A Ransom, Sohrab Gollogly, Kai-Uwe Lewandrowski, Anthony Yeung Learning curve study consisting of 40 patients, with 20 treated via traditional laminectomy and 20 treated via spinal endoscopy Mean follow-up of 38.58 months Pre-op VAS score of 7.95 and post-op VAS score at final follow-up of 4.01 across all patients Outcomes of endoscopic learning curve group improved significantly after 15 cases In retrospectively reviewing case log, second author noted a significant reduction in post-op narcotics use Takeaway: During the initial learning curve, spinal endoscopy produced patient outcomes equivalent to traditional techniques and may continue to improve as experience increases. J Spine Surg. 2020;6(Suppl 1):S197-S207. doi:10.21037/jss.2019.10.03 01 of 02 Complications and management of endoscopic spinal surgery. Chang Il Ju, Seung Myung Lee Reviewed 103 articles related to endoscopic spinal surgery complications The most common complications related to endoscopic spinal surgery include dural tears, perioperative hematoma, transient dysesthesia, nerve root injury, and recurrence The overall incidence of clinically symptomatic complications is below 10% One study reported a total complication rate of 4.7% and reoperation rate of 1.1% following cervical endoscopic surgery One study reported the most common complications following thoracic endoscopic surgery were dural tear (2%) and transient paresthesia (2%). This study also reported a revision rate of 1.5%. A meta-analysis of lumbar endoscopic spinal surgery cases reported that transforaminal endoscopic lumbar surgery had approximately 3 times more complications (9.1%) than interlaminar endoscopic lumbar surgery (3.4%) Takeaway: Endoscopic spinal surgery does not yield good results for all spinal diseases, and it is important to select appropriate indications to obtain achievable surgical results. Most literature published is retrospective (level 3 evidence), and randomized controlled trials (level 1 evidence) are lacking. Higher-quality evidence is needed to further understand of the benefits and risks of an endoscopic approach to spine surgery. The overall incidence of clinically symptomatic complications with all types of endoscopic spine surgery is <10%. Most complications were minor, and life-threatening complications, such as thromboembolism, sepsis, severe bleeding, and pulmonary complications, are less frequent compared to open surgery. Neurospine. 2023;20(1):56-77. doi:10.14245/ns.2346226.113 Initial learning curve after switching to uniportal endoscopic discectomy for lumbar disc herniations. Catherine Olinger, Alex Coffman, Chad Campion, Kirk Thompson, Raymond Gardocki Median operative time decreased approximately 50% for the first 50 patients, then plateaued for both approaches (mean: 65 min) No difference in reoperation rate observed during the learning curve As the senior author increased their experience, they noted the duration of post-op narcotics use and the overall need for narcotics decreased and, ultimately, was eliminated No differences were observed between groups in other metrics Takeaway: An initial learning curve was identified as 50 patients measured by decreased operative time, while reoperation rates remained similar without the need for hospital transfer or conversion to an open procedure in an ambulatory setting. Endsocopic spine surgery can be performed safely during the initial learning curve as long as the surgeon does not sacrifice safety for speed. Eur Spine J. 2023;32(8):2694-2699. doi:10.1007/s00586-023-07583-x The utilization of percutaneous endoscopic lumbar discectomy in recurrent lumbar disc herniation: a systematic review and meta-analysis. Saiganesh Ravikumar, Aaron Bloschichak, Sanjeev Kumar Percutaneous endoscopic lumbar discectomy (PELD) is a safe, effective treatment for recurrent herniated discs, but it is unclear whether it is superior to other minimally invasive options 32 articles were reviewed to identify the usability of PELD in comparison to other minimally invasive options to treat recurrent lumbar disc herniations (R-LDH) The meta-analysis revealed the transforaminal approach to PELD is equivalent to minimally invasive transforaminal lumbar interbody fusion (MIS-TILF) in terms of ability to improve patients’ functional capacity with shorter operative time, and randomized controlled trials comparing PELD to MIS-TLIF, microendoscopic decompression (MED), and open lumbar microdiscectomy (OLM) are warranted as there is insufficient evidence to state which is superior Takeaway: This is an effective tool in the management of R-LDH based on reasonable quality and methodology. J Spine Surg. 2025;11(1):45-64. doi:10.21037/jss-24-47 © 2026-01 Arthrex, Inc. All rights reserved. DOC1-001335-en-US_C 02 of 02 arthrex.com

Endoscopic Spine Learning Curve

Sohrab Gollogly, MD (Monterey, CA), explains how to identify adherent vs mobile nerve roots during an interlaminar approach.

video

Short procedural videos offering expert tips and best practices.

SpeedPearls

Vídeos curtos sobre procedimentos que oferecem dicas de especialistas e melhores práticas.

Vídeos breves de procedimientos que ofrecen consejos de expertos y mejores prácticas.

SpeedPearl: Comparing Adherent vs Mobile Nerve Roots During an Interlaminar Endoscopic Approach

Speaker  Adhesions, which I define in the context of endoscopic spine surgery as filamentous strands of connective tissue that appear like filaments of a spiderweb can be seen during endoscopic mobilization of the nerve root in proximity to a disc herniation. These adhesions are not well visualized when performing the same operation microscopically, because the dura is artificially inflated by venting the canal to atmospheric pressure, and there is no hydrostatic force from the arthroscopic arrogant assisting with hemostasis and visualization. The existence of these inflammatory changes may be underappreciated. They may represent an unrecognized source of ongoing nerve root entrapment. After the acute phase of the disc herniation. In this speed pearl, we present the typical anatomic findings associated with a large disc herniation at the L5 S1 level and demonstrate how the nerve root is tightly tethered by adhesions between the ventral and lateral aspects of the traversing S1 nerve root and the annulus. In contrast, in the course of an endoscopic contralateral approach, we demonstrate how the normal anatomy is remarkable for the absence of these adhesions, there is much more perineural fat and much greater mobility of the nerve root. We present these observations in order to suggest that there is the possibility that nerve root adhesions can tether the root and prevent its natural sliding motion. These adhesions may cause repetitive neurapraxic stretch injury to the root in cases of chronic disc herniations, calcified herniations and broad based subannular bulges. Release of these adhesions without concomitant discectomy may be sufficient to achieve resolution of symptoms.

Prof. Dr. med. Mazda Farshad (Zurich, Switzerland) presents a case of a 74- year-old female with a L1-L2 caudally migrated disc herniation causing L2 radiculopathy, characterized by anterior thigh pain, hip flexor weakness, and hypesthesia, treated using an endoscopic transpedicular approach.

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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Cirurgiões que apresentam um ou mais casos clínicos.

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Case Presentation Videos

Endoscopic Transpedicular Discectomy: Case Presentation of a 74-Year-Old Patient

Speaker  My name is Zafar from Zurich, Switzerland. I will present a typical case for the Transpedicular approach. The particular approach can be a valuable option for addressing pathologies located medial to the pedicle, such as high grade Caudally migrated disc herniations. However, the technique requires experience in spinal endoscopy and has biomechanical limitations. This case involves a 74 year old female patient presenting with a L2 radiculopathy caused by a right sided caudally migrated disc sequestration. Clinically, she reported anterior type pain and demonstrated the M4 minus weakness of the hip flexors. Surgical removal using a monopolar endoscopic technique was indicated. Three potential surgical approaches were evaluated the interlaminar endoscopic lumbar discectomy, the transforaminal, endoscopic lumbar discectomy, and the trans particular approach. While each technique has its merits, application of the established complexity classification system suggested that the Transpedicular approach could technically be the least complex. The Interlaminar approach is limited by a bony, occluded interlaminar window at L1 two, whereas the Transforaminal approach was constrained by the anatomy and position of the dural sac and the far migrated disc herniation. Consequently, a particular approach was selected. The procedure was performed using a small diameter endoscope and a bur through an approach with a skin entry eight centimetres paramedian oriented perpendicular to the spinal alignment line. The anesthesiologist was instructed to avoid muscle relaxation and to maintain systolic blood pressure below 110mm mercury. Speaker  Tranexamic acid and fortecortin were administered according to the standard protocol, beginning eight centimetres lateral to the midline. The trajectory was directed towards the typical entry point of a pedicle screw. The transverse process lateral facet junction was exposed by clearing the surrounding soft tissue. Burring was performed under continuous fluoroscopic guidance to minimize biomechanical compromise. The bony defect was kept as small as possible given the risk of pedicle weakening after perforation of the second cortical layer, the ligamentum flavum was visualized and removed using rongeurs. The nerve root was then identified and gently mobilized medially, allowing stepwise removal of the disc herniation fragments. Throughout the procedure, excessive pressure on the endoscope was strictly avoided to reduce the risk of transverse process fracture. Postoperative computed tomography confirmed the trajectory and extent of the bony defect. The patient was discharged two days after surgery, pain free, with improved strength of the hip flexors. We have extensively investigated the biomechanical consequences of the trans radicular approach, and identified an approximately 30% reduction in pedicle load bearing capacity. This finding limits the broader clinical application of this technique, and supports its use only in carefully selected cases, where it provides a clear and specific surgical advantage.

In this digital collection, you will find all resources given to attendees of the Endoscopic Approaches to Spine Level I course.