Name: Endoscopic Approach to Lateral Recess Decompression
Uploaded: 2026-05-08T00:00:00Z
Channel: Arthrex
Description: John Ogunlade, DO (St. Louis, MO), demonstrates the technique for decompressing the lateral recess through an interlaminar endoscopic approach.

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John Ogunlade, DO (St. Louis, MO), demonstrates the technique for decompressing the lateral recess through an interlaminar endoscopic approach.

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English  - en

video

VID1-008818-en-US | A | Endoscopic Approach to Lateral Recess Decompression

John Ogunlade, DO

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Endoscopic Approach to Lateral Recess Decompression

Speaker  Hi, my name is John Ogunlade. I'm an endoscopic spine surgeon. Today I'll be presenting on lateral recess decompression. So first you want to chew AP through the intended surgical level. So we're going to be targeting L405. What you can see here, this is the interlaminar window of L405. And then we're going to mark this inferior medial edge of that lamina of the L4 level. And that looks pretty good. We're right at the midpoint of that inferior medial edge of the lamina. And that's where we'll make our incision. So we'll make an incision through the fascia. And then we'll go straight in following the angle of our c-arm until we find a positive stop. And that's a positive stop there. You can actually see that I'm scraping the bottom edge of that inferior laminar edge there. And that looks great. So that one step dilator is on the inferior edge of that lamina. And then we'll use a tubular retractor to dilate over that one step dilator. And I like to have the bevel facing cranially. So that way when we come in, the first thing that we see is that area we're targeting the bony surface. And then now we can bring in our scope. So now that we've brought in our working tubular retractor, we're going to introduce our radio frequency flex tip probe to identify the area that we just targeted. So for orientation purposes, you can see that the bevel of my cane is facing cranially. Speaker  So this is towards the head. This is towards the feet. We are here. This is lateral and this is medial. So now that we brought in our tubular retractor, we're going to now expose that inferomedial edge of that L4 lamina. And this is kind of exposing what we were targeting so that we can start our lateral recess decompression. You can see this little slope here kind of signifies where that medial edge of the lamina falls off. There's a little bit of fibers from the facet capsule. And we're ready to start our drilling. So we're going to introduce this drill. This is a little bit more aggressive. And really we want to drill along this attachment of this ligamentum flavum where it attaches to the ventral surface of this lamina. So you can see this is part of this defect that I just created using the drill. And you can see this is actually the ventral surface of the lamina where we're going to focus our drilling. And we're going to follow this nice curvilinear path along the inferior edge of the lamina so that we can detach the ligamentum flavum. We've seen how you can use the fluted burr for more aggressive resection of the medial border of the medial facet joint. I'm going to now demonstrate how you can use a diamond burr to really target and remove some of this attachment of the ligamentum flavum. Speaker  But really what I want to demonstrate here is how we're using this diamond burr push directly on this ligamentum flavum and drill right along the attachment of the ligamentum flavum. And that's how we're going to detach our ligament and do our lateral recess decompression. Often we'll run into the most cranial extent of our interlaminar window and we may have to extend that. So what I'm going to do is I'm going to use this diamond burr to polish off some of this soft tissue. Then we're going to also extend our interlaminar window more cranially so we can reach the insertion of the ligamentum flavum. So what you might see here is by just gentle pressure on any soft tissue, you could use that to polish and remove that soft tissue attachment from bony surfaces, so that you don't have to go back to using a pituitary or any other instruments to increase your field of vision. So we're going to deploy our sheath here. And we're going to go more cranial to remove some of this laminar edge. So we can continue our detachment of that ligamentum flavum. And the goal here is to work in planes. So once you have reached the depth that you want for your detachment, the ligamentum flavum, you're going to keep that depth and you're going to follow this curvilinear path all the way caudally so that you get nice smooth lines. Speaker  So before we get to the cranial attachment of our ligamentum flavum for our lateral recess decompression, it's important to find the inferior border of this caudal attachment and expose it. This is a little bit of synovium here. We're just going to move that out of the way. What we'll do is we'll use the drill to detach the Ligamentum flavum both Cranially and Caudally. And I can feel a bone deep to this soft tissue. It would be great to expose this so that when you go for your caudal ligamentum flavum detachment, you can actually see the removal and the detachment of that caudal ligamentum flavum. So again we're on the patient's left side. This is now the top of the L5 lamina right where it becomes the spinous process. And what you can see here this is the inferior articulating process of L4 on the left that's coming to create the joint with the SAP, which is going to be right underneath this soft tissue. And what we want to do is we want to trim this ligamentum flavum off of the ventral attachment of this L5 lamina. So that's going to be part of our goal. And we'll use the shaver to do that. Right now our orientation the top of the screen is directly cranial. Speaker  So this is towards the head. This is towards the feet. This is lateral and this is medial. And what you're noticing is that I'm constantly changing the rotation of the scope by adjusting my hand so that I can get the best view without destroying tissue. That's unnecessary. So this is the medial border of our inferior articulating process of L4. That's our ligamentum flavum attachment to that inferomedial articular process of L4. And now you can see we're now attaching the ligamentum flavum from the ventral surface of the L5 lamina. So you can see here this is the cranial edge of L5 and the ligamentum flavum attaching to the ventral surface of it. We're going to detach that using this diamond burr. And again you know there's different shaver burr tips that you can use whether it's fluted or diamond burr. I would argue that you should use a diamond burr for this step, as the attachment of the ligamentum flavum will come up very quickly. Okay, so what we're looking at now is the facet joint. This. Here to the left is our inferior trickling process of L4. And this here is our superior articulating process of L5 coming up from the lamina of L5. We're going to drill along this attachment of this ligamentum flavum. And for the goal of this surgery for decompressing the lateral recess, we really need to get to the superior articular process as that's our compressive lesion. Speaker  If the patient has significant amount of ligamentum flavum hypertrophy by detaching it from the superior articular process, you're also decompressing the neural elements. So now we can start to detach our ligamentum flavum. You're starting to see the ligamentum flavum thin out to this thin wispy white insertion point. So we know that we've detached it caudally. We can now follow this out laterally, and it's very hard to get the lateral attachment of the ligamentum flavum completely because it goes out the foramen. However, you can use this as a guide of detachment from the actual superior articulating process of L5 in this case. And from there we'll make our turn cranially so that we can detach the flavum off the ventral surface of L4 and go all the way to our cranial attachment. So now we're drilling along the medial ventral surface of L4 along the IAP to the lamina. So occasionally I would encourage you to take a break so that you can actually clean up some of these surfaces and remove some of the soft tissue that may impede your view, as in this case, some of the soft tissue creep was getting in our way. And I want you guys to see the attachment of the ligamentum flavum. So now we're here along the medial border of the facet joint. And we're going to continue to remove this ligamentum flavum from its medial attachment. Speaker  We can follow this all the way up cranially and caudally so that we're making one smooth line across the switch that joint. And now we're getting to the attachment of the ligamentum flavum. So now you can clearly see the attachment of the ligamentum flavum ventrally at the caudal aspect of the L4 lamina. And as we continue to work with our drill, we're going to detach it completely. And then we'll use our Kerrison to remove the ligamentum flavum on this ipsilateral side. So we're detaching the ligamentum flavum from its cranial L4 attachment. So it looks like the ligamentum flavum is ready to be detached. We can continue using the drill. Or we can use this angled curette to now detach the ligamentum flavum. We're going to use this Curette to go circumferentially around the ipsilateral medial facet joint and come all the way down to the lamina of L5. So now that we've detached the ligamentum flavum, both cranially and caudally, we'll use the kerosene to detach ligamentum flavum. You can see this. Here is the sap here. We'll decompress that as well. We're going to grab the ligamentum flavum, and we're going to peel it off from caudal to cranial. So you can see our neural elements and our thecal sac down below. This is our sap here. And now we can actually take down some of this sap. Speaker  Now we're just going to remove the bulk of this ligamentum flavum. It's still attached medially. So it may be hard to get out, but you can typically detach it in one big piece. So we've successfully detached the Ligamentum flavum, both Cranially and Caudally. Now we're just going to remove this ligamentum flavum with the pituitary. So you can see we have our dura exposed. There's still some flavum here. Medially. We can use a kerosene to detach that. But you know I'm going to use the shaver. We're going to go a little bit more lateral with our lateral recess decompression so that we can get to the lateral edge of that exiting route. So. This is now our AP. You can see that we've now completely decompressed this traversing route. It's the last of our ligamentum flavum still attached here as it starts to go out the foramen. Oftentimes you might find that the facet joint is significantly overgrown. And as in this case, you would want to make sure we have a thorough decompression until we reach the edge of that lateral recess and the traversing root. So that would require us to remove a little bit more of this medial facet joint. So if you don't get to this edge of the sap, you may have an insufficient decompression. So don't be afraid to go back, bring in your shaver and safely remove the medial border of overgrown facet joint so that you can reach the lateral edge of this traversing root to ensure that it's decompressed. Speaker  And now we use this soft tissue shaver to clean up some of these floaters. So now that we've done our lateral recess decompression we'll take a look at the anatomy. So right now we're resting on the superior edge of the L5 lamina. You can see our laminectomy defect where we have detached the ligamentum flavum from the ventral surface of the lamina. Here is the superior surface of the L5 lamina that we've detached the ligamentum flavum. You can follow this lamina up to the sap. You can see that this is now the lateral recess. And this is our traversing root completely decompressed with our disc space underneath. We continue in this orientation here. We'll go out the foramen. And again, the goal of our lateral recess decompression is to make sure that this traversing root is completely decompressed from the inferior border of that disc space to the superior border of that disc space. You can see it's completely mobilized, and that's our disc underneath. So if you look at the pre-op image and compare it to the post-op image, you can see that our interlaminar window has been widened and that the lateral recess and the facet joint has been trimmed very minimally to decompress that traversing root.

Interlaminar Endoscopic Lateral Recess Decompression 

Endoscopic Approach to Lateral Recess Decompression

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