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An endoscopic approach to medial branch nerve transection can help relieve pain caused by facet joint arthropathy. Combining 4K visualization&nbsp;with minimally invasive techniques allows surgeons to&nbsp;view and treat the spinal pathology while maintaining surgical precision&nbsp;and reducing postoperative complications.1,2
References
1. Lewandrowski&nbsp;KU, Ransom NA, Yeung A. Return to work and recovery time analysis after&nbsp;outpatient endoscopic lumbar transforaminal decompression surgery. J Spine Surg. 2020&nbsp;Jan;6(Suppl 1):S100-S115. doi:10.21037/jss.2019.10.01
2. Sivakanthan&nbsp;S, Williams JR,&nbsp;Feroze&nbsp;AH, et al. Endoscopic spine surgery in athletes: case series&nbsp;and review of literature. World&nbsp;Neurosurg. 2021;145:702-707.&nbsp;doi:10.1016/j.wneu.2020.08.211​

Medial Branch Transection

Secondary (C)

The endoscopic approach to interlaminar discectomies provides minimally invasive access to posterior herniations in the lower lumbar spine that may be difficult to reach through a transforaminal approach. Additionally, interlaminar discectomy results in less tissue and muscle disruption, faster recovery times, and a quicker return to activity compared to traditional open procedures.1-4 WishBone™ endoscopic instruments feature superior feel and improved ergonomics that facilitate inverted and retrograde usage with either hand.
References
1. Matsumoto M, Hasegawa T, Ito M, et al. Incidence of complications associated with spinal endoscopic&nbsp;surgery: nationwide survey in 2007 by the Committee on Spinal Endoscopic Surgical Skill Qualification of&nbsp;Japanese&nbsp;Orthopaedic&nbsp;Association.&nbsp;Orthop&nbsp;Sci. 2010;15(1):92-96. doi:10.1007/s00776-009-1428-6​
2. Ahn Y, Oh HK, Kim H, Lee SH, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced&nbsp;surgical technique and clinical outcomes. Neurosurgery. 2014;75(2):124-133.&nbsp;doi:10.1227/NEU.0000000000000361
3.&nbsp;Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and&nbsp;foraminotomy for the treatment of lumbar spinal stenosis. J Orthop. 2013;10(1):13-16.&nbsp;doi:10.1016/j.jor.2013.01.006
4. Ruetten&nbsp;S,&nbsp;Komp&nbsp;M, Merk H, Godolias G. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J&nbsp;Neurosurg Spine 2007;6(6):521-530. doi:10.3171/spi.2007.6.6.2

Interlaminar Endoscopic Lumbar Discectomy

A transforaminal, or paraspinal, approach provides the ability to reach far-lateral disc herniations. Using a spine-specific endoscope minimizes soft-tissue disruption, resulting in less postoperative pain.1,2 Additionally, studies showed that approximately 85% patients who underwent endoscopic lumbar discectomy returned to athletic activity in as few as 6 to 8 weeks.3,4
References
1. Sairyo&nbsp;K, Matsuura T,&nbsp;Higashino&nbsp;K, et al. Percutaneous endoscopic lumbar&nbsp;discectomy for athletes. J Spine. 2013;S5(006):1-4. doi:10.4172/2165-7939.S5-006&nbsp;​
2. Sivakanthan&nbsp;S, Williams JR,&nbsp;Feroze&nbsp;AH, et al. Endoscopic spine surgery in&nbsp;athletes: case series and review of literature. World&nbsp;Neurosurg. 2021;145:702-707. doi:10.1016/j.wneu.2020.08.211
3. Polikandriotis&nbsp;JA, Hudak EM, Perry MW. Minimally invasive surgery through&nbsp;endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal&nbsp;stenosis. J&nbsp;Orthop. 2013;10(1):13-16. doi:10.1016/j.jor.2013.01.006
4. Ruetten&nbsp;S,&nbsp;Komp&nbsp;M, Merk H,&nbsp;Godolias&nbsp;G. Use of newly developed instruments&nbsp;and endoscopes: Full-endoscopic resection of lumbar disc herniations via the&nbsp;interlaminar and lateral transforaminal approach. J&nbsp;Neurosurg&nbsp;Spine.&nbsp;2007;6(6):521-530. doi:10.3171/spi.2007.6.6.2

Transforaminal Endoscopic Lumbar Discectomy

The traditional open approach for treating far lateral disc herniations at L5-S1 is challenging. Alternatively, with proper targeting, the transforaminal endoscopic approach lands directly at the far lateral zone and requires little or no facet resection to achieve decompression.

Far Lateral Transforaminal Endoscopic Lumbar Discectomy

The ultra-minimally invasive trans-SAP approach provides a targeted corridor for accessing foraminal and lateral recess pathology, as well as cranial disc extrusions, particularly when facet anatomy or pathology limits a direct trajectory beneath the superior articular process.1,2&nbsp;
 
References
 
1. Lee S, Kim SK, Lee SH, et al. Percutaneous endoscopic lumbar discectomy for migrated disc herniation: classification of disc migration and surgical approaches. Eur Spine J. 2007;16(3):431-437. doi:10.1007/s00586-006-0219-4
2. Lewandrowski KU, Telfeian AE, Hellinger S, et al. Difficulties, challenges, and the learning curve of avoiding complications in lumbar endoscopic spine surgery. Int J Spine Surg. 2021;15(suppl 3):S21-S37. doi:10.14444/8161

Endoscopic Trans-SAP Approach for Lumbar Discectomy

Lumbar Discectomy

Endoscopic lateral recess decompression is an ultra-minimally invasive technique designed to relieve nerve pressure caused by a specific form of spinal stenosis, where the central canal remains open but the lateral recess compresses the traversing nerve root. This often-overlooked pathology is a common cause of unilateral or bilateral radiculopathy. By using the interlaminar corridor, surgeons can precisely remove compressive bone and tissue with minimal disruption to surrounding anatomy. Patients typically experience significant pain relief and improved mobility shortly after surgery.1 Long-term studies suggest these benefits are durable, with low reoperation rates.2
 
References&nbsp;
 
1. Lee CH, Choi M, Ryu DS, et al. Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis. Spine (Phila Pa 1976). 2018;43(24):1756-1764. doi:10.1097/BRS.0000000000002708. Erratum: Spine (Phila Pa 1976). 2019;44(4):E258. doi:10.1097/BRS.0000000000002988
 
2. Kesornsak W, Kuansongtham V, Lwin KMM, Pongpirul K. Pain improvement and reoperation rate after full-endoscopic decompression for lateral recess stenosis: a 10-year follow-up. Eur Spine J. 2023;32(8):2882-2888. doi:10.1007/s00586-023-07801-6

Interlaminar Endoscopic Lateral Recess Decompression 

Endoscopic lumbar unilateral laminotomy for bilateral decompression (ULBD) is an ultra-minimally invasive surgical technique that enables decompression of both sides of the spinal canal through a unilateral approach while preserving midline structures and posterior stabilizing elements. This technique is commonly used to treat central and lateral recess lumbar spinal stenosis, where bilateral nerve compression contributes to neurogenic claudication and radiculopathy, often resulting in leg pain, numbness, weakness, and difficulty walking. By using the interlaminar corridor, surgeons can perform an “over-the-top” decompression to remove compressive bone and ligamentous tissue with minimal disruption to surrounding anatomy.
 
Research has shown that patients can experience clinically meaningful improvements in pain and function following surgery.1 Prospective randomized studies have demonstrated that full-endoscopic interlaminar decompression provides clinical outcomes comparable to those of conventional microsurgical techniques, while offering potential advantages such as less tissue disruption, lower complication rates, shorter hospital stays, and faster postoperative recovery.2-4
 
 
References
 
1. Lee CH, Choi M, Ryu DS, et al. Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis. Spine (Phila Pa 1976). 2018;43(24):1756-1764. doi:10.1097/BRS.0000000000002708
 
2. Komp M, Hahn P, Oezdemir S, et al. Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician. 2015;18(1):61-70.
 
3. McGrath LB, White-Dzuro GA, Hofstetter CP. Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. J Neurosurg Spine. 2019;30(4):491-499. doi:10.3171/2018.9.SPINE18689
 
4. Perez-Roman RJ, Gaztanaga W, Lu VM, Wang MY. Endoscopic decompression for the treatment of lumbar spinal stenosis: an updated systematic review and meta-analysis. J Neurosurg Spine. 2021;36(4):549-557. doi:10.3171/2021.8.SPINE21890

Interlaminar Endoscopic Lumbar ULBD

Lumbar Decompression

Dural tears are a common concern during traditional open or mini-open spine surgery, with studies showing as high as a 10% occurrence rate during lumbar stenosis procedures.1-4 This page provides information and solutions for the management of incidental durotomies during endoscopic procedures.
References
1. Nielsen TH, Rasmussen MM, Thygesen MM. Incidence and risk factors for incidental durotomy in spine surgery for lumbar stenosis and herniated disc. Acta Neurochir (Wien). 2022;164(7):1883-1888.
2. Greil ME, Bergquist J, Kashlan ON, Kwon WK, Durfy S, Hofstetter CP. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression.&nbsp;Eur Spine J. 2023;32(8):2889-2895. doi:10.1007/s00586-023-07749-7
3. Lewandrowski KU, Hellinger S, De Carvalho PST, et al. Dural tears during lumbar spinal endoscopy: surgeon skill, training, incidence, risk factors, and managment.&nbsp;Int J Spine Surg. 2021;15(2):280-294. doi:10.14444/8038
4. Trathitephun W, Asawasaksakul A, Jaruwanneechai K, et al. Intraoperative management of iatrogenic durotomy in endoscopic spine surgery: a systematic review.&nbsp;Neurospine. 2024;21(3):756-766. doi:10.14245/ns.2448346.173

Dural Repair

JumpStart antimicrobial wound dressing is an advanced microcurrent-generating dressing for the management of surgical incision sites. Microcell batteries made of elemental silver and zinc generate an electrical current when activated by conductive fluids, such as wound exudate, water-based wound hydrogels, saline, or water. These microcell batteries create microcurrents to support the body's natural electrical healing process and provide antimicrobial protection to assist with wound healing. JumpStart antimicrobial wound dressing has demonstrated broad-spectrum bactericidal activity against antibiotic-resistant strains of wound isolates within 24 hours.1-3
References
1. Kim H, Makin I, Skiba J, et al. Antibacterial efficacy testing of a bioelectric wound dressing against clinical wound pathogens. Open Microbiol J. 2014;8:15-21. doi:10.2174/1874285801408010015
2. Banerjee J, Ghatak P, Roy S, et al. Silver-zinc redox-coupled electroceutical wound dressing disrupts bacterial biofilm. PLoS One. 2015:1-15. doi:10.1371/journal. pone.0119531
3. Kim H, Izadjoo M. Antibioilm efficacy evaluation of a bioelectric dressing in mono- and multi-species biofilms. J Wound Care. 2015;24 Suppl 2:S10-S14. doi:10.12968/jowc.2015.24.Sup2.S10

JumpStart® Antimicrobial Wound Dressing

The Spine Scorpion™ suture passer is ideal for closing the fascia up to 75% faster at the end of minimally invasive spine procedures.1 Its low-profile design eases access for approaches through tubular or mini open incisions. The suture passer automatically passes and retrieves multiple types of commonly used sutures, such as 0 and 2-0 absorbable suture.
Reference
1. Arthrex, Inc. Data on file (APT 05722). Naples, FL;2021.

Spine Scorpion™ Suture Passer

Lumbar Soft Tissue Repair and Reconstruction

The graft gun can be used to deliver even the most challenging bone grafts, such as fibers, chips, and autograft chunks. This device can be used for interbody fusions requiring bone graft both pre- and postimplantation, and a cartridge loading system allows for quick assembly and loading on the back table.

Arthrex Graft Gun

The GraftNet XL bone collection device allows for efficient and large volume collection of autologous bone. With unique features that allow for efficient OR workflow integration and quick access to autologous bone, the GraftNet XL device is ideal for any spinal fusion procedure.

GraftNet™ XL Bone Collection Device

Arthrocell is a viable bone allograft that contains cellular, scaffold, and gel components derived from human bone. The microparticulate scaffold is comprised of a proprietary blend of cortical and cancellous allograft bone. The bone-derived gel component provides optimal handling and resists irrigation. The cellular component consists of mesenchymal stem cells (MSCs), osteoprogenitor cells and pluripotent cells.

ArthroCell™ Viable Bone

The AlloSync bone grafting solutions line is a comprehensive offering of advanced DBMs for various bone grafting needs. AlloSync bone grafts contain osteoconductive and osteoinductive properties, providing the optimal signaling and scaffold for bone remodeling.
The unique geometry of AlloSync Expand 100% demineralized bone is ideal for intraoperative handling and controlled expansion into bone voids. AlloSync Expand fibers come preloaded in a syringe that allows for consistent hydration of the graft with biologic fluids, such as bone marrow aspirate (BMA).
AlloSync Pure DBM is derived from 100% demineralized cortical bone with no extrinsic carriers. When prepared, AlloSync Pure DBM will resist irrigation and can be used in a fluid environment. The clinician can control the handling properties of AlloSync Pure DBM, including decreasing viscosity of for injectable applications or increasing viscosity to add autograft bone. AlloSync bone grafts can be hydrated with fluids including platelet-rich plasma or concentrated BMA.

AlloSync™ Bone Grafting Solutions

AlloSync™ Pure DBM is an osteoinductive demineralized bone matrix (DBM) derived from 100% human allograft bone. With zero extrinsic carriers, AlloSync Pure DBM maintains exceptional handling characteristics and can hold its shape in arthroscopic fluid environments. In addition to preserving the native bone's morphogenetic proteins and growth factors during the demineralization process, AlloSync Pure DBM can be hydrated with bioactive fluids like platelet-rich plasma (PRP) and concentrated PRP (cPRP) from bone marrow aspirate (BMA) for maximum bone grafting potential.

AlloSync™ Pure Demineralized Bone Matrix 

AlloSync Expand fibers are 100% demineralized bone that provide controlled expansion into bone voids to improve bone gap fill. A unique geometry and structure give way to the fibers' excellent handling characteristics and the preservation of the demineralized bone's osteoinductive potential. AlloSync Expand fibers may be hydrated with bone marrow, blood, and other physiological fluids to create a cellular bone graft solution for bone voids.

AlloSync™ Expand Demineralized Cortical Fibers 

AlloSync bone grafting solutions maintain optimal osteoconductive potential and can be combined with bioactive fluids like platelet-rich plasma (PRP) or Angel(r) concentrated PRP (cPRP) from bone marrow aspirate. AlloSync bone grafts are derived from human allograft bone and provide excellent handling characteristics in intraoperative settings.
 
The portfolio of AlloSync putty, strips, and chips includes a wide selection of advanced demineralized bone matrix (DBM) graft options:
<ul>
 <li>Demineralized cancellous sponges and cortical fibers</li>
 <li>Putty, gel, and paste</li>
 <li>Wedges</li>
</ul>

AlloSync™ Strips, Chips, Fibers, and Cubes

The BioSurge™ cell and bone graft processing system combines the matrices of the AlloSync™ bone grafting solutions line with the Angel® system’s proprietary technology to prepare customized platelet-rich plasma concentrate (cPRP) from bone marrow aspirate (BMA). Hydrated AlloSync bone grafts provide the optimal scaffold for cPRP from BMA, which is a rich source of platelets and nucleated progenitor cells.

BioSurge™ Cell and Bone Graft Processing System

The BoneSync™ filler portfolio provides surgeons with several bone void solutions with excellent handling characteristics. These products provide an osteoconductive scaffold and can be hydrated with biologic fluids such as bone marrow aspirate to optimize bone remodeling potential.1,2
The BoneSync portfolio includes:
<ul>
 <li>BoneSync putty</li>
 <li>BoneSync strips</li>
</ul>
References
1. Cho AR, Kim HK, Kwon JY, Kim TK, Choi YM, Kim KH. Pain Physician J. 2014;17(6):E737-E745.
2. Chen JC, Ko CL, Shih CJ, Tien YC, Chen WC. J Dent. 2012;40(2):114-122. doi: 10.1016/j.jdent.2011.11.003.

BoneSync™ Putty and Strips

BoneSync™ BioActive is a second-generation synthetic bone void filler that elicits osteoconductivity and osteostimulative potential, allowing for bony ingrowth across a fracture or fusion site.1 Comprised of a sophisticated trio of components that includes bioactive glass, BoneSync BioActive filler provides healing benefits to patients and is available in a variety of sizes in strip and putty forms.
 
Reference
1. Xynos ID, Hukkanen MV, Batten JJ, Buttery LD, Hench LL, Polak JM. Bioglass 45S5 stimulates osteoblast turnover and enhances bone formation In vitro: implications and applications for bone tissue engineering. Calcif Tissue Int. 2000;67(4):321-9. doi:1.1007/s002230001134

BoneSync™ BioActive Synthetic Bone Void Filler

The OsteoAuger™ Bone Graft Harvesting System provides surgeons with an efficient way to recover autogenous, morselized bone from various harvest sites including the calcaneus, distal and proximal tibia, iliac crest, and distal radius. These harvesters are sterile, single-use systems that are available in diameters of 6 mm, 8 mm, and 10 mm. The autogenous morselized bone can be packed into fusion or fracture sites to enhance bone healing and remodeling.

OsteoAuger™ Bone Graft Harvesting System

The Vortex™ threaded recovery needle is ideal for maximizing the concentration of osteoprogenitor cells harvested during bone marrow aspiration.1 The unique designs of the threaded tip and vent holes allow the user to easily and accurately reposition the tip of the needle within the bone for optimal aspiration volume.
Patent pending
Reference
1. McLain RF, Boehm CA, Rufo-Smith C, Muschler GF. Transpedicular aspiration of osteoprogenitor cells from the vertebral body: progenitor cell concentrations affected by serial aspiration. Spine J. 2009;9(12):995-100

Spine Vortex™ Threaded Recovery Needles

The Angel cPRP and bone marrow processing system uses a proprietary platelet sensor and 1-button automation to deliver customized platelet-rich plasma (PRP) concentrate from bone marrow aspirate (BMA). Bone marrow is a rich source of platelets and nucleated progenitor cells. The Angel device is the only one to provide PRP concentrate from BMA with adjustable cellular levels.

Angel® cPRP and Bone Marrow Processing System

The Arthrex ACP double-syringe system is used to facilitate the safe and rapid preparation of autologous platelet-rich plasma (PRP) from a small sample of blood at the patient’s point of care. The PRP can be mixed with autograft and allograft bone prior to application to an orthopedic surgical site as deemed necessary by the clinical use requirements. There has been increased interest in autologous blood products for use in a number of orthopedic therapies.

Arthrex ACP® Double-Syringe System

The ACP Max™ system allows for collection of 30 mL, 60 mL, or 90 mL of whole blood for the preparation of platelet-rich plasma (PRP). Using a double-spin regimen, this buffy–coat-based system creates a PRP solution depleted of red blood cells and granulocytes, including neutrophils.1 Additional whole blood in the ACP Max PRP system encourages a more concentrated PRP solution and has the capability to create platelet concentrations up to 12 times higher than whole blood alone.1
 
Reference
1. Arthrex, Inc. Data on file (APT-5535). Naples, FL; 2022.

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Medial Branch Transection

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