Over-The-Top versus Transforaminal Lumbar Endoscopic Techniques

A systematic review of contemporary lumbar endoscopic decompression techniques shows that the lion’s share of lumbar endoscopic decompressions is done via the transforaminal and interlaminar approach. Many modifications and diverse applications for the more complex clinical applications have been described. Clinical outcomes in well-trained, experienced hands suggest that these modified endoscopic procedures are genuine advances. However, from the point of view of the communitybased or academic traditionally trained spine surgeon adoption of these complex endoscopic procedures may still seem either impractical or out of reach when these endoscopic procedures are considered for each individual patient. The surgeon will have to figure out how to implement these procedures into their routine clinical operations by replacing the well-tried, time-proven and reliable open or other forms of minimally invasive spine surgeries. Recognizing a surgical technique's clinical advantages over another is one thing, but transforming one's practice is much more complex and depends not only on one's training or comfort level, but in most cases, the actual experience for each surgeon that will evolve due to the feedback from their patients. In patients who have experienced both the transforaminal and translaminar endoscopic approach, each surgeon will likely use the approach that gives the safest, most cost-effective, as well as the approach chosen by the surgeon for each anatomically based and guided approach. Many additional factors could potentially impede endoscopic spine surgery implementation, most of which will evolve, as the surgeon circle around the anatomic limitations of each approach. The availability or lack of equipment, trained staff, and support system also plays a role.
 
The institutionalized spine surgeons may encounter additional hurdles since endoscopic spine surgery's disparate nature may disrupt well-established revenue cycles, making its implementation difficult. The surgeon's institutions may have to shoulder the burden of capital equipment purchases while facing lower reimbursement. To aid the prospective endoscopic spine surgeons in overcoming these implementation hurdles, the authors aimed to provide a systematic step-by-step comparison of the lumbar endoscopic overthe-top versus the transforaminal decompression techniques to illustrate their various technical aspects and clinical indications to aid the reader in selecting a “preferred” endoscopic technique

Keywords: Endoscopy, Lumbar endoscopic surgery, Over the top technique, Transforaminal approach.