ABSTRACT Objective: To define which laminoplasty technique provides the greatest increase in spinal canal dimensions. Methods: This was an experimental clinical trial. A patient diagnosed with multilevel degenerative cervical spinal canal stenosis causing myelopathy was initially identified. Magnetic resonance imaging and computed tomography of the patient’s cervical spine were imported to a software program to print the anatomical model. A total of 20 identical cervical spine biomodels were printed, equally distributed into four groups: control, Open-door (OD), French-door (FD), and Two-open-doors (TOD) laminoplasty. The biomodels of the experimental groups underwent the laminoplasty surgical procedure, from C3 to C6, according to each technique. All specimens underwent computed tomography, and the cross-sectional area and anteroposterior diameter of the spinal canal were measured. The data were subjected to statistical analyses, and p-values < 0.05 were considered statistically significant. Results: All techniques increased the dimensions of the spinal canal. OD laminoplasty was superior to FD in the area evaluation (OD: 2.17 cm2; FD: 1.92 cm2), and there was no statistically significant difference in the increase in anteroposterior diameter (OD: 10.97 mm; FD: 10.42 mm). TOD laminoplasty (area: 2.30 cm2; diameter: 11.94 mm) was superior to FD in both variables. There was no statistical difference between OD and TOD laminoplasty. Conclusions: The OD technique expands the cross-sectional area of the spinal canal more than FD laminoplasty, with no significant difference in diameter. TOD laminoplasty increases the dimensions of the spinal canal more than FD, and it tends to be superior to OD laminoplasty. Level of Evidence I, Therapeutic Studies.
ABSTRACT Objective: To evaluate the effects of the frequency of physiotherapeutic intervention on quality of life, anxiety, and depression in patients with chronic low back pain. Methods: A randomized clinical trial was conducted with 40 patients undergoing treatment at the Physiotherapy Outpatient Clinic of a teaching hospital. Participants were divided into two groups: Group 1 received the physiotherapeutic protocol once a week for four weeks (totaling four sessions); Group 2 received the protocol three times a week for four weeks (totaling twelve sessions). The protocol included mat and studio Pilates, myofascial release, and elastic functional bandaging. Assessments were performed at the beginning and end of treatment using a visual analog scale for pain, the WHOQOL-PAIN quality of life questionnaire validated for Portuguese, the Beck Anxiety Inventory, and the Beck Depression Inventory. Results: Group 2 showed significantly greater improvement compared to the group that underwent the protocol once a week, confirming that more frequent physiotherapy ensures better psychophysical outcomes and functional-clinical improvement. Conclusion: Physiotherapy administered three times per week was more effective in improving quality of life, anxiety, and depression in patients with chronic low back pain. Level of evidence I; Therapeutic studies - Investigation of treatment outcomes.
ABSTRACT Three-dimensional (3D) printing has rapidly advanced in the healthcare field over the past decades, becoming more accessible due to the wide variety of technologies and materials available. This has secured 3D printing a prominent place in medical specialties, such as spinal surgery, due to its ability to create complex objects, including anatomical models of the spine and its adjacent structures, based on medical imaging. In this specialty, the technology can be used for both preoperative planning and intraoperative support through biomodels and surgical guides. To recognize and explore the use of 3D printing in spinal surgeries, a systematic review was conducted in two databases, focusing on its applications and cost reports. Of the 142 studies identified, only 13 were included in the review due to their strict relevance to the topic. Although scientific studies on the impact of 3D printing in healthcare remain scarce, largely due to a lack of broad, robust research, it was possible to detail the financial impact in the surgical field throughout the entire process of producing 3D-printed objects, from planning and printing to the surgical center. Economic and decision analyses were also conducted. Level of evidence II; review article.
ABSTRACT Objective: To describe the clinical profile and postoperative outcomes of patients undergoing instrumented spinal arthrodesis under a preemptive antibiotic therapy protocol with vancomycin and ciprofloxacin. Methods: A retrospective, consecutive, and single-center case series was conducted involving 88 patients operated on between January 2021 and December 2022. The protocol consisted of intravenous vancomycin (1 g) and ciprofloxacin (400 mg) administered 60 minutes before incision, with postoperative maintenance for five days. The minimum clinical follow-up was 24 months. Results: The mean age was 45.2 years, with a male predominance (60.2%). Trauma was the most frequent surgical indication (38.9%), followed by neoplasms (25%). The overall arthrodesis infection rate was 4.5% (4/88 patients), with 75% of these cases occurring in patients with oncological etiology. Only one adverse event (1.1%) related to vancomycin was recorded. Conclusions: The preemptive antibiotic therapy protocol showed favorable infection rates (4.5%) and good pharmacological tolerability in the studied sample, suggesting it is a viable strategy for high-complexity spine surgeries. Level of Evidence IV; Case series.
ABSTRACT Cervical radiculopathy is a common condition affecting the cervical spine. Few trials with a small number of patients tried to establish the most efficient treatment in the literature that varies between surgical and nonsurgical approaches. We conducted a systematic review and meta-analysis to evaluate surgical versus nonsurgical treatment efficacy for cervical radiculopathy PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to July 2025 to identify randomized controlled trials (RCTs) studies comparing surgical and nonsurgical treatment on adult patients with cervical radiculopathy. Outcomes of interest included Neck Disability Index (NDI), Arm pain and Neck pain (pain grade measured by Visual Analogue Scale and Numeric Rating Scale). We calculated the mean difference for each comparison and did a conventional random effects meta-analysis. We included 4 RCTs with 323 total patients with 161 randomized to surgery group and 162 to nonsurgery group. Mean difference NDI score of surgical vs. nonsurgical group at 12 months follow-up has no statistically significant difference (MD: -2.54 95% CI: -6.33 to 1.24; I2=52%; P=0.19). Short-term outcomes were also analyzed, resulting in a rapid efficacy of surgical treatment and a progressive efficacy of nonsurgical therapy on 3 months follow-up (MD: -7.61 95% CI: -12.48 to -2.74; I2=0%; P=0.002) and 6 months follow-up (MD: -5.87 95% CI: -9.59 to -2.15; I2=0%; P=0.002). Surgical group was associated with a considerable reduction of arm pain (MD: -1.17; 95% CI: -1.66 to -0.68; I2=0%; P<0.00001) and neck pain (MD: -0.84; 95% CI: -1.38 to -0.31; I2=23%; P=0.002) on the comparative analysis of both groups. These findings suggest a mid-term association of quality of life and pain reduction in patients with cervical radiculopathy who underwent surgery compared to nonsurgical treatments. The long-term comparison between surgical and nonsurgical therapy showed no statistically significant difference. Level of Evidence: II; Systematic Review/Meta-analysis.
ABSTRACT Objective: This study aims to evaluate the treatment preferences among spine surgeons in Latin America in the management of degenerative spondylolisthesis. Methodology: A questionnaire with 30 clinical cases of patients with degenerative spondylolisthesis, containing images, radiological measurements, and patient data, was sent to 33 spine surgeons in Latin America with fellowship training. The surgeons chose between conservative treatment, isolated decompression, or decompression with fusion. Cluster analyses identified decision-making profiles among the surgeons, and the Kappa coefficient measured the degree of interobserver agreement at the 5% and 1% levels. Results: Four clusters were revealed: A (15.2% - clear preference for fusion), B (39.4% - tendency towards fusion), C (39.4% - tendency towards decompression), and D (6.1% - clear preference for decompression). In a comparison of 528 pairs of assessments, 43% showed significant agreement at the 5% level and 28.2% at the 1% level. Conclusion: The facet angulation, as well as the extent of surgical decompression, were the only relevant factors for decision-making. Individual preference was the strongest factor in decision-making, as revealed by cluster analysis. There is a tendency towards performing fusion rather than decompression among spine surgeons in Latin America, influenced by group polarization and personal bias, more than by the radiological characteristics of each case. Level of evidence III; Retrospective study.
ABSTRACT Objective: To evaluate the feasibility and effectiveness of using Google Forms for longitudinal application of the Oswestry Disability Index (ODI) in patients undergoing spine surgery. Methods: Retrospective observational study conducted at a specialized orthopedic clinic in Belo Horizonte, Brazil, between 2021 and 2023. Patients undergoing spine surgery (n=402) were invited to complete the ODI via Google Forms preoperatively and at 30, 90, 180, and 360 days postoperatively. The clinic secretary made telephone contact and sent the form link via email. Response rates were analyzed over time, by sex, age group, and year of inclusion. Results: Response rates were 100% preoperatively and at 30 days, 93.8% at 90 days, 84.6% at 180 days, and 62.4% at 360 days. Patients aged 41-60 years showed the most consistent response rates. Women demonstrated slightly higher adherence in longer periods (64.9% vs 59.3% at 360 days). Patients included in 2021 and 2022 maintained response rates above 98% after one year. Conclusion: The use of Google Forms for longitudinal ODI application in spine surgery proved to be feasible and effective, with high response rates, especially in initial follow-up periods. This approach offers a promising alternative to traditional data collection methods, potentially improving the efficiency of postoperative follow-up in spine surgery. Level of Evidence IV; retrospective observational study.
ABSTRACT Objective: To create and implement a structured database for patients treated by the spine surgery team at Santa Casa de Misericórdia de São Paulo, analyzing the epidemiological profile, therapeutic strategies, and clinical outcomes. Methods: Retrospective observational study including 5,085 patients treated between 2016 and 2024, comprising 4,192 outpatient consultations and 893 surgical procedures. Data were prospectively collected and recorded on the REDCap platform, including demographic information, diagnoses, treatments, clinical evolution, and standardized questionnaires. Statistical analyses were performed using R software. Results: The mean age was 46.2 ± 20.6 years, with a male predominance in outpatient care (57.8%). Low back pain and degenerative diseases were the most frequent diagnoses (26.2%), followed by lumbar disc herniation (7.6%) and thoracolumbar fractures (7.3%). In the surgical group, metastases (12.3%) and fractures (10.6%) stood out. Conservative treatment was recommended in 71.4% of outpatient cases. Among surgical patients, 47.6% underwent instrumentation, mostly via posterior approach (84.9%). The mean Oswestry Disability Index (ODI) was 31.0. Women reported higher pain intensity but showed better neurological outcomes. The surgical complication rate was 9.2%, with satisfactory evolution in 90.8% of operated cases. Conclusion: This study highlights the predominance of degenerative diseases and low back pain in outpatient settings and underscores the essential role of surgery in complex cases. The implementation of the REDCap database proved effective for clinical monitoring, contributing to the improvement of therapeutic practices and future research in spine surgery. Level of Evidence IV; Retrospective observational study.
ABSTRACT Objective: To determine and evaluate radiological changes in the asymmetry of the lateral atlantodental interval and atlas tilt after the application of the Atlasprofilax intervention. Methods: A radiological prospective study was conducted on patients who underwent the Atlasprofilax Method in Mexico. A total of 258 patients provided informed consent and were enrolled in the study. Group A (n=79) underwent the intervention, while Group B (n=179) served as the control group. Anteroposterior transoral radiographs were obtained for both groups. The open-mouth anteroposterior projection was selected for clear visualization of relevant structures. Results: Both groups had a very similar distribution of lateral atlantodental interval prior to the intervention. Both groups exhibited positive lateral atlantodental interval asymmetry with most values ranging from 1 mm to 2.9 mm. After the intervention in Group A, a highly significant and clear improvement was observed, with a reduction in lateral atlantodental interval asymmetry trending toward zero and enhanced orthogonality of the C1-C2 complex. Atlas tilt and the alignment of the C2 spinous process did also significantly improve. Conclusions: The Atlasprofilax intervention yielded significant improvements by decreasing lateral atlantodental interval asymmetry, correcting atlas tilt, and aligning the C2 spinous process in the treated group, both in comparison to the control group and when evaluating preand post-intervention changes. These results contribute valuable data to the ongoing debate regarding the clinical significance of lateral atlantodental interval asymmetries and underscore the need for further research to better understand their implications. Level of Evidence II; Prospective comparative therapeutic (radiological) study.
ABSTRACT Objective: To investigate the issues related to the waiting list of patients with early onset scoliosis awaiting surgical treatment through an epidemiological study conducted in a tertiary public hospital that is a reference center for spine care in the State of Goiás. Methods: An analytical cross-sectional epidemiological study was conducted with 73 patients diagnosed with early onset scoliosis referred to and treated at the only reference center in the State of Goiás. Results: The average age of the evaluated patients was 11.6 years, with a higher frequency of females (64.68%). The most common etiology was neuromuscular (54.79%), followed by idiopathic (26.03%). Almost half of the patients (49.32%) had a Cobb angle between 20 and 50º. The average waiting time between referral to the reference center and the consultation was 12 months. The most indicated treatment at the reference center for these patients was expectant treatment with serial observation (57.53%), followed by surgical treatment (34.25%). The majority (83.5%) had not undergone any type of treatment before being referred to the reference center. The only two patients who underwent surgery during the data collection had an average waiting time from the date of request to the procedure of 24 months. Conclusions: The waiting list for surgical treatment of EOS is generally composed of girls with neuromuscular scoliosis, with a longer waiting time than the average for EIA. This queue is fueled both by delays in diagnosis and in referrals to treatment reference centers, as well as by high demand overwhelming a single specialized center. Based on the analysis of this queue, it becomes more feasible to provide new fundamental elements for the development of guidelines and the reorganization of priorities in the waiting list, promoting greater efficiency and equity in the treatment of EOS. Level of Evidence IV; Descriptive Study.
ABSTRACT The purpose of the present review was to evaluate, by means of a meta-analytic study, the main preexisting risk factors in patients with neuromuscular scoliosis associated with readmission up to 90 days after the posterior spinal arthrodesis procedure. The databases evaluated were PubMed, BVS/BIREME, Scopus, Web of Science and Embase. The search strategy established for the selection of studies was as follows: “patient readmission” OR rehospitalization OR rehospitalizations OR “unplanned readmission” OR “unplanned readmissions” OR “hospital readmissions” OR “unplanned hospital readmissions” OR “unplanned hospital readmission” OR “hospital readmission”. As a result, after applying the exclusion criteria, of the 46 previously selected articles, seven were included in the statistical analyses, considering the description of the associated comorbidities. The risk factors most closely related to readmissions were the presence of pulmonary diseases and high BMI. All of these events resulted in a cumulative odds ratio of 2.7 (95%CI 1.1-4.6). The readmission rates had a geometric mean of 3.0%. Conclusion: This meta-analysis revealed that the presence of pulmonary diseases and a high BMI were the main risk factors significantly associated with the readmission of patients undergoing posterior spinal arthrodesis. Level of Evidence II; Systematic review with homogeneity of cohort studies.
ABSTRACT Objective: To describe the clinical and epidemiological profile of patients diagnosed with spinal fracture treated at a tertiary hospital in Santa Catarina from January to December 2022 and to perform a statistical analysis of the prevalence, distribution, and correlation between spinal fractures and associated injuries, identifying possible risk factors and patterns of association. Methods: Analytical cross-sectional observational study, data were tabulated in the Excel program and exported to the SPSS 20.0 program, the Chi-Square Test or Fisher’s Exact Test was used, and the prevalence ratios (PR) and their respective confidence intervals were presented ( IC95%). A significance level of p ≤ 0.05 was adopted. Result: A predictive value of a higher risk of associated trauma was found in male patients, being 1,590 times greater than in women and regarding the type of trauma, traffic accident (1.41x) was the most prevalent with a significant predictive value (p 0.013). Conclusion: Actively look for associated traumas in male patients and when the trauma mechanism is due to a traffic accident. Level of evidence III; Case-control study.
ABSTRACT Objective: To map obstacles in the diagnosis and treatment of early-onset scoliosis in patients treated through the Brazilian Public Health System (SUS) at a tertiary hospital in São Paulo, supporting action plans to improve treatment access. Methods: Descriptive epidemiological study with 24 patients treated between June and November 2024. Demographic variables, referral process, time to specialist consultation, and proposed treatment were analyzed. Statistical analysis included descriptive statistics for continuous and categorical variables. Normality was tested using Shapiro-Wilk, with p ≤ 0.05. This is a descriptive epidemiological study with retrospective analysis, presenting level II evidence according to the Oxford classification Results: Most patients were female, with a median age of 24 months at the initial evaluation. The most common etiology was congenital (41.7%). The mean referral time to a specialized center was 61.9 months, with 70.8% arriving via direct medical referral, without official regulation. At data collection, 37.5% were still awaiting treatment, with an average wait time of 57.4 months. Conclusion: The study highlights delays in the diagnosis and treatment of early-onset scoliosis within the public health system, impacting patient access to care. Improvements in screening, referral, and specialized resources are essential to optimize care. Level of evidence II; retrospective study.
ABSTRACT Objective: To evaluate the radiographic fusion rate and safety of a deproteinized bovine-derived xenograft as an adjunct in spinal arthrodesis. Methods: A prospective case series study (n=35) was conducted on adult patients undergoing instrumented spinal fusion. Radiographic fusion was assessed at 6 months using the Molinari classification. Descriptive and inferential statistical analyses (Fisher’s Exact Test, Mann-Whitney U, Kruskal-Wallis) were performed to investigate associations between demographics, etiology, and the outcomes of fusion and complications. Results: The overall fusion rate (Molinari grade I or II) was 88.6% (31/35). There was no statistically significant association between etiology, sex, or age and the fusion outcome (p > 0.05). The complication rate was 11.4% (4/35), consisting of superficial wound infections. The occurrence of complications was significantly associated with deformity patient group (p < 0.001). Conclusion: The deproteinized bovine xenograft proved to be a safe and effective adjunct for spinal arthrodesis, with a high and consistent radiographic fusion rate (88.6%) across different pathologies. Complications were associated with the surgical magnitude of the underlying disease rather than the graft material itself. Level of Evidence IV; cross-sectional study.
ABSTRACT Objective: To describe the epidemiology, outcomes, complications, and risk factors of lumbar endoscopic discectomies at a tertiary hospital. Methods: 138 patients treated for lumbar disc herniation (LDH) between 2021 and 2024 were analyzed regarding outcomes and complications through medical records and statistical analysis. Results: Of the 138 patients: 52.89% (n=73) male, 47.10% (n=65) female (mean 44.2 years; BMI 27.9 kg/m2). Preoperative pain: 32.6% (n=45) acute, 36.9% (n=51) subacute, and 30.43% (n=42) chronic. Approaches: interlaminar (58%; n=80) and transforaminal (42%; n=58). Comorbidities: hypertension (23.2%), smoking (6.5%), DM (5.8%), and prior lumbar surgery (15.94%). VAS improvement: acute 2.64 (SD 0.712), subacute 1.73 (SD 0.843), and chronic 1.33 (SD 0.798). Average stay: 2 days; surgical time: 80 min (60-90). Complications: acute (2.2%), subacute/acute-on-chronic (4.1%), and chronic (9.5%), p=0.314. Pain recurrence: 13.3%, 30.6%, and 23.8% (p=0.122). Specific complications (n=6): insufficient decompression 3.4% (n=5), dural injury 0.7% (n=1), infection 0.7% (n=1). Symptom return: 23.9% (63.4% low, 15.15% moderate, 21.21% high intensity); recurrent herniation 16.7%; reoperation 10.1%; 105 patients asymptomatic. Prior surgery increased complications (OR 8.16; p=0.013; 18.2% vs. 2.6%). BMI associated with pain recurrence (p=0.024; 29.4 vs. 27.3 kg/m2). Transforaminal approach showed higher recurrence (31.0% vs. 12.5%; OR 3.15; p=0.0075) and complications (10.34% vs. 1.25%; OR 9.11; p=0.025). Symptom-free time (n=33): mean 162.7 days (SD 211.1); return in 25% (immediate), 50% (up to 90 days), and 75% (up to 210 days). Conclusions: Lumbar endoscopy is safe and effective. Success depends on patient factors, pain profile, and pathology. Level of evidence IV; Cross-sectional, observational study.
ABSTRACT Objective: To evaluate the clinical effects, radiographic outcomes, and complications of oblique lateral interbody fusion combined with anterolateral fixation using unilateral screws and rods in patients with degenerative lumbar disc disease. Methods: Fourteen medical records were analyzed, with comparison of preoperative and postoperative radiographs over a 12-month follow-up period. Patients with degenerative lumbar disease, foraminal stenosis, central canal stenosis, grade I or II degenerative spondylolisthesis, and/or adjacent segment degeneration were included, provided they underwent oneor two-level intervention after failure of conservative treatment for at least three months. Cases of spinal infection, trauma, local malignancy, specific L5-S1 pathologies, and loss to postoperative follow-up were excluded. Low back and lower limb pain were assessed using the Visual Analog Scale (VAS), and lumbar function was evaluated with the Oswestry Disability Index (ODI). Radiographic analysis was performed using Surgimap®, assessing the Cobb angle, bone fusion, cage positioning, as well as migration and subsidence. Results: Significant improvement in VAS and ODI scores was observed after surgery (p<0.001). Indirect decompression was effective at all operated levels. An increase in lordosis was noted, with significant change in the lumbar Cobb angle (p<0.001), and the fusion rate was 81.4%. Osteolysis and subsidence occurred in 14.3% of cases, particularly in older patients. Conclusion: The procedure promoted clinical and functional improvement in more than 80% of patients, bone fusion in 81.4% of cases, and a 4.4-degree increase in lumbar lordosis, with osteolysis and cage subsidence being more frequent, especially in individuals older than 63 years. Level of evidence II; Retrospective study.
ABSTRACT Spinal epidural abscess is a pyogenic infection located between the dura mater and the vertebral periosteum, characterized by its severity and potential lethality. Its incidence has been progressively increasing, driven by predisposing factors such as diabetes mellitus and intravenous drug use. Diagnosis is often challenging, requiring imaging tests, especially MRI, to accurately detect the lesion, which can cause spinal cord compression and result in significant neurological deficits. Early intervention is essential to prevent irreversible neurological sequelae and the development of sepsis. The gold standard treatment consists of immediate surgical decompression combined with antibiotic therapy. In this scenario, endoscopic spine surgery has emerged as a promising alternative, as it provides less tissue damage and promotes faster recovery. This study aims to deepen knowledge about the technique and results of the endoscopic approach in the treatment of spinal epidural abscesses by reporting a clinical case in which the patient was successfully treated with uniportal endoscopic surgery. It is important to acknowledge the limitations of this study, which is based on the analysis of a single case. This limitation reinforces the need for studies with larger sample sizes to more robustly validate the efficacy and safety of this surgical technique. Level of Evidence IV; Case report.
ABSTRACT Tumorous calcinosis is a condition characterized by dystrophic calcification in periarticular soft tissues. Its main locations are the shoulder, hip, and metatarsophalangeal joints, but it is rarely found in the spine. Common symptoms include pain, limited range of motion, and extremity weakness. In the spine, surgical resection is indicated for lesions that cause acute, progressive symptoms, or refractory neurological dysfunction. There are few reports of these tumors in the spine, with the largest series comprising 32 cases. The objective of this report is to describe a rare case of tumorous calcinosis of the lumbar spine. A brief literature review is presented, covering the main characteristics of the tumor, differential diagnoses, histological study, and the surgical approach performed through spinal endoscopy. Level of Evidence IV; Case Report.
ABSTRACT Endoscopic spine surgery has become increasingly popular among specialized surgeons, driven by its minimally invasive approach and increasing clinical versatility. Initially restricted to the lumbar spine, its indications have expanded to the cervical region and, to a lesser extent, the thoracic region, offering a less aggressive and more affordable alternative to traditional procedures such as laminectomy, costotransversectomy, and the anterior extracavitary approach to the thoracic spine. During interventions in this segment, it is common to identify segmental vessels, whose anatomical position may vary depending on the surgical level. In certain cases, the segmental artery and vein overlap or invade the disc space, becoming critical structures to consider during endoscopic decompression. This study’s primary objective was to highlight the relevance of Adamkiewicz’s artery in endoscopic spinal surgery. To this end, a narrative review was conducted according to the PRISMA method guidelines, structured according to the PICOS criteria: adults, as defined by the World Health Organization (Population); endoscopic procedures involving the artery of Adamkiewicz (Intervention); surgical techniques that do not consider this vascular structure (Comparison); and clinical trials and case studies (Outcome). The analysis culminated in the selection of 20 articles, which supported the discussion and the findings presented. It is concluded that accurate identification of the artery of Adamkiewicz is essential for preventing neurological complications, and its preservation is a determining factor in reducing the risk of spinal cord ischemia during spinal procedures. Advanced imaging techniques, such as magnetic resonance angiography, have demonstrated high efficacy in locating this vessel, allowing surgeons to plan minimally invasive approaches with greater precision and safety. Level of Evidence III; Review Article.
ABSTRACT Minimally invasive endoscopic surgery of the lumbar spine has transformed the way degenerative disorders of this segment are understood and treated. However, the technological advances associated with this modality have required surgeons to face a new and challenging learning curve. Among the technical aspects, the transforaminal endoscopic lumbar access has stood out due to the complexity of disc puncture, a critical step for procedural success. During training, this phase has represented one of the main barriers to skill acquisition, and the accumulation of unsuccessful attempts has been a determining factor for withdrawal among many surgeons. In this context, an alternative technique based on osseous landmarks was proposed, using an oblique biplanar access, aiming to improve positional safety during disc puncture and to provide greater predictability for surgeons in the early stages of training in this approach. Level of Evidence IV;Technique Description and Case Report.
