• Alessio Iacoangeli, Mostafà Alsagheir, Denis Aiudi, Maurizio Gladi, Alessandro Di Rienzo, Domenic P Esposito, Mohammed Diab, Hamza Naas, Alì Eldellaa, Antonio Gigante, Maurizio Iacoangeli, Nabeel S Alshafai, and Gustavo Luzardo.
• Department of Neurosurgery, Marche Polytechnic University and Medical Center, Ancona, Italy. Electronic address: alessio.iacoangeli95@gmail.com.
• World Neurosurg. 2024 Jun 1; 186: e142e150e142-e150.

ObjectivesThe aim of this study was to explore the effectiveness of a less-invasive posterior spine decompression in complex deformities. We studied the potential advantages of the microendoscopic approach, supplemented by the piezoelectric technique, to decompress both sides of the vertebral canal from a one-sided approach to preserve spine stability, ensuring adequate neural decompression.MethodsA series of 32 patients who underwent a tailored stability-preserving microendoscopic decompression for lumbar spine degenerative disease was retrospectively analyzed. The patients underwent selective bilateral decompression via a monolateral approach, without the skeletonization of the opposite side. For omo- and the contralateral decompression, we used a microscopic endoscopy-assisted approach, with the assistance of piezosurgery, to work safely near the exposed dura mater. Piezoelectric osteotomy is extremely effective in bone removal while sparing soft tissues.ResultsIn all patients, adequate decompression was achieved with a high rate of spine stability preservation. The approach was essential in minimizing the opening, therefore reducing the risk of spine instability. Piezoelectric osteotomy was useful to safely perform the undercutting of the base of the spinous process for better contralateral vision and decompression without damaging the exposed dura. In all patients, a various degree of neurologic improvement was observed, with no immediate spine decompensation.ConclusionsIn selected cases, the tailored microendoscopic monolateral approach for bilateral spine decompression with the assistance of piezosurgery is adequate and safe and shows excellent results in terms of spine decompression and stability preservation.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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