Abd-El-Barr’s Mountain: A Radiographic Landmark for Consistent and Successful Docking in Tubular and Endoscopic Retractor-Assisted Minimally Invasive Lumbar Decompression Surgery

Introduction: Minimally invasive spine surgery (MISS) and spine endoscopy continue to have increasing roles in the treatment of various spine pathologies. An attractive benefit of these minimally invasive techniques is the potential to decrease the morbidity associated with traditional open surgery. However, surgeons may hesitate to implement minimally invasive decompression techniques to their practice due to limited direct visualization and an arduous learning curve. The purpose of this retrospective case series was to present a radiographic landmark to allow accurate and reproducible tubular and endoscopic docking in tubular and endoscopic retractor-assisted minimally invasive lumbar decompression surgery, and to support efficient decompression while minimizing surgical footprint and the risk of iatrogenic instability.

Methods: From April 2024 to October 2024, 25 consecutive patients who underwent tubular retractor-assisted minimally invasive lumbar decompression were reviewed for a retrospective case series. Patients in the series underwent either general anesthesia or wide awake spine surgery with epidural anesthesia. Saved intra-operative lateral view fluoroscopy images were reviewed to confirm use of the radiographic landmark for tubular docking. Intra-operative video recordings from the surgical microscope were collected for two patients to demonstrate successful docking and decompression using the described radiographic landmark for initial tubular docking.

Results: Patient ages ranged from 40 to 88 years old (mean 72.7 years old). Postoperatively, 24/25 patients (96%) experienced improvement in preoperative symptoms and 1/25 (4%) patients experienced no improvement. There were no postoperative neurologic deficits, dural tears, worsening preoperative symptoms, or wound infections.

Conclusion : Use of this radiographic landmark on lateral fluoroscopy in minimally invasive lumbar decompression is a safe and effective technique that can be utilized with both general anesthesia and wide-awake spine surgery for successful and consistent tubular and endoscopic docking.