Abstract / Summary
Abstract Background Revision decompression after prior lumbar surgery carries a higher risk of incidental durotomy than primary surgery because epidural fibrosis obliterates the plane between dura and bone. In biportal endoscopic surgery, bilateral revision decompression by the conventional unilateral approach requires crossing the scarred midline. Methods We describe a workflow that avoids this crossing: each side is decompressed from ipsilateral portals, with the surgeon changing sides between them, and dissection proceeds from a freshly exposed bony margin using curved curettes rather than punches or burrs. Position switching and bone-referenced dissection have each been described previously; the present contribution is their combination and sequencing for the revision setting. Results The workflow has been applied in 11 patients. Incidental durotomy occurred in 2, both linear tears managed with a patch. A representative case is presented: a man in his 60s with residual L4–5 stenosis 2 years after decompression elsewhere underwent the procedure in 135 min without durotomy, with right leg radiating pain decreasing from VAS 8 to 2 at 8 weeks. Conclusions The sequence is reproducible. No claim of reduced durotomy incidence is made; the safety profile requires evaluation in a clinical series.