{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:42:19Z","timestamp":1791520939042,"version":"4.3.4"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Uniportal lumbar endoscopic decompression is fluoroscopy-dependent, and the two dominant approaches, transforaminal and interlaminar, might impose distinct intraoperative targeting demands. Therefore, the aim of this study was to examine differences in radiation exposure based on technique and identify modifiable predictors beyond choice of approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The authors identified 51 consecutive patients who underwent single-level uniportal lumbar endoscopic decompression with and without unilateral erector spinae blocks (ESBs). After excluding 4 with bilateral procedures, 2 with discography, and 1 with bilateral ESB, 44 patients remained for analysis (n = 16 transforaminal, n = 28 interlaminar). Of these, 38 received a single unilateral ESB, 4 received 2 ipsilateral ESBs, and 2 received none. Primary outcomes were intraoperative radiation dose (in milligrays), fluoroscopy time (in seconds), and operative duration. The Mann-Whitney U-test and Kruskal-Wallis test were used for group comparisons. A multivariable regression model was adjusted for approach, laterality, age, BMI, and the number of ESB injections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Transforaminal cases had 1.8 times the radiation dose of interlaminar cases (median 11.48 vs 6.25 mGy, p &lt; 0.001) and 2.4 times the fluoroscopy time (56 vs 23.5 seconds, p &lt; 0.001). In the adjusted model (n = 44; R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.48, adjusted R\n                      <jats:sup>2<\/jats:sup>\n                      = 0.42, F-test p &lt; 0.0001), the transforaminal approach was an independent predictor of radiation dose [exp(\u03b2) = 1.83, 95% CI 1.25\u20132.69; p = 0.003], as was higher BMI [exp(\u03b2) = 1.067 per unit, 95% CI 1.02\u20131.11; p = 0.004]. In a restricted cohort limited to patients who received a single ipsilateral ESB, the transforaminal effect was preserved; in the overall cohort, interlaminar-specific BMI sensitivity was strong (\u03c1 = 0.54, p = 0.003). The use of a second ESB trended toward an increase in cumulative radiation dose (95% CI 1.00\u20132.39, p = 0.051).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Within a single-surgeon uniportal endoscopic practice, the transforaminal approach and higher BMI were independently associated with greater intraoperative radiation dose. Because the approach effect persisted after adjustment for patient and case factors, surgeons should consider BMI-sensitive technique refinement particularly for an interlaminar approach. While these findings require further validation in larger multisurgeon series, they suggest that approach selection should remain governed by the underlying pathology. The transforaminal radiation premium is best interpreted as a modifiable cost to be anticipated and mitigated rather than a reason to favor one corridor over another. Only in the subset of disc herniations amenable to either corridor does the lower radiation footprint of the interlaminar approach become a relevant secondary consideration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.7.focus26329","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:05:18Z","timestamp":1790121918000},"page":"E17","source":"Crossref","is-referenced-by-count":1,"title":["Radiation stewardship in uniportal lumbar endoscopic decompression"],"prefix":"10.3171","volume":"61","author":[{"given":"Sahil","family":"Garg","sequence":"first","affiliation":[{"name":"The Steadman Philippon Research Institute, Vail;"},{"name":"The Steadman Clinic, Vail, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick G.","family":"Young","sequence":"additional","affiliation":[{"name":"The Steadman Philippon Research Institute, Vail;"},{"name":"The Steadman Clinic, Vail, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saqib","family":"Hasan","sequence":"additional","affiliation":[{"name":"Golden State Orthopedics and Spine, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjitpal S.","family":"Gill","sequence":"additional","affiliation":[{"name":"The Steadman Philippon Research Institute, Vail;"},{"name":"The Steadman Clinic, Vail, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Gallizzi","sequence":"additional","affiliation":[{"name":"The Steadman Philippon Research Institute, Vail;"},{"name":"The Steadman Clinic, Vail, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"J Neurosurg Spine","first-page":"802","article-title":"Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis","volume":"31","author":"Barber SM","year":"2019","unstructured":"Barber SM, Nakhla J, Konakondla S,  Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis. J Neurosurg Spine. 2019;31(6):802\u2013815. doi:10.3171\/2019.6.SPINE19532"},{"issue":"8","key":"b2","series-title":"Eur Spine J","first-page":"2736","article-title":"Comparison of full-endoscopic and tubular-based microscopic decompression in patients with lumbar spinal stenosis: a randomized controlled trial","volume":"32","author":"Kotheeranurak V","year":"2023","unstructured":"Kotheeranurak V, Tangdamrongtham T, Lin GX,  Comparison of full-endoscopic and tubular-based microscopic decompression in patients with lumbar spinal stenosis: a randomized controlled trial. Eur Spine J. 2023;32(8):2736\u20132747. doi:10.1007\/s00586-023-07678-5"},{"issue":"2","key":"b3","series-title":"Spine Open","first-page":"e0079","article-title":"Clinical outcomes of open, tubular, and endoscopic lumbar discectomy","volume":"2","author":"Stone DH","year":"2026","unstructured":"Stone DH, Bentz GP, O\u2019Malley J,  Clinical outcomes of open, tubular, and endoscopic lumbar discectomy. Spine Open. 2026;2(2):e0079. doi:10.1097\/bn9.0000000000000079"},{"issue":"9","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"931","article-title":"Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study","volume":"33","author":"Ruetten S","year":"2008","unstructured":"Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931\u2013939. doi:10.1097\/BRS.0b013e31816c8af7"},{"issue":"7","key":"b5","series-title":"Global Spine J","first-page":"1104","article-title":"Is endoscopic discectomy the next gold standard in the management of lumbar disc disease? Systematic review and superiority analysis","volume":"11","author":"Muthu S","year":"2021","unstructured":"Muthu S, Ramakrishnan E, Chellamuthu G. Is endoscopic discectomy the next gold standard in the management of lumbar disc disease? Systematic review and superiority analysis. Global Spine J. 2021;11(7):1104\u20131120. doi:10.1177\/2192568220948814"},{"issue":"1","key":"b6","series-title":"Int J Spine Surg","first-page":"72","article-title":"Percutaneous endoscopic lumbar discectomy versus microdiscectomy for the treatment of lumbar disc herniation: pain, disability, and complication rate \u2014 a randomized clinical trial","volume":"14","author":"Meyer G","year":"2020","unstructured":"Meyer G, DA Rocha ID, Cristante AF,  Percutaneous endoscopic lumbar discectomy versus microdiscectomy for the treatment of lumbar disc herniation: pain, disability, and complication rate \u2014 a randomized clinical trial. Int J Spine Surg. 2020;14(1):72\u201378. doi:10.14444\/7010"},{"issue":"1","key":"b7","series-title":"Semin Spine Surg","first-page":"101080","article-title":"Uniportal endoscopic lumbar decompression: interlaminar and transforaminal techniques and outcomes","volume":"36","author":"Perfetti DC","year":"2024","unstructured":"Perfetti DC, Derman PB. Uniportal endoscopic lumbar decompression: interlaminar and transforaminal techniques and outcomes. Semin Spine Surg. 2024;36(1):101080. doi:10.1016\/j.semss.2024.101080"},{"issue":"Suppl 19","key":"b8","series-title":"Spine (Phila Pa 1976)","first-page":"B30","article-title":"Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up","volume":"41","author":"Nie H","year":"2016","unstructured":"Nie H, Zeng J, Song Y,  Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation via an interlaminar approach versus a transforaminal approach: a prospective randomized controlled study with 2-year follow up. Spine (Phila Pa 1976). 2016; 41(Suppl 19):B30-B37. doi:10.1097\/BRS.0000000000001810"},{"issue":"6","key":"b9","series-title":"World Neurosurg","first-page":"1337","article-title":"Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure","volume":"82","author":"Srinivasan D","year":"2014","unstructured":"Srinivasan D, Than KD, Wang AC,  Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure. World Neurosurg. 2014;82(6):1337\u20131343. doi:10.1016\/j.wneu.2014.07.041"},{"issue":"6","key":"b10","series-title":"Occup Med (Lond)","first-page":"498","article-title":"Increased cancer risk among surgeons in an orthopaedic hospital","volume":"55","author":"Mastrangelo G","year":"2005","unstructured":"Mastrangelo G, Fedeli U, Fadda E, Giovanazzi A, Scoizzato L, Saia B. Increased cancer risk among surgeons in an orthopaedic hospital. Occup Med (Lond). 2005;55(6):498\u2013500. doi:10.1093\/occmed\/kqi048"},{"issue":"2","key":"b11","series-title":"Global Spine J","first-page":"575","article-title":"Transforaminal versus interlaminar endoscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis","volume":"13","author":"Jitpakdee K","year":"2023","unstructured":"Jitpakdee K, Liu Y, Kotheeranurak V, Kim JS. Transforaminal versus interlaminar endoscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis. Global Spine J. 2023;13(2):575\u2013587. doi:10.1177\/21925682221120530"},{"issue":"2","key":"b12","series-title":"J Neurosurg Spine","first-page":"211","article-title":"Impact of body habitus on fluoroscopic radiation emission during minimally invasive spine surgery","volume":"22","author":"Kukreja S","year":"2015","unstructured":"Kukreja S, Haydel J, Nanda A, Sin AH. Impact of body habitus on fluoroscopic radiation emission during minimally invasive spine surgery. J Neurosurg Spine. 2015;22(2):211\u2013218. doi:10.3171\/2014.10.SPINE14163"},{"issue":"2","key":"b13","series-title":"Global Spine J","first-page":"1232","article-title":"Fluoroscopy-guided erector spinae plane block reduces early postoperative pain following lumbar fusion: a randomized controlled trial","volume":"16","author":"Jahangiri P","year":"2026","unstructured":"Jahangiri P, Bagherzadeh S, Roohollahi F,  Fluoroscopy-guided erector spinae plane block reduces early postoperative pain following lumbar fusion: a randomized controlled trial. Global Spine J. 2026;16(2):1232\u20131239. doi:10.1177\/21925682251378470"},{"key":"b14","series-title":"World Neurosurg","first-page":"e1287","article-title":"Fluoroscopic guided lumbar erector spinae (ESP) field blocks: a new technique and radiographic analysis","volume":"185","author":"Robertson SC","year":"2024","unstructured":"Robertson SC, Kamm C, Ashley M. Fluoroscopic guided lumbar erector spinae (ESP) field blocks: a new technique and radiographic analysis. World Neurosurg. 2024;185:e1287\u2013e1293. doi:10.1016\/j.wneu.2024.03.072"},{"issue":"9596","key":"b15","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457. doi:10.1016\/S0140-6736(07)61602-X"},{"key":"b16","series-title":"J Clin Orthop Trauma","first-page":"103404","article-title":"Comparing percutaneous transforaminal endoscopic discectomy and micro-endoscopic discectomy in the treatment of lumbar disc herniation: an updated systematic review and meta-analysis of cohort and RCT","volume":"76","author":"Suskhan RF","year":"2026","unstructured":"Suskhan RF, Sahara RA, Azizi MI, Hendriarto A. Comparing percutaneous transforaminal endoscopic discectomy and micro-endoscopic discectomy in the treatment of lumbar disc herniation: an updated systematic review and meta-analysis of cohort and RCT. J Clin Orthop Trauma. 2026;76:103404. doi:10.1016\/j.jcot.2026.103404"},{"issue":"1","key":"b17","series-title":"Neurosurg Rev","first-page":"299","article-title":"Full-endoscopic lumbar spine discectomy: in search of the optimal approach-a meta-analysis comparing interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD)","volume":"49","author":"Kozlowska K","year":"2026","unstructured":"Kozlowska K, Domisiewicz K, Klepinowski T, Kolodziej W, Latka D, Latka K. Full-endoscopic lumbar spine discectomy: in search of the optimal approach-a meta-analysis comparing interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD). Neurosurg Rev. 2026;49(1):299. doi:10.1007\/s10143-026-04187-z"},{"issue":"3","key":"b18","series-title":"Spine (Phila Pa 1976)","first-page":"255","article-title":"Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a prospective, controlled trial","volume":"36","author":"Mariscalco MW","year":"2011","unstructured":"Mariscalco MW, Yamashita T, Steinmetz MP, Krishnaney AA, Lieberman IH, Mroz TE. Radiation exposure to the surgeon during open lumbar microdiscectomy and minimally invasive microdiscectomy: a prospective, controlled trial. Spine (Phila Pa 1976). 2011;36(3):255\u2013260. doi:10.1097\/BRS.0b013e3181ceb976"},{"issue":"1","key":"b19","series-title":"Int J Spine Surg","first-page":"39","article-title":"Radiation exposure in minimally invasive transforaminal lumbar interbody fusion: the effect of the learning curve","volume":"13","author":"Kumar A","year":"2019","unstructured":"Kumar A, Merrill RK, Overley SC,  Radiation exposure in minimally invasive transforaminal lumbar interbody fusion: the effect of the learning curve. Int J Spine Surg. 2019;13(1):39\u201345. doi:10.14444\/6006"},{"issue":"6","key":"b20","series-title":"J Neurosurg Spine","first-page":"570","article-title":"Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion","volume":"9","author":"Bindal RK","year":"2008","unstructured":"Bindal RK, Glaze S, Ognoskie M, Tunner V, Malone R, Ghosh S. Surgeon and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine. 2008;9(6):570\u2013573. doi:10.3171\/SPI.2008.4.08182"},{"issue":"3","key":"b21","series-title":"J Neurosurg Spine","first-page":"359","article-title":"Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes","volume":"40","author":"Leyendecker J","year":"2024","unstructured":"Leyendecker J, Benedict B, Gumbs C,  Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes. J Neurosurg Spine. 2024;40(3):359\u2013364. doi:10.3171\/2023.10.SPINE23936"},{"issue":"4","key":"b22","series-title":"Pain Phys","first-page":"385","article-title":"Radiation exposure to the physician in interventional pain management","volume":"5","author":"Manchikanti L","year":"2002","unstructured":"Manchikanti L, Cash KA, Moss TL, Pampati V. Radiation exposure to the physician in interventional pain management. Pain Phys. 2002;5(4):385\u2013393. doi:10.36076\/ppj.2002\/5\/385"},{"issue":"7","key":"b23","series-title":"Orthop Traumatol Surg Res","first-page":"102795","article-title":"Minimising radiation exposure to the surgeon in minimally invasive spine surgeries: a systematic review of 15 studies","volume":"107","author":"Arif S","year":"2021","unstructured":"Arif S, Brady Z, Enchev Y, Peev N, Encheva E. Minimising radiation exposure to the surgeon in minimally invasive spine surgeries: a systematic review of 15 studies. Orthop Traumatol Surg Res. 2021;107(7):102795. doi:10.1016\/j.otsr.2020.102795"},{"issue":"2","key":"b24","series-title":"Korean J Pain","first-page":"148","article-title":"A randomized controlled trial about the levels of radiation exposure depends on the use of collimation C-arm fluoroscopic-guided medial branch block","volume":"26","author":"Baek SW","year":"2013","unstructured":"Baek SW, Ryu JS, Jung CH,  A randomized controlled trial about the levels of radiation exposure depends on the use of collimation C-arm fluoroscopic-guided medial branch block. Korean J Pain. 2013;26(2):148\u2013153. doi:10.3344\/kjp.2013.26.2.148"},{"issue":"4","key":"b25","series-title":"J Spine Surg","first-page":"529","article-title":"A protective method to reduce radiation exposure to the surgeon during endoscopic lumbar spine surgery","volume":"5","author":"Ishii K","year":"2019","unstructured":"Ishii K, Iwai H, Oka H, Otomo K, Inanami H. A protective method to reduce radiation exposure to the surgeon during endoscopic lumbar spine surgery. J Spine Surg. 2019;5(4):529\u2013534. doi:10.21037\/jss.2019.09.17"},{"key":"b26","series-title":"Essentials of Endoscopic Spine Surgery","first-page":"73","article-title":"Role of robotics in endoscopic spine surgery","author":"Garg S","year":"2026","unstructured":"Garg S, Turk RD, Gallizzi MA. Role of robotics in endoscopic spine surgery. In: Singh K, Park DK, Kim JS, eds.Essentials of Endoscopic Spine Surgery. Academic Press;2026:73\u201376. doi:10.1016\/B978-0-443-36628-4.00061-3"},{"key":"b27","series-title":"Essentials of Endoscopic Spine Surgery","first-page":"551","article-title":"The role of artificial intelligence and robots in spine research and surgery","author":"Turk RD","year":"2026","unstructured":"Turk RD, Garg S, Gallizzi MA. The role of artificial intelligence and robots in spine research and surgery. In: Singh K, Park DK, Kim JS, eds.Essentials of Endoscopic Spine Surgery. Academic Press;2026:551\u2013558. doi:10.1016\/B978-0-443-36628-4.00056-X"},{"key":"b28","series-title":"Essentials of Endoscopic Spine Surgery","first-page":"417","article-title":"Robotic-assisted endoscopic procedures","author":"Garg S","year":"2026","unstructured":"Garg S, Turk RD, Gallizzi MA. Robotic-assisted endoscopic procedures. In: Singh K, Park DK, Kim JS, eds.Essentials of Endoscopic Spine Surgery. Academic Press;2026:417\u2013426. doi:10.1016\/B978-0-443-36628-4.00063-7"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/4\/article-pE17.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/4\/article-pE17.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/61\/4\/article-pE17.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:48Z","timestamp":1791331248000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/61\/4\/article-pE17.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":28,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2026.7.focus26329","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}