Narrow lumbar canal L4-L5

We present a video illustrating the use of an ultrasonic knife (bone scalpel) in single-port endoscopy to perform L4-L5 recalibration in a 74-year-old patient with symptomatic lumbar spinal stenosis.

Clinical context

This 74-year-old patient had been experiencing the following symptoms for one year:

• limping in the lower limbs when walking

• a gradual decrease in walking range

• Relief when sitting or bending forward

MRI showed a narrowed lumbar canal at L4-L5, of degenerative origin.

After conservative treatments (medication, rehabilitation, injections) failed, lumbar recalibration at L4-L5 was recommended.

Technique: Bone Scalpel in single-port endoscopy

The unique feature of this procedure is the use of an ultrasonic bone scalpel in single-port endoscopic surgery.

The integration of this instrument into an endoscopic environment allows:

• Fast and precise bone sectioning

• a clean, even, and controlled cut

• a major limitation of bone bleeding

• better endoscopic visibility

• increased safety with regard to nerve structures
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The surgery lasted 45 minutes, with virtually no intraoperative bleeding.

The patient is helped to stand up as soon as they return to their room, with minimal post-operative pain, and is allowed to return home the same day (outpatient surgery).

Physical therapy rehabilitation will begin 15 days after surgery.

The combination of bone scalpel and single-port endoscopy optimizes the quality of the recalibration while maintaining the advantages of minimally invasive surgery: sub-centimeter incision, muscle preservation, and rapid recovery.

Objective of L4-L5 recalibration

Lumbar recalibration aims to:

• widen the lumbar canal

• release compressed roots

• improve neurogenic claudication

• Restore satisfactory walking range

Surgical video

The video shows:

• Single-port endoscopic approach at the L4-L5 level

• use of the bone scalpel for bone resection

• enlargement of the lumbar canal

• final decompression of the nervous structures

This case illustrates the evolution of minimally invasive spinal surgery techniques, combining technological innovation and endoscopic precision in the treatment of lumbar spinal stenosis.