The Use of Computed Tomography-Based Navigation System for Biportal Endoscopic Lumbar Decompression.

Intimate knowledge of local anatomy is required, especially in the biportal endoscopic approach due to its minimally invasive nature. Conditions such as aberrant anatomy, advanced degeneration, and deformities can make endoscopic lumbar decompression more challenging. The computed tomography (CT)-based surgical navigation system is employed with the biportal endoscopic technique to manage lumbar compressive pathologies. The CT-based navigation system offers clear advantages in precision, allowing for careful decompression without excessive bony work, thus preventing instability and reducing the chance of wrong-level surgery. We describe the general steps, indications, advantages, surgical tips, limitations, and ways to avoid complications. In conclusion, the use of CT-based navigation for biportal endoscopic lumbar decompression is an effective and precise strategy, particularly in more complex cases with challenging anatomy, multilevel pathologies, or significant anatomical variations.