Fig. 1

Representative clinical example where surgeries were performed using a uniform technique. A 90-year-old female patient was diagnosed with L4 osteoporotic vertebral collapse (concave-type), severe central canal and right foraminal stenosis at L3-L4, and L3 spondylolisthesis with instability. (A) Plain lateral radiographic image. (B) Dynamic flexion radiographic image. (C) Magnetic resonance T2-weighted sagittal image. (D) Magnetic resonance T1-weighted fat-suppression sagittal image. (E, F) The patient underwent percutaneous balloon kyphoplasty for L4 osteoporotic vertebral collapse but continued to experience severe radicular pain and its related gait disturbance. (G) Finally, she underwent unilateral biportal endoscopic decompressive laminectomy. Sufficient neural decompression of the right L3 exiting nerve root (black star), right L4 traversing nerve root (white star), and left L4 traversing nerve root (black cross) are shown by endoscopic visualization. The same can be seen on the preoperative (H) and postoperative (I) magnetic resonance T2-weighted axial images