Integration of technological advancements across multiple modalities enabled different surgical specialties to embrace various minimally invasive approaches. Such advancements related to spine surgery are gaining popularity due to focal nature of majority of the spine pathologies. Tubular retractors of various types and dimensions have proved their worth by giving very good results when used with either microscope or endoscope. They enable surgical decompression and fusion with minimal alteration of the normal musculoligamentous anatomy of back and have proven their versatility by delivering excellent outcomes for different conditions. The evolution of the techniques of full endoscopy opened new paths which seem promising to further refinement of spine surgery. This progress has brought us to the crossroads of either carrying out the satisfactory techniques of tubular retractors or to try something different by taking another steep learning curve and shifting to full endoscopic techniques. It has to be seen whether the transition to full endoscopic intervention is worth exploring new horizons by taking a longer trajectory of learning when similar advantages are being achieved by existing tubular techniques. In this report, we discuss the pathologies dealt with and the changing trends for developing to full endoscopic techniques under the experience of tubular endoscopic spine surgery.

Objective: To evaluate the technical feasibility and assess the clinical outcomes of tubular decompression (TD) in cases of multilevel lumbar canal stenosis operated through a single incision. TD has established itself in the surgical management of single level lumbar stenosis. Literature on performance of TD for multilevel stenosis through a single incision are non-existent.Methods: All patients undergoing TD for multilevel lumbar stenosis through a single incision from January 2007 to January 2018 were included. Patient demographics, operative and peri-operative details were documented. Patient based clinical outcomes, namely Visual Analogue Scale (VAS) scale for back and leg pain and Oswestry Disability Index (ODI) were assessed. Results: Favorable tube trajectory and adequate decompression could be achieved through a single incision to decompress multiple levels. The VAS improved from mean 31.5 (2–5) to 20.8 (1–4) and 71.4 (4–9) to 21 (1–5) for back and leg pain respectively; while the ODI improved from a mean 44.68.6 (32–68) to 20.25.3 (16–42) at 3 months post-op and was maintained at 10.8 (1–4), 1.60.67 (1–3) and 192.9 (16–26) respectively at 2 years follow-up.Conclusion: TD for multilevel stenosis done through a single incision is a feasible option with good to excellent results.

Case: A 58-year-old man underwent anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy. Immediately after surgery, the patient experienced elevated blood pressure with a fall in oxygen saturation which prevented extubation. He required admission to the critical care unit and was diagnosed with baroreflex failure syndrome (BFS). He was managed with a 4-drug medical regimen and stabilized by the second postoperative day. Conclusion: BFS should be considered in the setting of sudden sharp elevation in blood pressure after ACDF. Early diagnosis and initiation of appropriate pharmacotherapy may reduce patient morbidity and mortality.