Interlaminar endoscopic contralateral decompression: redefining technique through standardized maneuvers and nomenclature.

Performing surgeries in the cervical spine endoscopically is gaining more and more traction. Nowadays, there are four standard surgeries, which can be done endoscopically in the cervical spine; anterior endoscopic cervical discectomy (AECD), posterior endoscopic cervical discectomy (PECD), posterior endoscopic cervical foraminotomy (PECF), and cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD). Some authors consider “posterior cervical endoscopic ventral bony decompression” as a separate entity, counting it as the fifth procedure. Beyond these standard procedures, there are numerous individually adapted special approaches for not so common pathologies.Endoscopic procedures in the cervical spine are preferentially performed through a posterior approach. This chapter will focus on the standard procedure of CE-ULBD, a procedure intended for decompression of a cervical central canal stenosis. In cases of moderate and severe stenosis/myelopathy, there is a clear recommendation for surgical treatment.In microsurgery, anterior cervical discectomy and fusion (ACDF) is commonplace for the treatment of cervical spinal stenosis. However, the standard endoscopic anterior approach has limited range of motion and allows the use of only small instruments and therefore remains a procedure primarily reserved for the removal of (small) fresh disc herniations. Performing CE-ULBD through a posterior approach enables to effectively decompress a central stenosis due to sufficient mobility of the endoscope and the use of effective endoscopic decompression instruments such as power burrs.Nowadays, CE-ULBD is characterized in the literature. Beyond studies of feasibility, different authors could prove noninferiority of CE-ULBD in regard to Japanese Orthopedic Association (JOA) score and superiority in terms of duration of surgery, intraoperative blood loss, and length of hospital stay in comparison to microsurgical ACDF.KeywordsCervical spinal canal stenosisSpinal cord compressionCervical myelopathyCE-ULBDCervical laminotomyPosterior cervical endoscopic decompression

BackgroundEndoscopic lumbar interbody fusion is a new technology that is mostly used for single-segment and unilateral lumbar spine surgery. The purpose of this study is to introduce percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) with unilateral laminotomy for bilateral decompression (ULBD) for lumbar spondylolisthesis and evaluate the efficacy by comparing it with open posterior lumbar interbody fusion (PLIF).MethodsTwenty-eight patients were enrolled in PE-PLIF with the ULBD group and the open PLIF group. The perioperative data of the two groups were compared to evaluate the safety of PE-PLIF with ULBD. The visual analog scale (VAS) back pain, VAS leg pain, and Oswestry Disability Index (ODI) scores of the two groups preoperatively and postoperatively were compared to evaluate clinical efficacy. Preoperative and postoperative imaging data were collected to evaluate the effectiveness of the operation.ResultsNo differences in baseline data were found between the two groups (p > 0.05). The operation time in PE-PLIF with the ULBD group (221.2 ± 32.9 min) was significantly longer than that in the PLIF group (138.4 ± 25.7 min) (p < 0.05), and the estimated blood loss and postoperative hospitalization were lower than those of the PLIF group (p < 0.05). The postoperative VAS and ODI scores were significantly improved in both groups (p < 0.05), but the postoperative VAS back pain score in the PE-PLIF group was significantly lower than that in the PLIF group (p < 0.05). The excellent and good rates in both groups were 96.4% according to MacNab’s criteria. The disc height and cross-sectional area of the spinal canal were significantly improved in the two groups after surgery (p < 0.05), with no difference between the groups (p > 0.05). The fusion rates in PE-PLIF with the ULBD group and the PLIF group were 89.3% and 92.9% (p > 0.05), respectively, the cage subsidence rates were 14.3% and 17.9% (p > 0.05), respectively, and the lumbar spondylolisthesis reduction rates were 92.72 ± 6.39% and 93.54 ± 5.21%, respectively (p > 0.05).ConclusionThe results from this study indicate that ULBD can be successfully performed during PE-PLIF, and the combined procedure is a safe and reliable treatment method for lumbar spondylolisthesis.

The gold standard treatment for symptomatic lumbar stenosis refractory to conservative management is a facet-preserving laminectomy. New techniques of posterior decompression have been developed to preserve spinal integrity and to minimise tissue damage by limiting bony decompression and avoiding removal of the midline structures (i.e. spinous process, vertebral arch and interspinous and supraspinous ligaments). To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or avoid removal of posterior midline structures of the lumbar spine versus conventional facet-preserving laminectomy for the treatment of patients with degenerative lumbar stenosis. An experienced librarian conducted a comprehensive electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) for relevant literature up to June 2014. We included prospective controlled studies comparing conventional facet-preserving laminectomy versus a posterior decompressive technique that avoids removal of posterior midline structures or a technique involving only partial resection of the vertebral arch. We excluded studies describing techniques of decompression by means of interspinous process devices or concomitant (instrumented) fusion procedures. Participants included individuals with symptomatic degenerative lumbar stenosis only. Two review authors independently assessed risk of bias using the Cochrane Back Review Group criteria for randomised controlled trials (RCTs) and the Newcastle-Ottawa Scale for non-randomised studies. We extracted data regarding demographics, intervention details and outcome measures. A total of four high-quality RCTs and six low-quality RCTs met the search criteria of this review. These studies included a total of 733 participants. Investigators compared three different posterior decompression techniques versus conventional laminectomy. Three studies (173 participants) compared unilateral laminotomy for bilateral decompression versus conventional laminectomy. Four studies (382 participants) compared bilateral laminotomy versus conventional laminectomy (one study included three treatment groups and compared unilateral and bilateral laminotomy vs conventional laminectomy). Finally, four studies (218 participants) compared a split-spinous process laminotomy versus conventional laminectomy.Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in people who underwent bilateral laminotomy compared with conventional laminectomy (two RCTs, 223 participants, odds ratio 5.69, 95% confidence interval (CI) 2.55 to 12.71).Among the secondary outcome measures, unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low (three RCTs, 166 participants, odds ratio 0.28, 95% CI 0.07 to 1.15; three RCTs, 294 participants, odds ratio 0.10, 95% CI 0.02 to 0.55, respectively). The difference in severity of postoperative low back pain following bilateral laminotomy (two RCTs, 223 participants, mean difference -0.51, 95% CI -0.80 to -0.23) and split-spinous process laminotomy compared with conventional laminectomy (two RCTs, 97 participants, mean difference -1.07, 95% CI -2.15 to -0.00) was significantly less, but was too small to be clinically important. A quantitative comparison between unilateral laminotomy and conventional laminectomy was not possible because of different reporting of outcome measures. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies. Future research is necessary to establish the incidence of iatrogenic instability using standardised definitions of radiological and clinical instability at comparable follow-up intervals. Long-term results with these techniques are currently lacking.

Microscopic unilateral laminotomy for bilateral decompression (ULBD) is a minimally invasive technique used in the treatment of lumbar spinal stenosis and could limit spinal instability and be associated with better clinical outcomes. However, there is ongoing debate regarding its utility compared to conventional laminectomy (CL). The primary objective was to collate and describe the current evidence base for ULBD, including perioperative parameters, functional outcomes, and complications. The secondary objective was to identify operative techniques. A scoping review was conducted between January 1990 and August 2022 according to the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Major databases were searched for full text English articles reporting on outcomes following microscopic unilateral laminotomy in patients with lumbar spinal stenosis. Seventeen articles met the inclusion criteria. Two studies were randomised controlled trials. Two studies were prospective data collection and the rest were retrospective analysis. Three studies compared ULBD with CL. ULBD preserves the osteoligamentous complex and may be associated with shorter operative time, less blood loss, and similar clinical outcomes when compared to CL. This review highlights that ULBD aims to minimise disruption to the normal posterior spinal anatomy and may have acceptable clinical outcomes. It also highlights that it is difficult to draw valid conclusions given there are limited data available as most studies identified were retrospective or did not have a comparator group.

BACKGROUND: Unilateral laminotomy for bilateral decompression (ULBD) was adopted instead of traditional expanding laminectomy in the treatment of lumbar spinal stenosis (LSS).OBJECTIVE: The aim of this study was to evaluate the clinical and radiological outcomes of the endoscopic unilateral laminotomy for bilateral decompression (ULBD) approach in patients with multilevel lumbar spinal stenosis.METHODS: This is a retrospective clinical and radiological study of 42 patients treated with endoscopic ULBD for multilevel LSS at our center. The perioperative results were evaluated, including blood loss, length of hospital stay, and complications within one month postoperatively. Preoperative and postoperative magnetic resonance imaging (MRI) scans were performed. A functional evaluation was conducted using Oswestry disability index (ODI) questionnaire. Low back and leg pain were assessed preoperatively and postoperatively at follow-up visits using visual analog scale (VAS). Macnab’s criteria were applied at the last postoperative follow-up for clinical efficacy evaluation.RESULTS: The mean operative time was 119.6±13.7 minutes. The mean intraoperative blood loss was 76.4±19.1mL. The mean length of hospital stay was 1.7 days. Operation-related complications were identified in two (4.8%) of the 42 patients. The VAS scores at postoperative 3 months, 6 months, and last follow-up (back VAS: 1.8±0.67, 1.72±0.63, 1.54±0.67 respectively; leg VAS: 2.9±1.47, 2.18±1.22, 1.68±0.72 respectively) were significantly better than the preoperative ones (back VAS: 2.9±1.04; leg VAS: 6.45±1.14). Similarly, the ODI score at postoperative 3 months, 6 months, and last follow-up (21.95±4.78, 17.22±4.09, 13.31±2.07 respectively) were significantly better than the preoperative one (43.54 ± 11.75). Macnab’s criteria revealed satisfactory subjective outcomes (good to excellent results) in 39 patients (92.9%) at the final follow-up.CONCLUSION: Endoscopic ULBD in multiple LSS relieves pain and improves patient’s quality of life and satisfaction. The procedure is safe with positive results.

ObjectiveTo investigate the clinical efficacy and imaging outcomes of unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of severe lumbar spinal stenosis (SLSS).MethodsWe retrospectively analyzed 50 patients with SLSS treated with UBE-ULBD from October 2018 to March 2021. Visual analog scale (VAS) for back and legs pain, Oswestry disability index (ODI), modified Macnab criteria, complications, hospital stay, preoperative and postoperative dural sac cross-sectional area (DSCA) and Schizas grade, mean angle of facetectomy and osseous lateral recess decompression rate were examined.ResultsThe mean follow-up period was 10.7 months. The mean hospital stay was 2.76 ± 1.02 days. At the final follow-up, VAS for back pain and legs pain decreased from 7.22 ± 0.95 to 1.26 ± 0.44 and from 7.88 ± 0.69 to 1.18 ± 0.39, respectively; ODI decreased from 69.88 ± 6.32% to 14.96 ± 2.75%. According to the modified Macnab criteria, the results were excellent in 24 (48%), good in 22 (44%), and fair in 4 (8%). Excellent or good results (a satisfactory outcome) were obtained in 92% of the patients. There were 2 cases of complications of dural sac tear. The postoperative DSCA was significantly enlarged compared with that before surgery, from 44.74 ± 9.85 to 126.86 ± 14.81 mm2. According to Schizas grade, the stenosis grade changes from preoperative grade C in 16 cases, grade D in 34 cases, to postoperative grade A in 40 cases, and grade B in 10 cases. The mean angle of facetectomy of the ipsilateral facet joint was 70.87 ± 5.68, contralateral was 65.07 ± 4.98. The decompression rate was 70.81 ± 4.43% (ipsilateral side) and 71.22 ± 3.68% (contralateral).ConclusionsUBE-ULBD has a good clinical effect in the treatment of SLSS, and has achieved satisfactory results in spinal canal enlargement, undercutting of facet joints, and decompression effect. It is a safe and effective surgical for SLSS.

Study Design:Retrospective cohort study.Objectives:To investigate the usefulness of selective single-level lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with radiological multilevel lumbar spinal stenosis (LSS) and clarify the predictive factors of reoperation.Methods:A total of 128 patients who underwent LE-ULBD of radiological multilevel LSS were retrospectively examined. Single-level decompression was selected clinically and supplemented radiologically. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), numeric rating scale (NRS), and Macnab criteria (mean follow-up period, 28.6 months [range, 24-63 months]). Stenosis severity was classified as grades M (moderate) and S (severe) based magnetic resonance imaging findings. Multilevel LSS was classified as SS, SM, and MM according to the number of grade S levels.Results:The follow-up rate was 74.2%. All domains of the JOABPEQ and NRS significantly improved during follow-up. The Macnab outcome classification was “excellent” or “good” in 77.9% of the patients. The reoperation rate was 10.2%. None of the patients with unilateral symptoms required reoperation. The SS type was a significant risk factor of reoperation for multilevel LSS with bilateral symptoms. Additional LE-ULBD was performed for all the reoperation with the “excellent” or “good” results of the Macnab criteria in 69% of the patients.Conclusions:Selective single-level LE-ULBD provided favorable results for multilevel LSS. However, information about the risks of reoperation for multilevel severe stenosis with bilateral symptoms should be shared between surgeons and patients.

Degenerative lumbar spinal stenosis is a common spinal disease in elderly that can lead to spinal claudication, radiculopathy, or axial back pain. Removal of compressive pathologic lesions including hypertrophic ligamentum flavum, facet joint, and prolapsed intervertebral disc is required for satisfactory relief of neurologic symptoms. However, approach-related trauma to surrounding structures may lead to spinal instability, paraspinal muscle injury, adjacent segment degeneration, or back pain. Technique of unilateral laminotomy for bilateral decompression under microscopic guidance has been developed to minimize these potential complications. Lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) follows the same surgical principles as microscopic approach but with the potential advantages of less muscle injury, superior visualization of contralateral lateral recess under high-definition camera and monitor, and reduced blood loss. In this chapter, the details of this endoscopic approach are described.KeywordsSpinal stenosisUnilateral laminotomy bilateral decompressionEndoscopyInterlaminarLumbarSpinal decompressionULBD

BackgroundMicroscopic tubular unilateral laminotomy for bilateral decompression (MT-ULBD) is a minimally invasive technique for lumbar spinal stenosis (LSS) that aims to achieve adequate neural decompression while minimizing tissue disruption. This study evaluates its clinical and radiological outcomes and documents key surgical steps through detailed illustrations.MethodsThis single-center, single-arm cohort study was conducted at Amala Institute of Medical Sciences between September 2024 and April 2025 (IRB No. 34/EC/24/AIMS-16). Patients aged 20–60 years with LSS unresponsive to at least 6 months of conservative therapy were included after obtaining informed consent. Outcomes included pain relief (VAS), functional improvement (ODI), and radiological decompression (canal diameter). Operative parameters, hospital stay, and complications were recorded. Statistical analysis was performed using SPSS version 29.0 (IBM Corp., Armonk, NY); P < 0.05 was considered significant.ResultsOf 44 enrolled patients, 41 completed follow-up (28 females, 13 males; mean age 48.6 ± 8.3 years). Mean VAS scores improved from 7.0 ± 1.2 to 2.0 ± 1.1 (P < 0.001), and ODI from 52.4 ± 8.6 to 22.3 ± 6.1 (P < 0.001). Mean canal diameter increased from 10.8 ± 1.2 to 14.8 ± 1.4 mm (P < 0.001). Mean operative time was 26.3 ± 6.4 min, blood loss 7.5 ± 6.8 mL, and hospital stay 4.0 ± 1.1 days. Two patients (4.9%) had small dural tears successfully repaired with 6–0 Prolene; three (7.3%) developed superficial infections managed conservatively. No neurological deficits or postoperative instability were observed.ConclusionsMT-ULBD provides significant clinical and radiological improvement with minimal morbidity, making it an effective and safe minimally invasive alternative for the treatment of LSS. Surgical illustrations aid in the understanding and reproducibility of the technique.

Study designA retrospective review and prospective follow-up were performed of 106 patients who had undergone microscopic decompressive surgery without fusion in the year 2006 at Munich Spine Center, Germany.ObjectiveThis study aimed to determine the 4–5-year outcome of microscopic unilateral laminotomy for bilateral decompression in degenerative lumbar spinal stenosis and to detect the possible predictors of the surgical outcome.Summary of background dataThere is limited information on the impact of surgery for lumbar spinal stenosis on symptoms, functional status, and satisfaction, as well as reoperation.Patients and methodsPatients were considered eligible for the study if they had clinical and radiographic evidence of degenerative lumbar spinal stenosis, including patients with degenerative spondylolisthesis type 1 according to Myerding and patients with degenerative scoliosis. All patients underwent microscopic decompressive surgery without fusion in the year 2006 at the Munich Spine Center, Germany. One hundred and six patients were available for follow-up during the year 2010.ResultsAt 4–5 years after the operation, 76 (71.7%) patients were satisfied with the surgical outcome. The overall complication rate was 12.2%. 23 (21%) patients required a second operative procedure, whereas three (2.8%) patients required a third operative procedure after the index operation. Two of the 23 patients who had second operations had presumed instability and underwent fusion.ConclusionUnilateral laminotomy for bilateral decompression is an adequate microsurgical technique for decompression of lumbar spinal stenosis that minimizes operative invasiveness and tissue trauma while maximizing preservation of the spinal integrity and stability. Secondary postoperative instability is avoided and excellent long-term clinical outcome could be expected.

Although lumbar stenosis was recognized as a contraindication for endoscopic spine surgery in the past, the advancement in endoscopic system design and development of approach techniques and strategies now enabled the endoscopic spine surgeons to manage all types of lumbar stenosis safely and more effectively. A full-endoscopic lumbar technique for surgical management of spinal canal stenosis is now used today in many advanced spine centers around the world as one of their standard procedures which can be done under general, regional, local anesthesia with sedation. In this technical report, we described in detail the inside-out approach of performing lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) and retrospectively reviewed hospital records of 127 patients who underwent the approach from December 2018 to March 2019 to address 1 level lumbar spinal stenosis and determined its outcome after 12-month follow-up period. Perioperative outcomes, operation time, length of hospital stay, and surgical complications were recorded and analyzed. The cross-sectional area of the thecal sac at the operated level was measured. The visual analogue scale (VAS) was assessed preoperatively, 1 month, and 12 months as well as the Oswestry Disability Index (ODI). The data were statistically analyzed (using SPSS ver. 17.0). The inside-out approach LE-ULBD was shown to effect statistically significant improvement in the VAS of leg and back pain as well as the ODI. It is a familiar, safe, and effective way of performing spinal stenosis decompression with good reproducible outcomes.

Lumbar spinal stenosis is the most common spinal degenerative disease in patients over 60 years, and the unilateral biportal endoscopic (UBE) spine surgery treatment of lumbar spinal stenosis (LSS) has achieved preliminary clinical results. This systematic review and meta-analysis aimed to reveal the clinical efficacy of UBE for LSS and provide evidence for clinical practice. PubMed, Embase, Web of Science, and Cochrane databases were searched for literature. The papers selected were those published from inception till October 2021. The selected pieces of literature were graded for evidence using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Outcomes measures were operation time, blood loss, complication rate, admission period, Visual Analogue Scale (VAS)-back, VAS-leg, and Oswestry Disability Index (ODI) score, and radiological outcomes. The mean comparisons were based on VAS and ODI scores. A total of 823 patients with a single LSS segment were included from the selected nine studies. There were nine studies comparing UBE clinical outcomes and micro-endoscopic unilateral laminotomy for bilateral decompression (M-ULBD). The meta-analysis revealed that the UBE group had better VAS-leg and -back scores in the first week postoperatively [total: mean difference (MD) = -0.96, 95% confidence interval (CI): -1.19, -0.74, p < 0.00001; total: MD = -1.69, 95% CI: -1.93, -1.45, p < 0.00001], 1st month postoperatively (total: MD = -0.35, 95% CI: -0.61, -0.08, p = 0.01; total: MD = -0.40, 95% CI: -0.68, -0.12, p = 0.005), 6th month postoperatively (total: MD = -0.22, 95% CI: -0.35, -0.08, p = 0.002; total: MD = -0.24, 95% CI: -0.40, -0.07, p = 0.005), and UBE group also performed better in ODI score at 1st month postoperatively (total: MD = -3.36, 95% CI: -4.26, -2.46, p < 0.00001). There was no significant difference in VAS-leg and -back scores between both groups at the 3rd and 12th month postoperatively, and ODI scores did not significantly differ between both groups at 3, 6, and 12 months postoperatively (all p > 0.05). UBE has achieved good preliminary clinical results and may be a minimally invasive alternative surgery for patients with single segmental LSS.

Effect of Sagittal Spinal Balance on the Outcome of Decompression Surgery for Lumbar Canal Stenosis

The advent of endoscopic sinus surgery has created an exciting interface between rhinology and ophthalmology in the area of orbital and optic nerve decompression Objectives: (1) To study the utilization of open versus endoscopic medial orbital decompression based on geography and indication, (2) to describe the demographics of the patient populations who underwent these different techniques, and (3) to compare outcomes, including mean charges and operating room (OR) times Methods: Cases identified by Current Procedural and Terminology codes were extracted from the California, Florida, Maryland, and New York State Ambulatory Surgery Databases from 2009 to 2011. Patient demographics, diagnoses, mean charge, and OR time were compared. A total of 1009 patients underwent orbital decompression; 93.0% of cases involved the medial wall only; 22.9% of medial decompressions were performed endoscopically, 74.5% were open, and 2.6% were via combined approach. Eighty percent of patients had thyroid eye disease. Analyses adjusted for sex, age, race, state, and diagnosis found that surgeries for infection (N = 47) were more likely to be performed endoscopically compared with procedures for other diagnoses (N = 962) (odds ratio 5.27 [2.67-10.40], p < 0.001). Patients in Florida were more likely to undergo endoscopic decompression compared with patients in California (odds ratio 2.35 [1.42-3.62]). The difference in median charge for endoscopic ($13,119) versus open ($11,291; p = 0.085) procedures was not significant on bivariate analysis but was significant on multivariate analysis (p = 0.04). The median OR time for open procedures was, on average, 33 minutes shorter (endoscopic, 132 minutes; open, 98 minutes; p ≤ 0.001) on bivariate analysis but was not significantly different when controlling for covariables (p = 0.08). In the study sample, endoscopic orbital decompression was performed in 22.9% of patients, with significant variation in surgical technique based on geography and indication. Procedures that used endoscopic compared with open decompression techniques had no significant difference in charge on bivariate analysis. The OR time for open procedures was shorter on bivariate but not on multivariate analysis. Further research is required regarding the relative effectiveness of open versus endoscopic surgical techniques for various indications.

Motor vehicle and bicycle accidents are the most common causes of blunt head trauma. Other common etiologies are falls, physical violence, and sports accidents. Blunt trauma toward the superior orbital rim, lateral orbital rim, frontal region, and cranium may lead to intraorbital hematoma. A fracture following the blunt head trauma may form a one-way valve, which leads to orbital emphysema and a more pronounced increase in orbital pressure. Increased tissue pressure in an enclosed space will eventually lead to an inevitable decrease in tissue perfusion. It is important to treat the patient within the first 48 hours following the trauma, which is accepted as the "critical period." In this report we present a case involving a 42-year-old man who was admitted to our clinic with left periorbital pain, edema, proptosis, and blurred vision after experiencing physical violence. The medical history and physical examination findings, along with imaging studies and a description of the endoscopic orbital decompression procedure within the first 24 hours, are reported.