Biportal Endoscopic Spine Surgery for Various Foraminal Lesions at the Lumbosacral Lesion

Choi, Dae-Jung; Kim, Jueun; Jung, Je-Tea; Kim, Yong−Sang; Jang, Han-Jin; Yoo, Bang; Kang, Il-Ho

doi:10.4184/asj.2018.12.3.569

Cited by 53 publications

(40 citation statements)

References 4 publications

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“…A steeper angle of approach means that there is less likelihood of an injury to the traversing nerve root and cauda equina, while preserving most of the facet integrity. [96][97][98] However, this approach has a steep learning curve. The main challenge of this www.e-neurospine.org S27 approach is handling the dorsal root ganglion and its associated radicular artery.…”

Section: Paraspinal Endoscopic Approachmentioning

confidence: 99%

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

Kim

Jang

2020

Neurospine

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In the first phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc material through the working corridor of Kambin's triangle using transforaminal endoscopic lumbar discectomy. With the introduction of the interlaminar approach and increased interest from both industry and surgeons, there has been an exponential development of endoscopic surgical equipment and a corresponding expansion of endoscopic techniques. Endoscopic treatment strategies are applied to conditions ranging from contained prolapsed intervertebral discs to noncontained migrated herniated discs, hard calcified discs, spinal stenosis in the central or lateral recess and the foraminal and extraforaminal region, and other combinations of degenerative conditions requiring decompression or fusion surgery. The further expansion of endoscopic surgical management involving complicated spinal cases and the final quartet of trauma, infections, tumors, and possibly deformities could be the future stage of endoscopic spine surgery development. This article covers the full range of current treatment strategies and presents possible future developments of endoscopic spine surgery for the management of lumbar spinal conditions.

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Section: Paraspinal Endoscopic Approachmentioning

confidence: 99%

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

Kim

Jang

2020

Neurospine

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“…Biportal endoscopic spinal surgery (BESS) is widely per-formed as a minimally invasive surgery (MIS) technique for lumbar spinal disease [1][2][3][4][5]. Although the followup period for this is short, BESS can be applied not only to repair lumbar disc herniation [6] but also for lumbar spinal stenosis with improvement of clinical and radiological outcomes [1,3].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

2020

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Here we perform a retrospective analysis regarding an incidental dural tear (IDT) during biportal endoscopic spinal surgery (BESS). Purpose: This study investigates the causes of IDT specifically related to technical procedures of BESS with the aim of lowering its risk during training. Overview of Literature: The incidence of dural tear is reported 0.5%-18% in open spinal surgery and 1.7%-4.3% during endoscopic spinal surgery. Because conversion to open surgery for direct repair could become necessary during endoscopic spinal surgery, prevention of this complication is essential. Methods: We have retrospectively studied IDTs by four surgeons during 1 or 2 years after starting BESS for lumbar degenerative diseases and analyzed the locations, sizes, and specific endoscopic conditions specific to each. Results: Twenty-five cases (1.6%) of IDTs among 1,551 cases of BESS occurred; 13 cases (52%) of these were within the first 6 months. The locations were dorsal midline in 12 cases, ipsilateral side in 11 cases, and contralateral side in two cases. The tear sizes were <10 mm in 20 cases and ≥10 mm in five cases. IDT commonly occurred due to injury of central dural folding during flavectomy under turbid surgical fields due to small bleeds under water. Twenty cases with IDTs of <10 mm were treated well with the patch technique. Among five cases of ≥10 mm, three underwent open repair within a few days, and two of these which failed to conservative management required a delayed revision operation due to pseudomeningocele. No cases progressed to surgical site infection or infectious spondylitis. Conclusions: IDTs of <10 mm can be successfully treated with the patch technique. To prevent IDT during the early learning period, maintaining clear visibility by securing fluent saline outflow and meticulous hemostasis of small bleeding from exposed cancellous bone and epidural vessels is essential with caution not to injure the central dural folding during midline flavectomy.

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“…Biportal endoscopic (BE) technique is a minimally invasive spine surgical modality that is gaining attention worldwide [ 8 , 9 ]. When BE is applied to symptomatic LDH, it can achieve familiar surgical anatomy from the OM approach with a minimal footprint, regardless of the phase of lumbar degenerative disc disease and the location of disc herniation.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

et al. 2020

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Background Although literature provides evidence regarding the superiority of surgery over conservative treatment in patients with lumbar disc herniation, recurrent lumbar disc herniation (RLDH) was the indication for reoperation in 62% of the cases. The major problem with revisional lumbar discectomy (RLD) is that the epidural scar tissue is not clearly isolated from the boundaries of the dura matter and nerve roots; therefore, unintended durotomy and nerve root injury may occur. The biportal endoscopic (BE) technique is a newly emerging minimally invasive spine surgical modality. However, clinical evidence regarding BE-RLD remains limited. We aimed to compare the clinical outcomes after performing open microscopic (OM)-RLD and BE-RLD to evaluate the feasibility of BE-RLD. Methods This retrospective study included 36 patients who were diagnosed with RLDH and underwent OM-RLD and BE-RLD. RLDH is defined as the presence of herniated disc material at the level previously operated upon in patients who have experienced a pain-free phase for more than 6 months. BE-RLD was performed as follows: two independent surgical ports were made inside the medial pedicular line of the target segment and on the intact upper and lower laminas. Peeling off the soft tissue from the vertebral lamina helps to easily identify the traversing nerve root and the recurrent disc material without dealing with the fibrotic scar tissue. Clinical outcomes were obtained using a visual analog scale (VAS) and the modified Macnab criteria before and at 2 days, 2 and 6 weeks, and 3, 6, and 12 months after surgery. Results The data of 20 and 16 patients who underwent OM-RLD and BE-RLD, respectively, were evaluated. The demographic and perioperative data were comparable between the groups. During the year following the surgery, in the BE-RLD group, the VAS scores at each point were significantly improved over the baseline and remained improved up to 2 weeks after surgery (p < 0.05); however, no statistical difference between the two groups was observed after 6 weeks of surgery (p > 0.05). According to the modified Macnab criteria on the follow-up, the excellent or good satisfaction rates reported at 2 weeks, 6 weeks, 6 months, and 12 months after surgery were 81.25%, 81.25%, 75%, and 81.25%, respectively, in the BE-RLD group, and 50%, 75%, 75%, and 80%, respectively, in the OM-RLD group. Conclusion BE-RLD yielded similar outcomes to OM-RLD, including pain improvement, functional improvement, and patient satisfaction, at 1 year after surgery. However, faster pain relief, earlier functional recovery, and better patient satisfaction were observed when applying BE-LRD. Trial registration Retrospectively registered

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Biportal Endoscopic Spine Surgery for Various Foraminal Lesions at the Lumbosacral Lesion

Cited by 53 publications

References 4 publications

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic Spine Surgery

Clinical outcome of biportal endoscopic revisional lumbar discectomy for recurrent lumbar disc herniation

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