Can Percutaneous Biportal Endoscopic Surgery Achieve Enough Canal Decompression for Degenerative Lumbar Stenosis? Prospective Case–Control Study

Heo, Dong Hwa; Quillo-Olvera, Javier; Park, Choon Keun

doi:10.1016/j.wneu.2018.08.144

Cited by 85 publications

(103 citation statements)

References 21 publications

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“…Therefore, it has been suggested that the working cannula should be mobilized gently during the operation to reduce postoperative dysesthesia. The occurrence of a dural tear (2.24%) in the present study was similar to that reported in previous studies (9,15,37). A total of 2 patients experienced a dural tear in the MED group and in this circumstance, endoscopic surgery was changed to open surgery.…”

Section: Discussionsupporting

confidence: 91%

Clinical outcomes of MED and iLESSYS<sup>®</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Xiong²,

Tan

et al. 2020

Exp Ther Med

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Microendoscopic discectomy (MED) is an established procedure used to treat lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS). The Interlaminar Endoscopic Surgical System iLESSYS ® Delta approach has been developed from the traditional interlaminar endoscopic technique for the treatment of LCSS and LRS. In the present study, MED was used as a reference to evaluate this newly developed approach. A total of 82 and 52 patients with radicular leg pain and/or neurogenic claudication symptoms were treated by spinal canal decompression using the MED or iLESSYS ® Delta approach, respectively. The clinical outcomes of the patients were analyzed using the Modified MacNab's criteria, visual analogue scale (VAS) leg pain score, VAS back pain score and the Oswestry Disability Index (ODI) score. Finally, the effectiveness of the decompression was evaluated on a cross-sectional area of the dural sac (CSAD) at the disc level. The incision length in the iLESSYS ® Delta group was significantly decreased compared with the MED group (P<0.05); however, the duration of the operation in the iLESSYS ® Delta group was significantly longer compared with the MED group (P<0.05). The VAS score of the back and ODI score in the iLESSYS ® Delta group were significantly decreased compared with the MED group at the 1-week follow-up (P<0.0125). The postoperative CSAD was also significantly increased in both groups compared with before the operation (P<0.05); however, there were no significant differences in the postoperative CSAD between the two groups. The good-to-excellent rates of the MED and iLESSYS ® Delta approach were 89.0 and 90.4%, respectively, whereas the complication rates of the MED and iLESSYS ® Delta system were 3.66 and 3.85% in the two groups, respectively. In conclusion, the iLESSYS ® Delta approach was identified to be comparable with the MED approach for treating LCSS and LRS, demonstrating both precise and limited decompression. In addition, the iLESSYS ® Delta approach may reduce the short-term back pain and promote faster recovery compared with the MED.

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Section: Discussionsupporting

confidence: 91%

Clinical outcomes of MED and iLESSYS<sup>®</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Xiong²,

Tan

et al. 2020

Exp Ther Med

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“…4,14 The contralateral sublaminar approach for contralateral nerve root decompression is one of the advantages of the biportal endoscopic approach. 3,15 Also, indirect decompression was achieved by the reduction of spondylolisthesis and the restoration of the collapsed disc space. Since we could insert a large, long cage for conventional TLIF, the narrowed disc space was distracted by the insertion of a large-sized cage.…”

Section: Discussionmentioning

confidence: 99%

“…Through biportal endoscopic procedures, it was feasible to perform direct neural decompression through a laminectomy, contralateral sublaminar decompression, discectomy, foraminotomy, and facetectomy as well as indirect decompression by disc space restoration, and the reduction of spondylolisthesis. 4,5,11,[14][15][16] Also, the endoscopic approach is the least invasive and may preserve the normal structure. 6,17 Biportal endoscopic TLIF is hypothesized to have advantages of minimally invasive fusion surgery as well as those of endoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

Technique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion

Heo

Hong²,

Lee

et al. 2020

Neurospine

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Biportal endoscopic transforaminal lumbar interbody fusion (TLIF) may have advantages of minimally invasive fusion surgery as well as those of endoscopic surgery. The purpose of this study was to present the biportal endoscopic TLIF technique along with video presentations and a review of the literature on this technique. Basically, the biportal endoscopic TLIF technique is similar to minimally invasive TLIF with a tubular retractor. There were 2 options in the biportal endoscopic TLIF procedures. The first was the insertion of one long TLIF cage and the other was the insertion of 2 short posterior lumbar interbody fusion (PLIF) cages. After the interbody fusion procedures, percutaneous pedicles screw fixation was performed. Biportal endoscopic TLIF achieved complete neural decompression through laminectomy and facetectomy like conventional TLIF. Endplate preparation was performed completely under a clear and magnified endoscopic view. It was also feasible to insert a large TLIF cage or 2 cages for PLIF without exiting nerve root injury. Biportal endoscopic TLIF might have the advantages of endoscopic surgery as well as minimally invasive fusion surgery. Direct neural decompression, endplate preparation under endoscopic guidance, and the insertion of a large TLIF cage or 2 PLIF cages may be the merits of biportal endoscopic lumbar fusion procedures.

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“…Magnification of pathologic lesion via 4-mm biportal endoscope and clean operative field through continuous saline irrigation can allow visualization of details of surgical anatomy. 15,16 Basically all microsurgical instruments such as high-speed drill, pituitary forceps, and Kerrison punches can be also utilized in biportal endoscopic surgery. 14 Therefore, biportal endoscopic surgery is considered as the minimal invasive technique with relatively shorter learn-ing curve compared to any other minimal invasive spine surgery including the full endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Hydrostatic pressure on epidural space can reduce bleeding and offer the working epidural space for endoscope and surgical instruments via reduction of dura mater. 16 Good visualization of surgical field can be possible optimal decompression of lateral recess, which is significant factor of clinical outcomes. 14 Especially, the free usage of pituitary forceps, osteotomes, and Kerrison punches via working channel in biportal endoscopic surgery is very helpful to perform the decompression of spinal canal and removal of ruptured disc.…”

mentioning

confidence: 99%

Contralateral Keyhole Biportal Endoscopic Surgery for Ruptured Lumbar Herniated Disc: A Technical Feasibility and Early Clinical Outcomes

Park¹,

Jang

Park³

et al. 2020

Neurospine

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Objective: Spinal endoscopic surgery is increasingly adapted as a minimal invasive technique, however, significant facet joint violation may be developed after ipsilateral laminectomy. The aim of this study is to introduce surgical technique of contralateral keyhole biportal endoscopic surgery (CKES) for ruptured lumbar disc and report it is early surgical outcomes with facet joint violation. Methods: Between January to December 2019, 27 patients with ruptured lumbar disc were underwent CKES. Simple radiographs were obtained to investigate development of iatrogenic instability or spondylolisthesis. Magnetic resonance imaging scan was checked about 8 hours after surgery to evaluate successful removal of ruptured disc and existence of facet joint violation. Clinical outcomes were assessed by modified MacNab criteria, visual analogue scale (VAS) scores of back and radicular pain. Results: The mean age of the patients was 62.8 ± 12.48 years. The average operative time and mean follow-up period were 57.1 ± 21.36 minutes and 8.1 ± 3.78 months, respectively. Compared to preoperative scores, the VAS scores of back and radicular pain were significantly improved. Modified MacNab outcome grade was good to excellent in 96.3% (26 out of 27 patients) of patients. The reduction rate of facet joint plane was about 4.9% after contralateral approach. Conclusion: CKES may be considered as an excellent surgical option to treat ruptured lumbar disc without the development of iatrogenic instability. Low rate of facet joint reduction, good visualization of lateral recess, and identification of accurate midline of central spinal canal are advantages of the procedure.

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Can Percutaneous Biportal Endoscopic Surgery Achieve Enough Canal Decompression for Degenerative Lumbar Stenosis? Prospective Case–Control Study

Cited by 85 publications

References 21 publications

Clinical outcomes of MED and iLESSYS<sup>®</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Clinical outcomes of MED and iLESSYS<sup>®</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Technique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion

Contralateral Keyhole Biportal Endoscopic Surgery for Ruptured Lumbar Herniated Disc: A Technical Feasibility and Early Clinical Outcomes

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Can Percutaneous Biportal Endoscopic Surgery Achieve Enough Canal Decompression for Degenerative Lumbar Stenosis? Prospective Case–Control Study

Cited by 85 publications

References 21 publications

Clinical outcomes of MED and iLESSYS<sup>&reg;</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Clinical outcomes of MED and iLESSYS<sup>&reg;</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Technique of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion

Contralateral Keyhole Biportal Endoscopic Surgery for Ruptured Lumbar Herniated Disc: A Technical Feasibility and Early Clinical Outcomes

Contact Info

Product

Resources

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Clinical outcomes of MED and iLESSYS<sup>®</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study

Clinical outcomes of MED and iLESSYS<sup>®</sup> Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study