Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis

Min, Woo‐Kie; Kim, Jueun; Choi, Dae-Jung; Park, Eugene J.; Heo, Jeong

doi:10.1016/j.jos.2019.05.022

Cited by 64 publications

(122 citation statements)

References 27 publications

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“…After excluding non-relevant studies, 17 articles were screened by their full texts and 11 studies were excluded as they did not fulfill the inclusion criteria. Finally, 6 trials were included in the systematic review and meta-analysis (14)(15)(16)(17)(18)(19). The risk of bias assessment of the included studies is presented in Table I.…”

Section: Resultsmentioning

confidence: 99%

“…Secondary outcomes. A total of 5 studies (14,15,(17)(18)(19) reported on back pain VAS scores at the final follow-ups. The pooled analysis demonstrated no statistically significant difference in back pain scores between the two groups (MD, -0.17; 95% CI, -0.3-0.02; P=0.09; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 4 studies (14,15,17,18) reported data on the ODI scores at the final follow-ups. Meta-analysis indicated no statistically significant difference between the biportal endoscopic decompression and microscopic decompression groups (MD, -0.28; 95% CI, -1.25-0.69; P=0.58; Fig.…”

Section: Resultsmentioning

confidence: 99%

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Biportal endoscopic decompression vs. microscopic decompression for lumbar canal stenosis: A systematic review and meta‑analysis

et al. 2020

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Lumbar decompressive surgery is the gold standard treatment for lumbar spinal stenosis. Minimally invasive surgical techniques have been introduced with the aim of reducing the morbidity associated with open surgery. The purpose of the present study was to systematically search the literature and perform a meta-analysis of studies comparing the outcomes between biportal endoscopic technique and microscopic technique for lumbar canal stenosis decompression. A comprehensive search of the PubMed, Google Scholar, Web of Science, Embase and the Cochrane Library databases was performed to identify relevant articles up to 15th of December 2019. Eligible studies were retrieved, data were extracted by two authors independently and risks of bias were assessed. A total of six studies involving 438 patients were selected for review. The results of the pooled analysis indicated similar operative times [mean difference (MD),-3.41; 95% CI,-10.78-3.96; P<0.36], similar complications (MD, 0.70; 95% CI, 0.33-1.46; P=0.34), similar visual analogue scale scores for back and leg pain at the time of the final follow-up and similar Oswestry disability indexes (MD,-0.28; 95% CI,-1.25-0.69; P=0.58) for the two procedures. In conclusion, biportal endoscopic technique is a viable alternative to microscopic technique for lumbar canal stenosis decompression with similar operative time, clinical outcomes and complications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Biportal endoscopic decompression vs. microscopic decompression for lumbar canal stenosis: A systematic review and meta‑analysis

et al. 2020

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“…This permits a foraminal approach and a posterior interlaminar approach, so that the applications of endoscopic spine surgery become wider to include most degenerative spine disorders covered by microscopic spine surgery. BESS was reported to provide similar patient satisfaction, pain improvement, and earlier recovery compared with open microscopic spinal surgery due to the development of improved optics and surgical techniques [1]. Technically, the approach of BESS minimalizes damage to the soft tissue and muscle [2,3,5,16,17].…”

Section: Discussionmentioning

confidence: 99%

“…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]. BESS had widened indications for patients with segmental instability or degenerated lumbar disease with foraminal stenosis in hopes of preserving back muscle and facet integrity [5].…”

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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How to Go Further with My Clinical Practice on Unilateral Biportal Endoscopy

Hasan

2022

Unilateral Biportal Endoscopy of the Spine

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Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis

Cited by 64 publications

References 27 publications

Biportal endoscopic decompression vs. microscopic decompression for lumbar canal stenosis: A systematic review and meta‑analysis

Biportal endoscopic decompression vs. microscopic decompression for lumbar canal stenosis: A systematic review and meta‑analysis

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

How to Go Further with My Clinical Practice on Unilateral Biportal Endoscopy

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