Clinical and Radiological Outcomes of Foraminal Decompression Using Unilateral Biportal Endoscopic Spine Surgery for Lumbar Foraminal Stenosis

Abstract

BackgroundSince open Wiltse approach allows limited visualization for foraminal stenosis leading to an incomplete decompression, we report the short-term clinical and radiological results of unilateral biportal endoscopic foraminal decompression using 0° or 30° endoscopy with better visualization.MethodsWe examined 31 patients that underwent surgery for neurological symptoms due to lumbar foraminal stenosis which was refractory to 6 weeks of conservative treatment. All 31 patients underwent unilateral biportal endoscopic far-lateral decompression (UBEFLD). One portal was used for viewing purpose, and the other was for surgical instruments. Unilateral foraminotomy was performed under guidance of 0° or 30° endoscopy. Clinical outcomes were analyzed using the modified Macnab criteria, Oswestry disability index, and visual analogue scale. Plain radiographs obtained preoperatively and 1 year postoperatively were compared to analyze the intervertebral angle (IVA), dynamic IVA, percentage of slip, dynamic percentage of slip (gap between the percentage of slip on flexion and extension views), slip angle, disc height index (DHI), and foraminal height index (FHI).ResultsThe IVA significantly increased from 6.24° ± 4.27° to 6.96° ± 3.58° at 1 year postoperatively (p = 0.306). The dynamic IVA slightly decreased from 6.27° ± 3.12° to 6.04° ± 2.41°, but the difference was not statistically significant (p = 0.375). The percentage of slip was 3.41% ± 5.24% preoperatively and 6.01% ± 1.43% at 1-year follow-up (p = 0.227), showing no significant difference. The preoperative dynamic percentage of slip was 2.90% ± 3.37%; at 1 year postoperatively, it was 3.13% ± 4.11% (p = 0.720), showing no significant difference. The DHI changed from 34.78% ± 9.54% preoperatively to 35.05% ± 8.83% postoperatively, which was not statistically significant (p = 0.837). In addition, the FHI slightly decreased from 55.15% ± 9.45% preoperatively to 54.56% ± 9.86% postoperatively, but the results were not statistically significant (p = 0.705).ConclusionsUBEFLD using endoscopy showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability. It could be a feasible alternative to conventional open decompression or fusion surgery for lumbar foraminal stenosis.

Risk Factors and Options of Management for an Incidental Dural Tear in Biportal Endoscopic 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]. IDT may lead to incomplete decompression due to a blurred visual field, resulting in poor outcome.…”

Effectiveness of Gelatin-Thrombin Matrix Sealants (Floseal®) on Postoperative Spinal Epidural Hematoma during Single-Level Lumbar Decompression Using Biportal Endoscopic Spine Surgery: Clinical and Magnetic Resonance Image Study

“…Therefore, bleeding control is one of the factors affecting successful clinical outcomes after spine surgery. Owing to recent developments in the techniques of minimally invasive spine surgery and advancements in endoscope-related optical technology, BESS was introduced, and numerous results have been reported [8][9][10][11][12][13]. Because it has surgical indications similar to those in conventional open surgery, BESS is gaining interest recently as a minimally invasive spine surgery technique with favorable outcomes similar to those of microscopic decompression in spinal stenosis [8].…”

“…Recently, the use of an endoscope has gained interest in the field of minimally invasive surgery. For the treatment of spinal stenosis, biportal endoscopic spine surgery (BESS) was introduced as an alternative method for microscopic unilateral laminotomy for bilateral decompression (ULBD) [8][9][10][11][12][13]. The basic concept of the BESS is similar to those of arthroscopic and laparoscopic surgeries, in which an endoscope is inserted through a viewing portal, and surgical instruments are inserted into a separate working portal.…”

Unilateral Biportal Endoscopic Lumbar Interbody Fusion. Technical Note and Surgical Comparison with Conventional MIS TLIF.

“…The biportal technique has advantages of zero investment by using standard arthroscopic lenses either 0°, 30° or even 70° angle, more mobility, wide viewing angle and open surgery instrument such as Kerrison punch, forceps, endplate curretes and etc which are usually already available in the hospital performing orthopaedic and spine surgery. [12,13] The main disadvantages of is having two portals instead of one, in which some of the surgeon think of more soft tissue injury compared with uniportal technique.…”