Clinical outcomes and complications after biportal endoscopic spine surgery: a comprehensive systematic review and meta-analysis of 3673 cases

Abstract

Purpose Current literature suggests that biportal spinal endoscopy is safe and effective in treating lumbar spine pathology such as lumbar disc herniation, lumbar stenosis, and degenerative spondylolisthesis. No prior study has investigated the postoperative outcomes or complication profile of the technique as a whole. This study serves as the first comprehensive systematic review and meta-analysis of biportal spinal endoscopy in the lumbar spine. Methods A PubMed literature search provided over 100 studies. 42 papers were reviewed and 3673 cases were identified with average follow-up time of 12.5 months. Preoperative diagnoses consisted of acute disc herniation (1098), lumbar stenosis (2432), and degenerative spondylolisthesis (229). Demographics, operative details, complications, and perioperative outcome and satisfaction scores were analyzed. Results Average age was 61.32 years, 48% male. 2402 decompressions, 1056 discectomies, and 261 transforaminal lumbar Interbody fusions (TLIFs) were performed. Surgery was performed on 4376 lumbar levels, with L4-5 being most common(61.3%). 290 total complications occurred, 2.23% durotomies, 1.29% inadequate decompressions, 3.79% epidural hematomas, and < 1% transient nerve root injuries, infections, and iatrogenic instability. Significant improvement in VAS-Back, VAS-Leg, ODI, and Macnab Scores were seen across the cohort. Conclusion Biportal spinal endoscopy is a novel method to address pathology in the lumbar spine with direct visualization through an endoscopic approach. Complications are comparable to previously published rates. Clinical outcomes demonstrate effectiveness. Prospective studies are required to assess the efficacy of the technique as compared to traditional techniques. This study demonstrates that the technique can be successful in the lumbar spine.

Does the use of tranexamic acid intraoperatively reduce postoperative blood loss and complications following biportal endoscopic lumbosacral decompression?

“…Overall, patients in both groups showed significant and similar improvements in ODI, VAS Leg and VAS back scores following biportal decompression. Improvements in PROs in our cohort were similar to those reported in a recent meta-analysis of biportal endoscopic lumbosacral surgery by Park et al , which demonstrated a mean decrease in VAS back scores of 4.1, VAS leg scores of 5.5 and absolute ODI scores of 20 ( 9 ). Complication rates were also similar between groups, with low rates of transient post-operative weakness and re-herniation (2.4% each).…”

“…Compared to standard MIS techniques, the biportal technique utilizes smaller incisions with less soft tissue dissection, and has been shown to result in improved pain, early mobilization, and shorter length of stay (LOS) ( 5 - 8 ). Multiple clinical studies and meta-analyses have demonstrated excellent clinical results, with low complication rates ( 9 - 12 ). As the biportal technique involves the use of pressurized irrigation fluid and a small working space, intraoperative bleeding is minimized due to the hydrostatic pressure of the constant endoscopic irrigation.…”

Does obesity and varying body mass index affect the clinical outcomes and safety of biportal endoscopic lumbar decompression? A comparative cohort study

“…We did not find any significant difference in PROs amongst the various BMI groups. Each cohort exhibited significant improvements in VAS Back, VAS Leg, and ODI scores as compared to preoperative scores, which were statistically indistinguishable from one another and similar to the values reported in a recent meta-analysis of the general population by Park et al[ 36 ] These improvements were well beyond the reported minimum clinically important difference (MCID) for ODI, VAS leg, and VAS back scores of 12.8, 1.6, and 1.2, respectively, as reported by Copay et al[ 6 ] More recently, the value of a rigid MCID has been questioned, and a range allowing for calibration of specificity and sensitivity has been introduced. The PROs demonstrated by patients in this study remain exceedingly greater than the published MCID range for VAS scores of 2.5 to 3.5 published by Lewandrowski et al and fall directly within the suggested MCID range of 14 to 17 for ODI [ 27 ].…”

“…There were no instances of excessive manipulation of the nerve root during surgery, which would more likely cause immediate postoperative symptomatology and/or neurological deficits. While not routinely reported in the literature as a complication due to its transient nature and likely under-reported, a recent meta-analysis by Park et al demonstrated a reported rate of nerve root injury and transient radiculitis at 0.24% within the published biportal endoscopic lumbar complications [ 36 ]. Although occurring at a higher rate within our study, all instances of transient postoperative radiculitis in this study resolved by the six-week follow-up with conservative management.…”

“…Compared with traditional MIS techniques, this results in smaller incisions with less soft tissue dissection and has been shown to result in improved pain, increased mobilization, and shorter length of stay [ 9 , 33 , 35 , 40 ]. Multiple clinical studies, systematic reviews, and meta-analyses of biportal endoscopic techniques have demonstrated excellent clinical results with low complication rates [ 18 , 28 , 36 , 39 ].…”