Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis: A Technical Note

Abstract

Background and Study Aims Endoscopic lumbar diskectomy through the interlaminar window is gaining recognition. Most of the literature describes these endoscopic procedures using specialized uniportal multichannel endoscopes. However, a single portal limits the motion of the instruments and obscures visualization of the operating field. To overcome this limitation, we propose a new technique that utilizes two portals to access the spinal canal. The biportal endoscopic lumbar decompression (BELD) technique uses two portals to treat difficult lumbar disk herniations and also lumbar spinal stenoses.

Patients and Methods Seventeen patients were treated with BELD for 11 lumbar disk herniations and 6 lumbar spinal stenoses. Preoperative back and leg visual analog scale (VAS-B and VAS-L, respectively) scores and the Oswestry Disability Index (ODI) were recorded and compared with corresponding values on final follow-up.

Results There was an average follow-up of 14 months. For the disk herniation group, preoperative VAS-L (7.8750 ± 1.24) and ODI (51.73 ± 18.57) was significantly different from follow-up postoperative VAS-L (0.87 ± 0.64, p = 0.000) and ODI (9.37 ± 4.83, p = 0.001). For the stenosis group, preoperative VAS-B (6.17 ± 1.94), VAS-L(7.83 ± 1.47), and ODI (63.27 ± 7.67) were significantly different from follow-up postoperative values (2.5 ± 1.04, p = 0.022; 2.00 ± 1.67, p = 0.001; 24.00 ± 6.45, p = 0.000, respectively). One patient underwent revision microdiskectomy for incomplete decompression.

Conclusions BELD can achieve a similar decompression effect as microdiskectomy and unilateral laminotomy for bilateral decompression with a smaller incision than tubular diskectomy.

Keywords

spinal endoscopy - diskectomy - minimal invasive - biportal - BELD

• References

• 1 Caspar W. A new surgical procedure for lumbar disc herniation causing less tissue damaging through a microsurgical approach. In: Wullenweber R, Brock M. eds. Advances in Neurosurgery. Vol 7. Berlin, Germany: Springer; 1977: 74-77
• 2 Yasargil MG. Microsurgical operation for herniated disc. In: Wullenweber R, Brock M, Hamer J, Klinger M, Spoerri O. eds. Advances in Neurosurgery. Vol 7. Berlin, Germany: Springer; 1977: 81-82
• 3 Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev 2014; 9 (09) CD010328
• 4 Gibson JN, Waddell G. Surgical interventions for lumbar disc prolapse: updated Cochrane Review. Spine 2007; 32 (16) 1735-1747
• 5 Forst R, Hausmann B. Nucleoscopy—a new examination technique. Arch Orthop Trauma Surg 1983; 101 (03) 219-221
• 6 Kambin P, Casey K, O'Brien E, Zhou L. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg 1996; 84 (03) 462-467
• 7 Kambin P, O'Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 1998; (347) 150-167
• 8 Yeung AT. Minimally invasive disc surgery with the Yeung Endoscopic Spine System (YESS). Surg Technol Int 1999; 8: 267-277
• 9 Ahn Y, Oh HK, Kim H, Lee SH, Lee HN. Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery 2014; 75 (02) 124-133 ; discussion 132–133
• 10 Brayda-Bruno M, Cinnella P. Posterior endoscopic discectomy (and other procedures). Eur Spine J 2000; 9 (Suppl. 01) S24-S29
• 11 Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Res 1999; 21 (01) 39-42
• 12 Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci 2003; 10 (02) 231-235
• 13 Perez-Cruet MJ, Foley KT, Isaacs RE. , et al. Microendoscopic lumbar discectomy versus open surgery: technical note. Neurosurgery 2002; 51 (5 Suppl): S129-S136
• 14 Ruetten S. The full endoscopic interlaminar approach for lumbar disc herniations. In: Mayer HM. ed. Minimally Invasive Spine Surgery. Berlin, Germany: Springer; 2005: 346-355
• 15 Ruetten S, Komp M, Godolias G. A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. Minim Invasive Neurosurg 2006; 49 (02) 80-87
• 16 Komp M, Hahn P, Merk H, Godolias G, Ruetten S. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech 2011; 24 (05) 281-287
• 17 Maroon JC. Current concepts in minimally invasive discectomy. Neurosurgery 2002; 51 (5, Suppl): S137-S145
• 18 Schick U, Döhnert J, Richter A, König A, Vitzthum HE. Microendoscopic lumbar discectomy versus open surgery: an intraoperative EMG study. Eur Spine J 2002; 11 (01) 20-26
• 19 Weber BR, Grob D, Dvorák J, Müntener M. Posterior surgical approach to the lumbar spine and its effect on the multifidus muscle. Spine 1997; 22 (15) 1765-1772
• 20 Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 2008; 33 (09) 931-939
• 21 Choi G, Lee SH, Raiturker PP, Lee S, Chae YS. Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope. Neurosurgery 2006; 58 (1, Suppl): ONS59-ONS68 ; discussion ONS59–ONS68
• 22 Lee SH, Kang BU, Ahn Y. , et al. Operative failure of percutaneous endoscopic lumbar discectomy: a radiologic analysis of 55 cases. Spine 2006; 31 (10) E285-E290
• 23 Ruetten S, Komp M, Merk H, Godolias G. Full endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 2008; 33 (09) 931-939
• 24 Kambin P, Zhou L. Arthroscopic discectomy of the lumbar spine. Clin Orthop Relat Res 1997; (337) 49-57
• 25 Osman SG. Endoscopic transforaminal lumbar decompression, interbody fusion and pedicle screw implantation. A case series report. International Symposium and Hands-on Cadaver Workshop for Endoscopic Spine Surgery; November 28, 2014; Incheon, South Korea
• 26 Modi HN, Lee DY, Lee SH. Postoperative spinal epidural hematoma after microscopic lumbar decompression: a prospective magnetic resonance imaging study in 89 patients. J Spinal Disord Tech 2011; 24 (03) 146-150