Biportal Endoscopic Spinal Surgery versus Microscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Pranata, Raymond; Lim, Michael Anthonius; Vania, Rachel; July, Julius

doi:10.1016/j.wneu.2020.02.151

Cited by 62 publications

(59 citation statements)

References 22 publications

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“…Consistent with this, a previous study showed that PTED was associated with better postoperative ODI scores and shorter procedures and hospitalizations than fenestration discectomy for treatment of lumbar disc herniation [ 21 ]. Biportal endoscopic spinal surgery (BESS) unilateral laminotomy bilateral decompression (ULBD) also is associated with hospital stays similar to those with microscopic ULBD [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis

Zhang¹,

Zhu²,

Zhou³

et al. 2020

Med Sci Monit

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Background This study aimed to investigate the therapeutic and prognostic effects of percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). Material/Methods One hundred eighty-eight patients with DLSS were randomly divided into the fenestration and the PTED group for decompression treatment. Operative time, incision length, amount of blood loss, length of hospitalization, and rates of complications in the 2 groups were compared. All patients underwent computed tomography (CT) scanning and magnetic resonance imaging (MRI) on the first postoperative day. All patients were assessed preoperatively and the treatment effects at 3, 6, and 12 months postoperatively were evaluated using visual analog scale (VAS), Japanese Orthopedic Association Score (JOA) and Oswestry Disability Index (ODI). The modified MacNab criteria were used to assess patient satisfaction 1 year after surgery at the last follow-up. Results Patients who underwent PTED had shorter incisions, less blood loss, and shorter hospital stays than those in the fenestration group, but operative times and complication rates were similar in the 2 groups. Moreover, CT scanning and MRI revealed similar treatment effects in the 2 groups. Compared with preoperative status, improvements in VAS, ODI, and JOA scores occurred at different times after surgery in the 2 groups. In particular, all 3 scores in the PTED group were higher than those in the fenestration group at 3 and 6 months postoperatively. There were no significant differences in MacNab scores between the 2 groups. Conclusions PTED is safer and more effective than traditional fenestration for management of DLSS.

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Section: Discussionmentioning

confidence: 99%

Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis

Zhang¹,

Zhu²,

Zhou³

et al. 2020

Med Sci Monit

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“…Two similar articles of systematic review and meta-analysis concluded that bi-portal endoscopic technique could be considered as an alternative to the microscopic decompression 20,21) . There were no significant differences in VAS score for leg and back pain, ODI at final follow-up between bi-portal endoscopic decompression and microscopic decompression.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Biportal Endoscopic Decompression for Lumbar Central Stenosis

Hahn¹,

Jang²,

Lee³

et al. 2021

J Minim Invasive Spine Surg Tech

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Degenerative lumbar spinal stenosis commonly occurs in elderly patients aged above 50-60 years. Surgical intervention is indicated for patient refractory to conservative management, and microscopic decompression has been used for direct spinal canal decompression. The development of surgical instruments and spinal endoscopic system can make possible endoscopic surgery as the useful treatment option for degenerative lumbar disease. Endoscopic spine surgery was mainly preformed in lumbar disc disease through transforaminal route. And then, endoscopic interlaminar approach was introduced using endoscopic drill, more developed endoscopic disc forceps, and Kerrison punches, and so on. Uniportal endoscopic spine surgery through interlaminar space can make possible direct spinal canal decompression in cases with lumbar spinal stenosis, however stiff learning curve still remains the limitation of this surgery. Biportal endoscopic spine surgery was also introduced as the minimal invasive spine surgery, which is basically similar to microscopic surgery and relatively familiar approach to spine surgeons. Biportal endoscopic spine surgery can offer clean operative view in monitor through continuous irrigation and endoscope with large diameter compared to uniportal endoscopic equipment, and this approach may be alternative surgical approach for decompression of lumbar spinal stenosis. Now many spine surgeons perform biportal endoscopic surgery for lumbar central spinal stenosis, and the reports have been published. He we write the technical procedure of biportal endoscopic surgery for lumbar spinal stenosis, discussing about surgical considerations, and also review the surgical outcomes from the previously published articles.

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“…Lumbar spinal stenosis is a clinically symptomatic condition caused by narrowing of the spinal canal that compresses nerve roots 1,14) . Most elderly people experience at least one episode of lower back pain, sciatica, claudication, or walking difficulty during their lives 3) .…”

Section: Introductionmentioning

confidence: 99%

“…Most elderly people experience at least one episode of lower back pain, sciatica, claudication, or walking difficulty during their lives 3) . Previous studies have reported that surgery is required when symptoms are refractory to medical treatment or combined with neurological deficits 9,11,14,16) .…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of Microscopic versus Unilateral Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Preliminary Report

Lee¹,

Cho²,

Chough³

2020

J Korean Soc Geriatr Neurosurg

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Objective: The objective of this study was to compare clinical outcomes and length of hospitalization between microscopic decompression and unilateral biportal endoscopic (UBE) decompression for lumbar spinal stenosis. Methods: Medical records of patients with lumbar spinal stenosis who underwent microscopic fenestration and unilateral laminotomy bilateral decompression (ULBD) via UBE from January 2017 to May 2019 were reviewed retrospectively. Clinical outcomes were reviewed regarding preoperative and postoperative visual analogue scale of back pain (VAS-B), visual analogue scale of leg pain (VAS-L) and Oswestry Disability Index of the lumbar spine (ODI) scores. Length of hospitalization, postoperative total drainage volume, and type and incidence of complications were also reviewed. Results: A total of 103 patients (44 microscopic fenestration and 59 ULBD via UBE) was selected. The mean age of the two groups was the same. The preoperative and postoperative clinical results of the two groups showed no significant difference, and the mean operation time and complications were similar in the groups. The microscopic fenestration group (10.37 days) had longer hospitalization than the ULBD via UBE group (7.53 days, p=0.01) and larger postoperative drainage volume (157.10 cc) than the ULBD via UBE group (83.50 cc, p<0.01). Conclusion: These two surgical procedures showed no significant difference in clinical outcome, but the ULBD via UBE group had shorter hospitalization, allowing patients to return to their daily lives earlier. These improved recovery after surgery suggests that ULBD via UBE could be a viable surgical option for geriatric patients with lumbar spinal stenosis.

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Biportal Endoscopic Spinal Surgery versus Microscopic Decompression for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Cited by 62 publications

References 22 publications

Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis

Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis

Current Status of Biportal Endoscopic Decompression for Lumbar Central Stenosis

Surgical Outcomes of Microscopic versus Unilateral Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Preliminary Report

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