Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report

Abstract

Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This single-centered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, “excellent,” “good,” and “fair” results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.

Comparison of Cervical Biportal Endoscopic Spine Surgery and Anterior Cervical Discectomy and Fusion in Patients with Symptomatic Cervical Disc Herniation

“…This is crucial for ensuring endoscopic visibility, preventing microbleeding, and eliminating necrotic tissues. However, it is essential to avoid excessive fluid retention in the epidural space, maintaining the irrigation system pressure at around 30 mmHg [ 13 ].…”

“…A well-trained surgeon then uses specialized instruments to remove the bony structure or herniated disc without affecting the surrounding healthy tissues. Several reports on the technical notes and clinical outcomes of C-BESS have recently been published [ 13 , 14 ].…”

Unilateral biportal endoscopic supralaminar, posterior spinous process sparing approach for en bloc cervical laminectomy in case of cervical osteochondroma causing myelopathy: A case report

“…Endoscopic spine surgery has advantages of less muscle stripping, shorter hospital stay and less postoperative neck pain. Compared with uniportal, biportal technique allows greater freedom of movement for the instruments and easy bone removal [13] . After lumbo-sacral spine endoscopy is gradually expanding its indications in cervical spine.…”

Overview and Prevention of Complications During Biportal Endoscopic Lumbar Spine Surgery

“…One notable aspect of UBESS is the absence of postoperative infection, which is a relatively common occurrence in conventional lumbar spinal surgery [23]. The incidence of spine infection after spine surgery ranges from approximately 0.1% to 4.5%, [3] 2020 RCT Korea Dural tear (2), hematoma (1) Kim et al [7] 2020 Retrospective Korea Hematoma (5), recurrence (16), dural tear (3) Choi et al [16] 2016 Retrospective Korea Dural tear (2), nerve root injury (1), incomplete decompression (1) Eum et al [25] 2016 Retrospective Korea Postoperative headache (3), dural tear (2), transient leg numbness (2), hematoma(1) Czigléczki et al [29] 2020 Retrospective Hungary Postoperative headache (3), dural tear (2), incomplete decompression (1) Li et al [31] 2022 Retrospective China Dural tear (1), transient paresthesia (1) Jung and Kim [32] 2022 Retrospective Korea Transient motor weakness (1) Zhu et al [33] 2022 Technical note China Transient paresthesia (1) An and Lee [34] 2019 Technical note Korea Operation site pain and numbness (1) Lin et al [35] 2019 Retrospective China Dural tear (1) Kim and Park [36] 2020 Retrospective Korea Dural tear (2), root injury (3), infection (2) Kim et al [37] 2020 Retrospective Korea Dural tear (3), hematoma (1) Kim et al [38] 2019 Retrospective Korea Transient paresthesia (5) Kang et al [39] 2019 Retrospective Korea Dural tear (1) Kang et al [40] 2020 Retrospective Japan Dural tear (2) Kim and Choi [41] 2018 Retrospective Korea Dural tear (2), hematoma (1) Hong et al [42] 2020 Retrospective Korea Dural tear (2) Heo et al [43] 2019 Retrospective Korea Dural tear (1), hematoma (1) Heo et al [44] 2018 Prospective Korea Dural tear (1), hematoma (1) Pao et al [45] 2020 Retrospective China (Taiwan) Dural tear (4), transient paresthesia (1), hematoma (1), incomplete decompression (1) Song and Lee [46] 2020 Technical note Korea Dural tear (1) Fishchenko et al [47] 2020 Retrospective Ukraine Dural tear (4) Ahn et al [48] 2018 Retrospective Korea Dural tear (1) Kim et al [49] 2018 Retrospective Korea Incomplete decompression (3) Eun et ...…”