Current Status of Biportal Endoscopic Decompression for Lumbar Central Stenosis

Abstract

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.

Overview and Prevention of Complications During Fully Endoscopic Lumbar Spine Surgery

“…Dealing with more rare but highly impactful complications, such as massive or remote epidural/subdural hematoma due to hydrostatic pressure, warrants cautious and controlled use of irrigation during surgery, as well as attentive postoperative monitoring [29,[44][45][46]. This further accentuates the critical role of comprehensive postoperative care.…”