Treatment Concept and Technical Considerations of Biportal Endoscopic Spine Surgery for Lumbar Spinal Stenosis

Abstract

Decompression is a major component of surgical procedures for degenerative lumbar spinal stenosis (LSS). In addition to sufficient decompression to guarantee the relief of neurological pain, compensating surgical instability after wider laminectomy and foraminotomy and instrumentation with caging and fusion with grafting are performed to secure or restore the foraminal dimension and correct coronal/sagittal imbalance for longer survival of the adjacent segment. Endoscopic spinal surgery (ESS) has been developed under the flag of successful decompression while preserving structural integrity as much as possible with the help of magnification and illumination. ESS provides a technical possibility and feasibility for solving LSS by decompression alone. Recently, many endoscopic trials have been conducted to overcome conventional surgical treatment that requires wider dissection, escape inevitable complications from surgical damage, and compensate for the fusion technique. However, biportal ESS has some technical limitations, including clinical difficulties in accessibility for more moderate to severe stenosis and challenges for complicated conditions with segmental ventral slip, isthmic defect, stenosis combined with foraminal stenosis or foraminal disk rupture, or degenerative segmental scoliosis with disk height collapsing and endplate fatigue fracture. Because decompression alone is a skill for eliminating pathologies, there is no function of preserving degenerative structure or stopping the recurrence of disk degeneration or subsidence. This review of clinical reports investigated the possibility of biportal ESS for treating degenerative lumbar disorders by sufficient decompression and adequate elimination of various pathologies and decreasing technical complications. The results of this study may help develop better innovative spinal surgical techniques in the near future.

Expandable Cages for Lumbar Interbody Fusion: A Narrative Review

“…Lower back pain ranks among the foremost causes of disability worldwide, and its predominant etiology is lumbar degenerative spinal disease [1,2], which encompasses various pathological changes in the lumbar spine, including disc degeneration, facet joint arthritis, segmental slip, and spinal stenosis. Lumbar degenerative spinal diseases such as lumbar spondylolisthesis and spinal stenosis significantly affect the quality of life of several patients [3][4][5][6][7]. As the global elderly population continues to grow, there is an increasing number of individuals affected by lumbar degenerative spinal diseases, leading to an increased demand for treatment aimed at enhancing their quality of life [8,9].…”

Posterior inclinatory approach for degenerative foraminal stenosis with the biportal endoscopic technique: clinical and radiological outcomes

“…It offers a clear view of the surgical eld under water medium, exible operation under dual channels, an adaptable and variable surgical approach, and the use of more surgical instruments [8,9]. Jon Park et al reported the "four-level stenosis protocol" to evaluate the foraminal and lateral recess zones [10]. A contralateral sublaminar approach was recommended for the dominant foramen-to-extraforaminal stenotic pathology or disk extrusion at level 1 or 2 combined with lateral recess stenosis [11].…”