Unilateral Biportal Endoscopy for Decompression of Extraforaminal Stenosis at the Lumbosacral Junction: Surgical Techniques and Clinical Outcomes

Abstract

Objective: The aims of this study were to describe the unilateral biportal endoscopic (UBE) technique for decompression of extraforaminal stenosis at L5–S1 and evaluate 1-year clinical outcomes. Especially, we evaluated compression factors of extraforaminal stenosis at L5–S1 and described the surgical technique for decompression in detail.Methods: Thirty-five patients who underwent UBE decompression for extraforaminal stenosis at L5–S1 between March 2018 and February 2019 were enrolled. Clinical results were analyzed using the MacNab criteria, the visual analogue scale (VAS) for back and leg pain, and the Oswestry Disability Index (ODI). Compression factors evaluated pseudoarthrosis within the transverse process of L5 and ala of sacrum, disc bulging with or without osteophytes, and the thickened lumbosacral and extraforaminal ligament.Results: The mean back VAS was 3.7 ± 1.8 before surgery, which dropped to 2.3 ± 0.8 at 1-year postoperative follow-up (p < 0.001). There was a significant drop in postoperative mean VAS for leg pain from 7.2 ± 1.1 to 2.3 ± 1.2 at 1 year (p < 0.001). The ODI was 61.5 before surgery and 28.6 (p < 0.001). Pseudoarthrosis between the transverse process and the ala was noted in all cases (35 of 35, 100%). Pure disc bulging was seen in 12 patients (34.3%), and disc bulging with osteophytes was demonstrated in 23 patients. The thickened lumbosacral and extraforaminal ligament were identified in 19 cases (51.4%). No complications occurred in any of the patients.Conclusion: In the current study, good surgical outcomes without complications were achieved after UBE decompression for extraforaminal stenosis at L5–S1.

Comparative Study of the Outcomes of Unilateral Biportal Endoscopic Discectomy and Tubular Microdiscectomy Based on the Visual Analogue Scale, Oswestry Disability Index, and Short-form 36

“…Furthermore, although it can remove soft disc herniation and ruptured disc materials without foraminal obstruction, restricted movements of the instruments and obstructed intervertebral foramen following degenerative changes could disturb the procedure [1,3]. The UBE technique was first described by Soliman [10] as irrigation endoscopic discectomy (IED) in 2013 and by Eum et al [11] as percutaneous biportal endoscopic decompression (PBED) in 2016 and was reported to be feasible for lumbar spinal surgery, including lumbar fusion, by many authors in the following years [1,12,13]. The advantages of UBE are increased surgical movement of the instruments with independent visualization and working portals, good and wide field of visualization conferring unrestricted access to contralateral and foraminal areas, less bleeding because of continuous irrigation, visual similarity between the surgical field and that of conventional microscopic surgery, and a reduced armamentarium because the UBE system uses separated channel for instruments and only 0° or 30° arthroscopy for the knees or shoulders are used for standard laminectomy.…”

Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis

“…The median EBL was 100 ml with an IQR of 50. The average postoperative hospital stays were 6.18 ± 2.47 days (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The VAS and ODI scores at the last follow-up were significantly improved compared with those before the operation (P < 0.05) (Table 3 & Figure 3).…”

“…Recently, the unilateral biportal endoscopy technique (UBE) was used for the treatment of LDH and LSS, and several articles have reported satisfactory effect of UBE surgery [5][6][7][8] . As an emerging technology, the safety and learning curve of UBE have also received widespread attention.…”

An overview of lumbar anatomy with an emphasis on unilateral biportal endoscopic techniques: A review

“…Compared with the traditional open technique, unilateral 2-channel endoscopy is still a “point exposure” technique, with a high incidence of surgery-associated injury, including the dural sac, outlet nerve root, and dural injury on the walking nerve root. [5] Park [6] observed 643 patients who underwent UBE surgery and found that the incidence of dural injury was 4.5%. Lee [7] reported that the incidence of dural injuries was as high as 13.2%.…”