Comparison of Microscopic Decompression and Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Canal Stenosis and Herniated Disc: A One-year Follow-up

Didik Librianto; Fachrisal Ipang; Ifran Saleh; Widyastuti Srie Utami; Dina Aprilya; Rubiana  Nurhayati; Darma Imran

doi:10.3889/oamjms.2022.9043

Authors

Didik Librianto Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Jakarta Spine Center, Pondok Indah Hospital, Jakarta, Indonesia; Department of Orthopedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
Fachrisal Ipang Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Jakarta Spine Center, Pondok Indah Hospital, Jakarta, Indonesia; Department of Orthopedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
Ifran Saleh Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Widyastuti Srie Utami Jakarta Spine Center, Pondok Indah Hospital, Jakarta, Indonesia
Dina Aprilya Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
Rubiana Nurhayati Department of Neurology, Pondok Indah Hospital, Jakarta, Indonesia
Darma Imran Department of Neurology, Pondok Indah Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.9043

Keywords:

Lumbar spine, Lumbar canal stenosis, Herniated disc, Minimally invasive, Biportal endoscopic, Microscopic decompression

Abstract

Backgrounds. Microscopic decompression (MD) has been widely used as an alternative to open decompression. Lately, biportal endoscopic spinal surgery (BESS) - a new approach in minimal-invasive spinal surgery – has also been used with good results. Although both groups can achieve adequate lumbar decompression, there is still a lack of evidence regarding their comparison. We aim to compare the outcomes of both techniques in a one-year follow-up.

Methods. This is a retrospective study in 100 consecutive patients with symptomatic lumbar spine compression due to herniated nucleus pulposus (HNP) and lumbar canal stenosis (LCS) that was treated by either BESS or MD. Clinical evaluations using Visual Analog Score (VAS), Oswestry Disability Index (ODI), and SF-36 questionnaire were obtained. Objective data such as surgery duration, amount of postoperative drain production, and hospital length of stay were collected. Complications were noted throughout the follow-up time.

Results. The BESS group had a significantly lesser surgical duration, drain production, and length of stay. At one year follow-up, both groups achieved significant improvement in VAS, ODI, and SF-36 compared to the preoperative condition. Complications were not observed in the BESS group.

Conclusions. Both procedures were comparably effective to treat lumbar stenosis. Although this study shows superiority with BESS technique in immediate and long-term follow-up, the final choice may depend on the surgeon's preference

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

OppenHeimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: A historical review. Neurosurg Focus. 2009;27:1-15. https://doi.org/10.3171/2009.7.FOCUS09121 PMid:19722824 DOI: https://doi.org/10.3171/2009.7.FOCUS09121

Skovrlj B, Gologorsky Y, Haque R, Fessler RG, Qureshi SA. Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J. 2014;14(10):2405-11. https://doi.org/10.1016/j.spinee.2014.01.048 PMid:24486472 DOI: https://doi.org/10.1016/j.spinee.2014.01.048

Choi CM, Chung JT, Lee SJ, Choi DJ. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis. Acta Neurochir (Wien). 2016;158(3):459-63. https://doi.org/10.1007/s00701-015-2670-7 PMid:26782827 DOI: https://doi.org/10.1007/s00701-015-2670-7

Kambin P, O’Brien E, Zhou L, Schaffer JL. Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res. 1998;1(347):150-67. https://doi.org/10.1097/00003086-199802000-00018 PMid:9520885 DOI: https://doi.org/10.1097/00003086-199802000-00018

Goald HJ. Microlumbar discectomy: Followup of 147 patients. Spine (Phila Pa 1976). 1978;3(2):183-5. DOI: https://doi.org/10.1097/00007632-197806000-00016

Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg. 1997;3:301-7.

Ahn Y. Current techniques of endoscopic decompression in spine surgery. Ann Transl Med. 2019;7 Suppl 5:S169. https://doi.org/10.21037/atm.2019.07.98 PMid:31624735 DOI: https://doi.org/10.21037/atm.2019.07.98

Kim HS, Wu PH, Jang IT. Current and future of endoscopic spine surgery: What are the common procedures we have now and what lies ahead? World Neurosurg. 2020;140:642-53. https://doi.org/10.1016/j.wneu.2020.03.111 PMid:32797991 DOI: https://doi.org/10.1016/j.wneu.2020.03.111

Marappan K, Jothi R, Paul Raj S. Microendoscopic discectomy (MED) for lumbar disc herniation: comparison of learning curve of the surgery and outcome with other established case studies. J Spine Surg. 2018;4(3):630-7. https://doi.org/10.21037/jss.2018.06.14 PMid:30547129 DOI: https://doi.org/10.21037/jss.2018.06.14

Soliman MA, Ali A. Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: A prospective randomized study. Neurosurg Focus. 2019;46(5):E3. https://doi.org/10.3171/2019.2.FOCUS18725 PMid:31042649 DOI: https://doi.org/10.3171/2019.2.FOCUS18725

Choi CM. Biportal endoscopic spine surgery (BESS): Considering merits and pitfalls. J Spine Surg. 2020;6(2):457-65. https://doi.org/10.21037/jss.2019.09.29 PMid:32656383 DOI: https://doi.org/10.21037/jss.2019.09.29

Chen T, Zhou G, Chen Z, Yao X, Liu D. Biportal endoscopic decompression vs. microscopic decompression for lumbar canal stenosis: A systematic review and metaanalysis. Exp Ther Med. 2020;20:2743-51. https://doi.org/10.3892/etm.2020.9001 PMid:32765769 DOI: https://doi.org/10.3892/etm.2020.9001

Heo DH, Quillo-Olvera J, Park CK. Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case–control study. World Neurosurg. 2018;120:e684-9. https://doi.org/10.1016/j.wneu.2018.08.144 PMid:30165228 DOI: https://doi.org/10.1016/j.wneu.2018.08.144

Kim JE, Choi DJ, Park EJ, Lee HJ, Hwang JH, Kim MC, et al. Biportal endoscopic spinal surgery for lumbar spinal stenosis. Asian Spine J. 2019;13(2):334-42. https://doi.org/10.31616/ ASJ.2018.0210 PMid:30959588 DOI: https://doi.org/10.31616/asj.2018.0210

Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019;13(1):31-4. https://doi.org/10.4103/sja.SJA_543_18 PMid:30930717 DOI: https://doi.org/10.4103/sja.SJA_543_18

Phedy P, Djaja YP, Tobing SD, Gatam L, Librianto D, Fachrisal I, et al. Cross-cultural adaptation and psychometric validation of the Indonesian version of the Oswestry Disability Index. Eur Spine J. 2021;30(4):1053-62. https://doi.org/10.1007/s00586-020-06690-3 PMid:33389199 DOI: https://doi.org/10.1007/s00586-020-06690-3

Kang T, Park SY, Kang CH, Lee SH, Park JH, Suh SW. Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?: A prospective randomized comparative study. Medicine (Baltimore). 2019;98(18):e15451. https://doi.org/10.1097/MD.0000000000015451 PMid:31045817 DOI: https://doi.org/10.1097/MD.0000000000015451

Zhang F, Ye C, Li G, Ding W, Zhou W, Zhu H, et al. The rat model of type 2 diabetic mellitus and its glycometabolism characters. Exp Anim. 2003;52:(5):401-7. https://doi.org/10.1538/expanim.52.401 PMid:14625406 DOI: https://doi.org/10.1538/expanim.52.401

Park SM, Park J, Jang HS, Han H, Kim HJ, Chang BS, et al. Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: A randomized controlled trial. Spine J. 2020;20(2):156-65. https://doi.org/10.1016/j.spinee.2019.09.015 PMid:31542473 DOI: https://doi.org/10.1016/j.spinee.2019.09.015

Wu PH, Kim HS, Heo DH, Yu G, Tan H, Jang I. A systematic review of complications associated with initial learning curve of endoscopic spine surgery highlighting the necessity of introducing an effective fellowship to train competent endoscopic spine surgeons.J of Spine. 2020;9 :456. https://doi.org/10.37421/jsp.2020.9.456

Wong AP, Smith ZA, Lall RR, Bresnahan LE, Fessler RG. The microendoscopic decompression of lumbar stenosis: A review of the current literature and clinical results. Minim Invasive Surg. 2012;2012:325095. https://doi.org/10.1155/2012/325095 PMid:22900163 DOI: https://doi.org/10.1155/2012/325095

Nakagawa H, Kamimura M, Uchiyama S, Takahara K, Itsubo T, Miyasaka T. Microendoscopic discectomy (MED) for lumbar disc prolapse. J Clin Neurosci. 2003;10(2):231-5. https://doi.org/10.1016/S0967-5868(02)00337-5 PMid:12637057 DOI: https://doi.org/10.1016/S0967-5868(02)00337-5

Zeng H, Zhang P, Shen X, Luo C, Xu Z, Zhang Y, et al. One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: A retrospective study of 34 cases. BMC Musculoskelet Disord. 2015;16(1):186. https://doi.org/10.1186/s12891-015-0640-0 PMid:26242404 DOI: https://doi.org/10.1186/s12891-015-0640-0

Wu J, Guan T, Tian F, Liu X. Comparision of biportal endoscopic and microscopic decompression in treatment of lumbar spinal stenosis: A comparative study protocol. Medicine (Baltimore). 2020;99(30):e21309. https://doi.org/10.1097/MD.0000000000021309 PMid:32791717 DOI: https://doi.org/10.1097/MD.0000000000021309

Choi DJ, Kim JE, Jung JT, Kim YS, Jang HJ, Yoo B, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J. 2018;12(23):569-73. https://doi.org/10.4184/asj.2018.12.3.569 PMid:29879787 DOI: https://doi.org/10.4184/asj.2018.12.3.569

Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN. Factors affecting length of stay after elective posterior lumbar spine surgery: A multivariate analysis. Spine J. 2015;15(6):1188-95. https://doi.org/10.1016/j.spinee.2013.10.022 PMid:24184639 DOI: https://doi.org/10.1016/j.spinee.2013.10.022

Choi KC, Shim HK, Hwang JS, Shin SH, Lee DC, Jung HH, et al. Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World Neurosurg. 2018;116:e750-8. https://doi.org/10.1016/j.wneu.2018.05.085 PMid:29787880 DOI: https://doi.org/10.1016/j.wneu.2018.05.085

Chang SB, Lee SH, Ahn Y, Kim JM. Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine (Phila Pa 1976). 2006;31(10):1163-7. https://doi.org/10.1097/01.brs.0000216431.69359.91 PMid:16648754 DOI: https://doi.org/10.1097/01.brs.0000216431.69359.91

Senker W, Stefanits H, Gmeiner M, Trutschnig W, Weinfurter I, Gruber A. Does obesity affect perioperative and postoperative morbidity and complication rates after minimal access spinal technologies in surgery for lumbar degenerative disc disease. World Neurosurg. 2018;111:e374-85. https://doi.org/10.1016/j.wneu.2017.12.075 PMid:29274450 DOI: https://doi.org/10.1016/j.wneu.2017.12.075

Pranata R, Lim MA, Vania R, July J. Biportal endoscopic spinal surgery versus microscopic decompression for lumbar spinal stenosis: A systematic review and meta-analysis. World Neurosurg. 2020;138:e450-8. https://doi.org/10.1016/j.wneu.2020.02.151 PMid:32147545 DOI: https://doi.org/10.1016/j.wneu.2020.02.151

Eum JH, Heo DH, Son SK, Park CK. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: A technical note and preliminary clinical results. J Neurosurg Spine. 2016;24(4):602-7. https://doi.org/10.3171/2015.7.SPINE15304 PMid:26722954 DOI: https://doi.org/10.3171/2015.7.SPINE15304

Yang H-S, Lee N, Park J-Y. Current status of biportal endoscopic decompression for lumbar foraminal stenosis: Endoscopic partial facetectomy and outcome factors. J Minim Invasive Spine Surg Tech. 2021;6 Suppl 1:S157-63. https://doi.org/10.21182/jmisst.2021.00073 DOI: https://doi.org/10.21182/jmisst.2021.00073