Abstract
BackgroundPrevalent endoscopic spine surgeries have shown limitations especially in spinal stenosis (Ahn in Neurosurgery 75(2):124–133, 2014). Biportal endoscopic surgery is introduced to manage central and foraminal stenosis with its wide range of access angle and clear view.MethodsThe authors provide an introduction of this technique followed by a description of the surgical anatomy with discussion on its indications and advantages. In particular, tricks to avoid complications are also presented.ConclusionsEffective circumferential and focal decompression were achieved in most cases without damage to the spinal structural integrity with preservation of muscular and ligamentous attachments. The biportal endoscopic spinal surgery (BESS) may be safely used as an alternative minimally invasive procedure for lumbar spinal stenosis (Figs. 1 and 2).Electronic supplementary materialThe online version of this article (doi:10.1007/s00701-015-2670-7) contains supplementary material, which is available to authorized users.
Highlights
Prevalent endoscopic spine surgeries have shown limitations especially in spinal stenosis (Ahn in Neurosurgery 75(2):124–133, 2014)
We could treat all kinds of spinal stenosis including central, lateral recesses, and foraminal stenosis
The contralateral superior articular process and the upper lamina can be decompressed without nerve damage by undercutting the thick bony structure with burrs and the ultrasonic bone cutter
Summary
Effective circumferential and focal decompression were achieved in most cases without damage to the spinal structural integrity with preservation of muscular and ligamentous attachments. Even minimally invasive surgeries including various endoscopic procedures might damage the medial multifidus, which is innervated by the medial branch of the dorsal ramus with no segmental nerve supply as in the other paraspinal muscles [4] This approach through spatium intermusculare with biportal endoscope and small cannula can prevent the erecta spinae from the injury by overdistracting procedures (Fig. 3). With the proper biportal endoscopic surgical technique, the injuries to these structures can be avoided By this procedure, we could treat all kinds of spinal stenosis including central, lateral recesses, and foraminal stenosis. 4. The contralateral superior articular process and the upper lamina can be decompressed without nerve damage by undercutting the thick bony structure with burrs and the ultrasonic bone cutter. Indications Moderate-to-severe spinal stenosis including central, lateral, and foraminal, moderate-to-large HNP, with or without mild instability; and grade I spondylolisthesis
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
