Biportal Surgery Research Articles

Minimizing Tissue Injury and Incisions in Multilevel Biportal Endoscopic Spine Surgery: Technical Note and Preliminary Results.

Background and Objectives: Biportal endoscopic spine surgery (BESS) is a promising technique that can be applied for the treatment of various spinal diseases. However, traditional BESS procedures require multiple, separate incisions. We present, herein, various techniques to reduce the number of incisions in multi-level surgery and their clinical outcomes. Materials and Methods: Three different techniques were used to reduce the number of incisions for the preservation of normal tissue associated with BESS: the step-ladder technique, employing a common portal for the scope and instruments; the portal change technique employing a two-level procedure with two incisions; and the tilting technique, employing more than three levels. Pain (Visual Analog Scale), disability (Oswestry Disability Index), and patient satisfaction were evaluated before and 12 months after the procedure. Results: Among the 122 cases of multilevel spine surgery, 1.43 incisions per level were employed for multilevel BESS. Pain and disability showed significant improvement. Patient satisfaction showed favorable results. Conclusions: Combining multiple techniques during biportal surgery could decrease the number of incisions needed and preserve musculature with favorable clinical outcomes.

Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis.

Systematic review and meta-analysis. Lumbar spinal stenosis (LSS) treatment has evolved with the introduction of minimally invasive surgery (MIS) techniques. Endoscopic methods take the concepts applied to MIS a step further, with multiple studies showing that endoscopic techniques have outcomes that are similar to those of more traditional approaches. The aim of this study was to perform an updated meta-analysis and systematic review of studies comparing the outcomes between both available endoscopic techniques (uni and biportal) for the treatment of LSS. Following PRISMA guidelines, we conducted a systematic literature search and compared the randomized controlled trials and retrospective studies of uniportal and biportal endoscopy in the treatment of LSS from several databases. Bias was assessed using quality assessment criteria and funnel plots. Meta-analysis using a random-effects model was used to synthesize the metadata. The authors used Review Manager 5.4 to manage the date and perform the review. After a preliminary selection of 388 studies from electronic databases, the full inclusion criteria were applied; three studies were found to be eligible for inclusion. There were 184 patients from three unique studies. Meta-analysis of visual analog scale score for low back pain and leg pain showed no significant difference at the final follow-up (P = 0.51 and P = 0.66). ODI score after biportal surgery was lower than uniportal surgery [SMD = 0.34, 95% CI (0.04, 0.63), P = 0.02]. The mean operation time was similar in the unilateral biportal endoscopy (UBE) and uniportal groups (P = 0.53). The UBE group was associated with a shorter length of hospital stay (P = 0.05). Complications were similar in both groups (P = 0.89). Current evidence shows no significant differences in most clinical outcomes between uniportal and biportal surgery. UBE may have a better ODI score at the end of the follow-up compared to uniportal. Further studies are required before drawing a definite conclusion. PROSPERO prospective register of systematic reviews: Registration Nº. CRD42022339078, Available from: https://www.crd.york.ac.uk/prospero/displayrecord.php?ID=CRD42022339078.

"Pin Method" for Endoscopic Lumbar Interbody Fusion.

Endoscopic lumbar interbody fusion using a cage can have a similar fusion rate as minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or open lumbar interbody fusion. Direct visual control during cage insertion is the key to prevent neural structure incarceration in endoscopic lumbar interbody fusion. Creating a track with any kind of retractor or cannula for cage insertion under fluoroscopic guidance is not safe enough, because the retractor and cannula can create many blind spots and can displace during cage insertion. The pin method utilizes two flexible metallic guide pins inserted from the skin incision through the annulotomy site into the disk space until the anterior longitudinal ligament is reached under direct endoscopic monitoring. The two guide pins could be oriented parallel or perpendicular or even reduce to one or increase to many as needed to serve as a sliding track and a see-through barrier to prevent neural incarceration. Two cases of L4/L5 grade 2 spondylolisthesis with neurogenic claudication were treated with endoscopic lumbar interbody fusion with 1-year follow-up, and the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, EuroQol five-dimensional questionnaire (EQ-5D, %) score, and modified Macnab score all improved greatly in both. The author developed an original, cheap, accessible, and safe method called the "pin method," which can be used in both full-endoscopic and biportal surgery and can apply to various approaches and has no limitation on the size and shape of the cage.