Search Results (7)

Background/Objectives: Biportal endoscopic spine surgery (BESS) is one of the minimally invasive spine surgery techniques. BESS has several advantages, such as better visualization, less muscle injury, early rehabilitation, etc. Due to its clear visualization, delicate intraoperative hemostasis of the bleeding foci, including cancellous bone and small epidural vessels, can be achieved. Therefore, some authors have reported that BESS resulted in less intraoperative visible blood loss (VBL) compared to conventional open surgery. However, it is difficult to analyze the exact amount of intraoperative blood loss because of the continuous normal saline irrigation. In addition, hidden blood loss (HBL) tends to be overlooked, and the amount of HBL might be larger than expected. We aim to calculate the amount of HBL during BESS and to compare our findings with convention open surgery. Methods: We retrospectively obtained the clinical data of patients that underwent lumbar central decompression from July 2021 to June 2024. Patients were divided into two groups: the BESS group that underwent biportal endoscopic lumbar decompression, and the open surgery group that underwent open decompression. Both groups used unilateral laminotomy and bilateral decompression techniques. Total blood loss (TBL) using preoperative and postoperative change in hematocrit (Hct) was measured using Gross’s formula and the Nadler equation. Since TBL consists of VBL and HBL, HBL was calculated by subtracting the VBL measured intraoperatively from TBL. Results: A total of sixty-six patients in the BESS group and seventeen patients in the open surgery group were included in the study. The TBL was 247.16 ± 346.88 mL in the BESS group and 298.71 ± 256.65 mL in the open surgery group, without significant difference (p = 0.569). The calculated HBL values were 149.44 ± 344.08 mL in the BESS group and 171.42 ± 243.93 mL in the open surgery group. The HBL in the BESS group was lower than the HBL in the open surgery group, without significant difference (p = 0.764). Conclusions: The TBL and HBL during lumbar central decompression were smaller in patients who underwent BESS compared to those who underwent open surgery. While TBL was significantly lower in BESS, HBL did not show statistical significance between the two groups. HBL during BESS should not be neglected, and related hemodynamics should be considered postoperatively. Full article

Background/Objectives: This is a retrospective study. We aimed to identify an optimal biportal endoscopic spine surgery (BESS) technique that maximizes facet joint preservation while achieving sufficient decompression for central to extraforaminal lumbar stenosis across all spinal levels. Methods: We retrospectively analyzed the data of 46 patients who underwent surgery and assessed clinical outcomes (visual analogue scale scores for pain; pregabalin usage) and radiological changes (using computed tomography/magnetic resonance imaging) in the spinal canal; intervertebral foramen area expansion; facet joint preservation; and degenerative change. Results: Using interlaminar and transforaminal approaches (two-way BESS decompression technique), the mean facet joint volume preservation ratio was 87%, and the mean facet joint length maintenance ratio was 90%, indicating a successful anatomical preservation compared with previous studies. Radiological outcomes revealed effective decompression (178% in the spinal canal; 245% in intervertebral foramen expansion). Additionally, all clinical outcome parameters significantly improved (p < 0.001). Conclusions: To the best of our knowledge, this study is the first to accurately estimate the degree of facet joint preservation using different methods after endoscopic surgery. The two-way BESS decompression technique maximized facet joint preservation with sufficient decompression and clinically improved central to extraforaminal stenosis across all lumbar levels. Therefore, this technique can sufficiently preserve facet joints to prevent rapid degenerative change after surgery. Full article

Background/Objectives: This study compares clinical and radiological outcomes of open microscopic posterior cervical foraminotomy (PCF) and biportal endoscopic spine surgery (BESS) PCF in multi-level cases. While BESS PCF is effective in single-level surgeries, its role in multi-level procedures remains unclear. Methods: This retrospective cohort study included 60 patients treated for cervical radiculopathy from 2016 to 2023, divided into two groups, open microscopic PCF (Group M, n = 30) and BESS PCF (Group B, n = 30). Clinical outcomes were assessed using visual analogue scale (VAS) scores for neck and arm pain and the neck disability index (NDI). Radiological parameters included cervical angle, segmental angle, range of motion (ROM), and the extent of facetectomy. Results: Both groups showed improvement in the arm pain VAS and the NDI. However, Group B exhibited significantly better neck pain on the VAS at the final follow-up (p = 0.03). Radiologically, Group B maintained lordotic cervical and segmental angles postoperatively, while Group M showed kyphotic changes (p < 0.01). Segmental ROM was larger in Group M, indicating greater instability (p < 0.01). Group B had less extensive facetectomy while achieving comparable foraminal enlargement. Operative time was longer for Group B (p < 0.001). Conclusions: BESS PCF preserves cervical stability and reduces postoperative neck pain compared to open microscopic PCF in multi-level procedures. Despite longer operative times, its benefits in minimizing instability make it a promising option for treating multi-level cervical radiculopathy. Further research with long-term follow-up is recommended. Full article

Biportal endoscopic spine surgery (BESS) is minimally invasive and therefore benefits both surgeons and patients. However, concerning complications include dural tears and neural tissue injuries. In this study, we aimed to develop a deep learning model for neural tissue segmentation to enhance the safety and efficacy of endoscopic spinal surgery. We used frames extracted from videos of 28 endoscopic spine surgeries, comprising 2307 images for training and 635 images for validation. A U-Net-like architecture is employed for neural tissue segmentation. Quantitative assessments include the Dice-Sorensen coefficient, Jaccard index, precision, recall, average precision, and image-processing time. Our findings revealed that the best-performing model achieved a Dice-Sorensen coefficient of 0.824 and a Jaccard index of 0.701. The precision and recall values were 0.810 and 0.839, respectively, with an average precision of 0.890. The model processed images at 43 ms per frame, equating to 23.3 frames per second. Qualitative evaluations indicated the effective identification of neural tissue features. Our U-Net-based model robustly performed neural tissue segmentation, indicating its potential to support spine surgeons, especially those with less experience, and improve surgical outcomes in endoscopic procedures. Therefore, further advancements may enhance the clinical applicability of this technique. Full article

Background: We aimed to analyze the clinical outcomes and effectiveness of cervical biportal endoscopic spine surgery (C-BESS) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical disc herniation. Methods: This study was a retrospective chart review of four-year clinical data involving 318 cases of symptomatic cervical disc herniation, with 156 patients undergoing the ACDF and 162 patients receiving the C-BESS. Preoperative and postoperative one-year data were collected. Results: The numeric rating scale and neck disability index showed statistically significant improvement for both ACDF and C-BESS groups. While showing a longer operation time and more blood loss during surgery compared to the ACDF group, the C-BESS group demonstrated a learning effect as the surgeon’s proficiency increased with more cases. There was no significant difference in the postoperative length of hospitalization between the two methods. The subgroup with predominant arm pain revealed the statistical difference in arm pain intensity changes between the two groups (p < 0.001). The rates of complication were 2.6% for the ACDF group and 1.9% for the C-BESS group. Conclusions: C-BESS and ACDF are effective surgical treatments for patients with symptomatic single-level cervical disc herniation in relieving relevant pain intensities and pain-related disabilities. Full article

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. Full article

The clinical and radiological results before and after surgery were compared and analyzed for patients with multilevel lumbar stenosis who underwent bi-portal endoscopic spine surgery (BESS) and microscopic unilateral laminotomy for bilateral decompression (ULBD). We retrospectively identified 47 and 49 patients who underwent BESS and microscopic ULBD, respectively, who were diagnosed with multi-level lumbar stenosis. Clinical outcomes were evaluated using the visual analog scale score for both back and leg pain, and medication (pregabalin) use and Oswestry Disability Index (ODI) scores for overall treatment outcomes were used pre-operatively and at the final follow-up. Radiological outcomes were evaluated as the percentage of dura expansion volume, and percentage preservation of both facets and both lateral recess angles. The follow-up period of patients was about 17.04 months in the BESS group and about 16.90 months in the microscopic ULBD group. The back and leg visual analog scale (VAS) scores and average pregabalin use decreased more significantly in the BESS group than in the microscopic ULBD group (each p-value 0.0443, <0.001, 0.0378). All radiological outcomes were significantly higher in the BESS group than in the ULBD group. The change in ODI in two-level spinal stenosis showed a significantly higher value in the BESS group compared to the microscopic ULBD group (p-value 0.0335). Multilevel decompression with the BESS technique in multiple spinal stenosis is an adequate technique as it shows better clinical and radiological results than microscopic ULBD during a short-term follow-up period. Full article