Effective Biportal Endoscopic Spine Surgery Technique With Better Facet Joint Preserving for Lumbar Lateral Recess Stenosis

Abstract

Background: Biportal endoscopic spinal surgery (BESS) for the treatment of spinal stenosis provided favorable clinical outcomes in many studies. They reported that interlaminar BESS decompression achieved favorable effects in patients with central spinal stenosis. However, many patients still experienced radiating pain even after conventional interlaminar BESS decompression. Therefore, a more reliable BESS decompression method for traversing root and lateral recess areas is necessary. Hence, we investigated a method to better decompress both lateral recess areas while preserving both facet joints as much as possible with bilateral radiculopathy.

Methods: We retrospectively analyzed the data of 48 patients undergoing interlaminar BESS decompression; 24 patients underwent decompression using the conventional BESS technique (group A), and the other 24 patients underwent a both facet joint preserving BESS technique (group B). The following steps are the characteristics of a better decompression technique: using a 30° endoscope at ipsilateral side decompression, enough decompression through traversing root pathway, and enough removal of fibrotic tissue. Clinical outcomes (visual analog scale scores for pain, pregabalin usage, and modified MacNab criteria) and radiological changes (using magnetic resonance imaging) in the spinal canal expansion, lateral recess angle, and facet joint preservation were evaluated.

Results: In radiological outcomes, there were significant differences in ipsilateral facet joint preservation ratio and contralateral lateral recess increasing ratio (ipsilateral facet joint preservation ratio 92.15% ± 2.62% vs 90.96% ± 2.88%, P value 0.041 and contralateral lateral recess increasing ratio 155.22% ± 15.99% vs 165.39% ± 22.07%, P = 0.0136). In clinical outcomes, there were significant differences between the 2 groups over time in leg visual analog scale score and pregabalin medication use.

Conclusion: The BESS technique for preserving both facet joints was an effective treatment option in long-term follow-up; it achieved favorable clinical outcomes while preserving both facet joints and making as much decompression space as possible.