J Korean Orthop Assoc.  2019 Jun;54(3):211-218. 10.4055/jkoa.2019.54.3.211.

Biportal Endoscopic Spinal Surgery for Lumbar Intervertebral Disc Herniation

• Lee HJ
• Choi DJ
• Park EJ

• KMID: 2450140
• DOI: http://doi.org/10.4055/jkoa.2019.54.3.211

Abstract

Herniation of the intervertebral disc is a medical disease manifesting as a bulging out of the nucleus pulposus or annulus fibrosis beyond the normal position. Most lumbar disc herniation cases have a favorable natural course. On the other hand, surgical intervention is reserved for patients with severe neurological symptoms or signs, progressive neurological symptoms, cauda equina syndrome, and those who are non-responsive to conservative treatment. Numerous surgical methods have been introduced, ranging from conventional open, microscope assisted, tubular retractor assisted, and endoscopic surgery. Among them, microscopic discectomy is currently the standard method. Biportal endoscopic spinal surgery (BESS) has several merits over other surgical techniques, including separate and free handling of endoscopy and surgical instruments, wide view of the surgical field with small skin incisions, absence of the procedure of removing fog from the endoscope, and lower infection rate by continuous saline irrigation. In addition, existing arthroscopic instruments for the extremities and conventional spinal instruments can be used for this technique and surgery for recurred disc herniation is applicable because delicate surgical procedures are performed under a brightness of 2,700 to 6,700 lux and a magnification of 28 to 35 times. Therefore, due to such advantages, BESS is a novel technique for the surgical treatment of lumbar disc herniation.

Keyword

lumbar vertebrae; herniated disc; endoscopic surgical procedure; orthopedic surgery

MeSH Terms

Diskectomy
Endoscopes
Endoscopy
Extremities
Fibrosis
Hand
Humans
Intervertebral Disc Displacement
Intervertebral Disc*
Lumbar Vertebrae
Methods
Orthopedics
Polyradiculopathy
Skin
Surgical Instruments
Weather

Figure

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  Figure 1. The anatomical lanmarks on true anteroposterior view of image intensifier during interlaminar approach. (A) Outer border of spinous process (black ovals) and outer border of interlaminar space (white curves). (B) The actual drawing on the patient.

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  Figure 2. The anatomical lanmarks on true anteroposterior view of image intensifier during extraforaminal approach. (A) Transverse process (white rectangle), pedicle (grey), and spinous process (black). (B) The actual drawing on the patient.

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  Figure 3. (A) Shoulder type lumbar intervertebral disc herniation. (B) Axillary type lumbar intervertebral disc herniation (black circle: herniated disc, black star: nerve root).

Reference

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