Research progress of unilateral biportal endoscopy technique in treatment of lumbar related diseases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yuhong , TIAN Lin ,  HU Peng , LU Huaiwang

Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China;

Corresponding author：

HU Peng, Email: qyhupeng@163.com

Keywords：

Unilateral biportal endoscopy technique; minimally invasive surgery; lumbar related disease

DOI：

10.7507/1002-1892.202205087

Video：

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Objective To review the application and research progress of unilateral biportal endoscopy (UBE) technique in the treatment of lumbar related diseases. Methods The domestic and foreign literature on the application of UBE technique in the treatment of lumbar related diseases was extensively consulted, and the development history, clinical application, operation points and precautions, related complications and adverse reactions, advantages and disadvantages of the technique were reviewed. Results As a minimally invasive technique developed in recent years, UBE technique is effective in the treatment of lumbar spinal stenosis caused by different causes, with satisfactory decompression effect, less damage, and good lumbar stability. UBE technique has significant advantages over open surgery and microscopy-assisted surgery in the treatment of lumbar disc herniation. In the treatment of lumbar spondylolisthesis, the postoperative trauma of UBE technique is less than that of conventional surgery, and the fusion rate is satisfactory. There are also complications such as spinal cord injury, spinal epidural hematoma, incomplete decompression or recurrence, nerve root irritation symptoms, and postoperative infection in the treatment of lumbar related diseases with UBE technique. Detailed preoperative planning is essential for patients with lumbar related diseases who are suitable for UBE surgery. Conclusion UBE technique is easy to operate, has a gentle learning curve, can use conventional instruments, and has definite effectiveness. It is suitable for a variety of lumbar related diseases, but there are some defects and deficiencies.

Citation： ZHANG Yuhong, TIAN Lin, HU Peng, LU Huaiwang. Research progress of unilateral biportal endoscopy technique in treatment of lumbar related diseases. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(10): 1234-1240. doi: 10.7507/1002-1892.202205087 Copy

1.	刘磊, 武建运, 黄伟敏, 等. 腰椎退行性疾病手术患者椎间盘退变及责任间隙分布情况研究. 中国全科医学, 2021, 24(5): 585-591.
2.	Sihvonen T, Herno A, Paljärvi L, et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976), 1993, 18(5): 575-581.
3.	Benoist M, Ficat C, Baraf P, et al. Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations. Rev Rhum Mal Osteoartic, 1979, 46(11): 593-599.
4.	Forst R, Hausmann B. Nucleoscopy-a new examination technique. Arch Orthop Trauma Surg (1978), 1983, 101(3): 219-221.
5.	Kambin P. Diagnostic and therapeutic spinal arthroscopy. Neurosurg Clin N Am, 1996, 7(1): 65-76.
6.	De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
7.	Osman SG, Marsolais EB. Endoscopic transiliac approach to L₅-S₁ disc and foramen. A cadaver study. Spine (Phila Pa 1976), 1997, 22(11): 1259-1263.
8.	Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
9.	Choi CM, Chung JT, Lee SJ, et al. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis. Acta Neurochir (Wien), 2016, 158(3): 459-463.
10.	Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
11.	Amundsen T, Weber H, Nordal HJ, et al. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976), 2000, 25(11): 1424-1435.
12.	Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus, 2019, 46(5): E9. doi: 10.3171/2019.2.FOCUS197.
13.	Kim JS, Park CW, Yeung YK, et al. Unilateral bi-portal endoscopic decompression via the contralateral approach in asymmetric spinal stenosis: A technical note. Asian Spine J, 2021, 15(5): 688-700.
14.	Aygun H, Abdulshafi K. Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: A prospective study. Clin Spine Surg, 2021, 34(6): E323-E328.
15.	毕经纬, 李瑞, 孙宁, 等. 单侧双通道内镜与椎间孔镜治疗腰椎管狭窄症的比较. 中国微创外科杂志, 2022, 22(2): 102-107.
16.	Lee HJ, Park EJ, Ahn JS, et al. Clinical outcomes of biportal endoscopic interlaminar decompression with oblique lumbar interbody fusion (OLIF): Comparative analysis with TLIF. Brain Sci, 2021, 11(5): 630. doi: 10.3390/brainsci11050630.
17.	Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976), 2000, 25(3): 389-394.
18.	Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J, 2018, 12(3): 569-573.
19.	Nardo L, Alizai H, Virayavanich W, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology, 2012, 265(2): 497-503.
20.	Wiltse LL, Guyer RD, Spencer CW, et al. Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine (Phila Pa 1976), 1984, 9(1): 31-41.
21.	Heo DH, Sharma S, Park CK. Endoscopic treatment of extraforaminal entrapment of L₅ nerve root (far out syndrome) by unilateral biportal endoscopic approach: Technical report and preliminary clinical results. Neurospine, 2019, 16(1): 130-137.
22.	Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22. doi: 10.1186/s13018-018-0725-1.
23.	Choi KC, Shim HK, Kim JS, et al. Cost-effectiveness of microdiscectomy versus endoscopic discectomy for lumbar disc herniation. Spine J, 2019, 19(7): 1162-1169.
24.	Ünsal ÜÜ, Senturk S. Minimally invasive far-lateral microdiscectomy: A new retractor for far-lateral lumbar disc surgery. Cureus, 2021, 13(1): e12625. doi: 10.7759/cureus.12625.
25.	Berra LV, Di Rita A, Longhitano F, et al. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop, 2021, 12(12): 961-969.
26.	Park JH, Jung JT, Lee SJ. How I do it: L₅/S₁ foraminal stenosis and far-lateral lumbar disc herniation with unilateral bi-portal endoscopy. Acta Neurochir (Wien), 2018, 160(10): 1899-1903.
27.	Zhu W, Yao Y, Hao J, et al. Short-term postoperative pain and function of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for single-segment lumbar disc herniation: A systematic review and meta-analysis. Appl Bionics Biomech, 2022, 2022: 5360277. doi: 10.1155/2022/5360277.
28.	Kim JE, Yoo HS, Choi DJ, et al. Learning curve and clinical outcome of biportal endoscopic-assisted lumbar interbody fusion. Biomed Res Int, 2020, 2020: 8815432. doi: 10.1155/2020/8815432.
29.	孔凡国, 周全, 乔杨, 等. 单侧双通道内镜下与微创通道下经椎间孔腰椎间融合术治疗腰椎退行性疾病的疗效比较. 中国修复重建外科杂志, 2022, 36(5): 592-599.
30.	Kang MS, Heo DH, Chung HJ, et al. Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy. J Orthop Surg Res, 2021, 16(1): 380. doi: 10.1186/s13018-021-02532-0.
31.	Quillo-Olvera J, Quillo-Olvera D, Quillo-Reséndiz J, et al. Unilateral biportal endoscopic-guided transcorporeal vertebroplasty with neural decompression for treating a traumatic lumbar fracture of L₅. World Neurosurg, 2020, 144: 74-81.
32.	Kang SS, Kim JE, Choi DJ, et al. Pseudomeningocele after biportal endoscopic spine surgery: A case report. J Orthop, 2019, 18: 1-4.
33.	Kim SK, Alarj M, Yang H, et al. Biportal endoscopic debridement and percutaneous screw fixation technique for spinal tuberculosis: how I do it. Acta Neurochir (Wien), 2021, 163(11): 3021-3025.
34.	Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
35.	蒋强, 丁宇, 刘金玉, 等. 有限元模拟全内镜下精准椎板开窗减压术及生物力学分析. 中国组织工程研究, 2020, 24(12): 1891-1896.
36.	Park HJ, Kim SK, Lee SC, et al. Dural tears in percutaneous biportal endoscopic spine surgery: Anatomical location and management. World Neurosurg, 2020, 136: e578-e585.
37.	Lee HG, Kang MS, Kim SY, et al. Dural injury in unilateral biportal endoscopic spinal surgery. Global Spine J, 2021, 11(6): 845-851.
38.	Choi CM. Biportal endoscopic spine surgery (BESS): considering merits and pitfalls. J Spine Surg, 2020, 6(2): 457-465.
39.	Kim JE, Choi DJ, Kim MC, et al. Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg, 2019, 129: e324-e329.
40.	Ahn DK, Lee JS, Shin WS, et al. Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine (Baltimore), 2021, 100(6): e24685. doi: 10.1097/MD.0000000000024685.
41.	Yamada K, Abe Y, Satoh S, et al. Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976), 2015, 40(13): 1046-1052.
42.	Kim W, Kim SK, Kang SS, et al. Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases. Acta Neurochir (Wien), 2020, 162(2): 279-287.
43.	Choi DJ, Choi CM, Jung JT, et al. Learning curve associated with complications in biportal endoscopic spinal surgery: Challenges and strategies. Asian Spine J, 2016, 10(4): 624-629.
44.	李扬, 张志文. 盘龙七片联合四维牵引治疗腰椎间盘突出症椎间孔镜术后神经根刺激症状35例临床观察. 甘肃中医药大学学报, 2021, 38(4): 62-65.
45.	Torudom Y, Dilokhuttakarn T. Two portal percutaneous endoscopic decompression for lumbar spinal stenosis: Preliminary study. Asian Spine J, 2016, 10(2): 335-342.
46.	Lin GX, Huang P, Kotheeranurak V, et al. A systematic review of unilateral biportal endoscopic spinal surgery: Preliminary clinical results and complications. World Neurosurg, 2019, 125: 425-432.
47.	Heo DH, Lee N, Park CW, et al. Endoscopic unilateral laminotomy with bilateral discectomy using biportal endoscopic approach: Technical report and preliminary clinical results. World Neurosurg, 2020, 137: 31-37.

1. 刘磊, 武建运, 黄伟敏, 等. 腰椎退行性疾病手术患者椎间盘退变及责任间隙分布情况研究. 中国全科医学, 2021, 24(5): 585-591.
2. Sihvonen T, Herno A, Paljärvi L, et al. Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome. Spine (Phila Pa 1976), 1993, 18(5): 575-581.
3. Benoist M, Ficat C, Baraf P, et al. Postoperative sciatica from epidural fibrosis and lumbar arachnoiditis. Results of 38 repeat operations. Rev Rhum Mal Osteoartic, 1979, 46(11): 593-599.
4. Forst R, Hausmann B. Nucleoscopy-a new examination technique. Arch Orthop Trauma Surg (1978), 1983, 101(3): 219-221.
5. Kambin P. Diagnostic and therapeutic spinal arthroscopy. Neurosurg Clin N Am, 1996, 7(1): 65-76.
6. De Antoni DJ, Claro ML, Poehling GG, et al. Translaminar lumbar epidural endoscopy: anatomy, technique, and indications. Arthroscopy, 1996, 12(3): 330-334.
7. Osman SG, Marsolais EB. Endoscopic transiliac approach to L₅-S₁ disc and foramen. A cadaver study. Spine (Phila Pa 1976), 1997, 22(11): 1259-1263.
8. Soliman HM. Irrigation endoscopic discectomy: a novel percutaneous approach for lumbar disc prolapse. Eur Spine J, 2013, 22(5): 1037-1044.
9. Choi CM, Chung JT, Lee SJ, et al. How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis. Acta Neurochir (Wien), 2016, 158(3): 459-463.
10. Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
11. Amundsen T, Weber H, Nordal HJ, et al. Lumbar spinal stenosis: conservative or surgical management?: A prospective 10-year study. Spine (Phila Pa 1976), 2000, 25(11): 1424-1435.
12. Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus, 2019, 46(5): E9. doi: 10.3171/2019.2.FOCUS197.
13. Kim JS, Park CW, Yeung YK, et al. Unilateral bi-portal endoscopic decompression via the contralateral approach in asymmetric spinal stenosis: A technical note. Asian Spine J, 2021, 15(5): 688-700.
14. Aygun H, Abdulshafi K. Unilateral biportal endoscopy versus tubular microendoscopy in management of single level degenerative lumbar canal stenosis: A prospective study. Clin Spine Surg, 2021, 34(6): E323-E328.
15. 毕经纬, 李瑞, 孙宁, 等. 单侧双通道内镜与椎间孔镜治疗腰椎管狭窄症的比较. 中国微创外科杂志, 2022, 22(2): 102-107.
16. Lee HJ, Park EJ, Ahn JS, et al. Clinical outcomes of biportal endoscopic interlaminar decompression with oblique lumbar interbody fusion (OLIF): Comparative analysis with TLIF. Brain Sci, 2021, 11(5): 630. doi: 10.3390/brainsci11050630.
17. Jenis LG, An HS. Spine update. Lumbar foraminal stenosis. Spine (Phila Pa 1976), 2000, 25(3): 389-394.
18. Choi DJ, Kim JE, Jung JT, et al. Biportal endoscopic spine surgery for various foraminal lesions at the lumbosacral lesion. Asian Spine J, 2018, 12(3): 569-573.
19. Nardo L, Alizai H, Virayavanich W, et al. Lumbosacral transitional vertebrae: association with low back pain. Radiology, 2012, 265(2): 497-503.
20. Wiltse LL, Guyer RD, Spencer CW, et al. Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine (Phila Pa 1976), 1984, 9(1): 31-41.
21. Heo DH, Sharma S, Park CK. Endoscopic treatment of extraforaminal entrapment of L₅ nerve root (far out syndrome) by unilateral biportal endoscopic approach: Technical report and preliminary clinical results. Neurospine, 2019, 16(1): 130-137.
22. Kim SK, Kang SS, Hong YH, et al. Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res, 2018, 13(1): 22. doi: 10.1186/s13018-018-0725-1.
23. Choi KC, Shim HK, Kim JS, et al. Cost-effectiveness of microdiscectomy versus endoscopic discectomy for lumbar disc herniation. Spine J, 2019, 19(7): 1162-1169.
24. Ünsal ÜÜ, Senturk S. Minimally invasive far-lateral microdiscectomy: A new retractor for far-lateral lumbar disc surgery. Cureus, 2021, 13(1): e12625. doi: 10.7759/cureus.12625.
25. Berra LV, Di Rita A, Longhitano F, et al. Far lateral lumbar disc herniation part 1: Imaging, neurophysiology and clinical features. World J Orthop, 2021, 12(12): 961-969.
26. Park JH, Jung JT, Lee SJ. How I do it: L₅/S₁ foraminal stenosis and far-lateral lumbar disc herniation with unilateral bi-portal endoscopy. Acta Neurochir (Wien), 2018, 160(10): 1899-1903.
27. Zhu W, Yao Y, Hao J, et al. Short-term postoperative pain and function of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for single-segment lumbar disc herniation: A systematic review and meta-analysis. Appl Bionics Biomech, 2022, 2022: 5360277. doi: 10.1155/2022/5360277.
28. Kim JE, Yoo HS, Choi DJ, et al. Learning curve and clinical outcome of biportal endoscopic-assisted lumbar interbody fusion. Biomed Res Int, 2020, 2020: 8815432. doi: 10.1155/2020/8815432.
29. 孔凡国, 周全, 乔杨, 等. 单侧双通道内镜下与微创通道下经椎间孔腰椎间融合术治疗腰椎退行性疾病的疗效比较. 中国修复重建外科杂志, 2022, 36(5): 592-599.
30. Kang MS, Heo DH, Chung HJ, et al. Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy. J Orthop Surg Res, 2021, 16(1): 380. doi: 10.1186/s13018-021-02532-0.
31. Quillo-Olvera J, Quillo-Olvera D, Quillo-Reséndiz J, et al. Unilateral biportal endoscopic-guided transcorporeal vertebroplasty with neural decompression for treating a traumatic lumbar fracture of L₅. World Neurosurg, 2020, 144: 74-81.
32. Kang SS, Kim JE, Choi DJ, et al. Pseudomeningocele after biportal endoscopic spine surgery: A case report. J Orthop, 2019, 18: 1-4.
33. Kim SK, Alarj M, Yang H, et al. Biportal endoscopic debridement and percutaneous screw fixation technique for spinal tuberculosis: how I do it. Acta Neurochir (Wien), 2021, 163(11): 3021-3025.
34. Hwa Eum J, Hwa Heo D, Son SK, et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine, 2016, 24(4): 602-607.
35. 蒋强, 丁宇, 刘金玉, 等. 有限元模拟全内镜下精准椎板开窗减压术及生物力学分析. 中国组织工程研究, 2020, 24(12): 1891-1896.
36. Park HJ, Kim SK, Lee SC, et al. Dural tears in percutaneous biportal endoscopic spine surgery: Anatomical location and management. World Neurosurg, 2020, 136: e578-e585.
37. Lee HG, Kang MS, Kim SY, et al. Dural injury in unilateral biportal endoscopic spinal surgery. Global Spine J, 2021, 11(6): 845-851.
38. Choi CM. Biportal endoscopic spine surgery (BESS): considering merits and pitfalls. J Spine Surg, 2020, 6(2): 457-465.
39. Kim JE, Choi DJ, Kim MC, et al. Risk factors of postoperative spinal epidural hematoma after biportal endoscopic spinal surgery. World Neurosurg, 2019, 129: e324-e329.
40. Ahn DK, Lee JS, Shin WS, et al. Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine (Baltimore), 2021, 100(6): e24685. doi: 10.1097/MD.0000000000024685.
41. Yamada K, Abe Y, Satoh S, et al. Large increase in blood pressure after extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976), 2015, 40(13): 1046-1052.
42. Kim W, Kim SK, Kang SS, et al. Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases. Acta Neurochir (Wien), 2020, 162(2): 279-287.
43. Choi DJ, Choi CM, Jung JT, et al. Learning curve associated with complications in biportal endoscopic spinal surgery: Challenges and strategies. Asian Spine J, 2016, 10(4): 624-629.
44. 李扬, 张志文. 盘龙七片联合四维牵引治疗腰椎间盘突出症椎间孔镜术后神经根刺激症状35例临床观察. 甘肃中医药大学学报, 2021, 38(4): 62-65.
45. Torudom Y, Dilokhuttakarn T. Two portal percutaneous endoscopic decompression for lumbar spinal stenosis: Preliminary study. Asian Spine J, 2016, 10(2): 335-342.
46. Lin GX, Huang P, Kotheeranurak V, et al. A systematic review of unilateral biportal endoscopic spinal surgery: Preliminary clinical results and complications. World Neurosurg, 2019, 125: 425-432.
47. Heo DH, Lee N, Park CW, et al. Endoscopic unilateral laminotomy with bilateral discectomy using biportal endoscopic approach: Technical report and preliminary clinical results. World Neurosurg, 2020, 137: 31-37.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of unilateral biportal endoscopy technique in treatment of lumbar related diseases

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