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A Beginner’s Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery – Lumbar Spinal Stenosis

This article compares the perioperative and clinical outcomes of two techniques, namely biportal endoscopic spinal surgery (BESS) and microscopic surgery, for single-level lumbar decompression surgery. The study involved 50 patients who underwent BESS and 150 patients who underwent microscopic surgery. The results showed that the BESS group had significantly lower postoperative disability and pain scores compared to the microscope group. However, the microscope group had higher levels of inflammatory markers and longer operation times. Both groups experienced surgery-related complications, with the BESS group having a slightly higher incidence. The study concludes that BESS is a viable option for surgical treatment of single-level lumbar degenerative disease, but new surgeons should be aware of the possibility of recurrence and incidental dural tears

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest sugical centre in UK

Published article

CONCLUSIONS: BESS as a new technique resulted in satisfying short-term outcomes. It was a well-tolerated option for surgical treatment of single-level lumbar degenerative disease. The relatively high incidence of recurrence at the index level and incidental dural tears should be considered for surgeons new to BESS; however, these were manageable complications.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Clin Orthop Surg. 2023 Oct;15(5):793-799. doi: 10.4055/cios22331. Epub 2023 Aug 2.ABSTRACTBACKGROUND: The application of biportal endoscopic spinal surgery (BESS) in spine surgery is increasing. However, the clinical results of related studies have been inconsistent. In this study, the perioperative and clinical outcomes of two techniques in single-level lumbar decompression surgery were compared using the perspective,

Clin Orthop Surg. 2023 Oct;15(5):793-799. doi: 10.4055/cios22331. Epub 2023 Aug 2.

ABSTRACT

BACKGROUND: The application of biportal endoscopic spinal surgery (BESS) in spine surgery is increasing. However, the clinical results of related studies have been inconsistent. In this study, the perioperative and clinical outcomes of two techniques in single-level lumbar decompression surgery were compared using the perspective of a spine surgeon experienced in microscopic surgery but inexperienced in BESS.

METHODS: This is a retrospective study performed with prospectively collected data. From April 2019, 50 consecutive patients who underwent a single-level lumbar decompression surgery with BESS were evaluated. Additionally, the data of 150 consecutive patients who underwent the same microscopic surgery before April 2019 were collected. We performed 1 : 1 ratio propensity score matching for these two groups to adjust for baseline variables. The postoperative patient-reported outcome measures included the Oswestry Disability Index (ODI) and numeric rating scale for the back and leg preoperatively and at 6 months after surgery. The laboratory data (C-reactive protein [CRP, mg/L] and hemoglobin [Hb, g/dL]) were measured preoperatively and 3 times (1, 2, and 3 or 4 days) postoperatively. In these periods, the peak and lowest CRP and Hb concentrations were evaluated. The perioperative outcomes, operation time (from skin incision to dressing), length of hospital stay, drainage (for 24 hours after surgery), and surgery-related complications were also evaluated.

RESULTS: Forty-seven patients (27 men and 20 women) were included in each group. The postoperative 6-month ODI was significantly lower in the BESS group than in the microscope group (6.90 ± 5.98 vs. 11.54 ± 9.70). The peak CRP concentration (16.63 ± 19.41 vs. 42.40 ± 37.73, p < 0.001) and CRP increment (peak CRP minus preoperative CRP, 14.69 ± 19.47 vs. 40.71 ± 37.32, p < 0.001) were significantly higher in the microscope group. Operation time (83.72 ± 35.71 vs. 70.27 ± 23.24, p = 0.047) was significantly longer in the BESS group. Surgery-related complications were found in 6 and 3 cases in the BESS group (3 revisions, 2 dural tears, and 1 conversion to open surgery) and microscope group (2 revisions and 1 hematoma), respectively.

CONCLUSIONS: BESS as a new technique resulted in satisfying short-term outcomes. It was a well-tolerated option for surgical treatment of single-level lumbar degenerative disease. The relatively high incidence of recurrence at the index level and incidental dural tears should be considered for surgeons new to BESS; however, these were manageable complications.

PMID:37811519 | PMC:PMC10551688 | DOI:10.4055/cios22331

The London Spine Unit : finest sugical centre in UK

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A Beginner’s Perspective on Biportal Endoscopic Spine Surgery in Single-Level Lumbar Decompression: A Comparative Study with a Microscopic Surgery

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Clin Orthop Surg. 2023 Oct;15(5):793-799. doi: 10.4055/cios22331. Epub 2023 Aug 2.ABSTRACTBACKGROUND: The application of biportal endoscopic spinal surgery (BESS) in spine surgery is increasing. However, the clinical results of related studies have been inconsistent. In this study, the perioperative and clinical outcomes of two techniques in single-level lumbar decompression surgery were compared using the perspective

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