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

IF 1.7 Q2 SURGERY

International Journal of Spine Surgery Pub Date : 2025-05-12 DOI:10.14444/8734

Sub-Ri Park, Namhoo Kim, Ji-Won Kwon, Kyung-Soo Suk, Seong-Hwan Moon, Si-Young Park, Byung Ho Lee, Hak-Sun Kim, Jin-Oh Park

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引用次数: 0

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.

Level of evidence: 3:

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有效的双门静脉内窥镜脊柱手术技术，更好地保留小关节治疗腰椎外侧隐窝狭窄。

背景：在许多研究中，双门静脉内镜脊柱手术（BESS）治疗椎管狭窄提供了良好的临床结果。他们报道椎板间减压对中枢性椎管狭窄患者取得了良好的效果。然而，许多患者即使在常规的椎板间BESS减压后仍经历放射性疼痛。因此，需要一种更可靠的BESS减压方法来穿越根和侧隐窝区。因此，我们研究了一种方法，以更好地减压两侧外侧隐窝区，同时尽可能保留双侧神经根病的两个小关节。方法：回顾性分析48例椎板间BESS减压患者的资料；24例患者采用常规BESS技术进行减压（A组），另外24例患者采用保留双关节突关节的BESS技术（B组）。较好的减压技术的特点如下：在同侧使用30°内窥镜减压，通过穿越根径进行足够的减压，并充分去除纤维化组织。评估临床结果（疼痛的视觉模拟评分、普瑞巴林的使用和改进的MacNab标准）和椎管扩张、侧隐窝角度和小关节保留的影像学变化（使用磁共振成像）。结果：在影像学结果上，同侧小关节关节保持率与对侧外侧隐窝增大率差异有统计学意义（同侧小关节关节保持率92.15%±2.62% vs 90.96%±2.88%，P值0.041；对侧外侧隐窝增大率155.22%±15.99% vs 165.39%±22.07%,P = 0.0136）。在临床结果方面，两组患者的腿部视觉模拟量表评分和普瑞巴林用药随时间的变化有显著差异。结论：BESS技术保留双侧小关节是长期随访的有效治疗选择；在保留双侧小关节和尽可能多的减压空间的同时取得了良好的临床效果。证据等级：3；

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.