Biportal Endoskopik Spine SurgeryBESS Tark YAZAR A MERTER
Biportal Endoskopik Spine Surgery(BESS) Tarık YAZAR, A MERTER Ankara University Medicine School Departmant of Orthopedics and Traumatology Section of Spine Surgery
• There are many minimally invasive procedures such as transforaminal endoscopic spine surgery, epiduroscopy, interlaminar endoscopic spine surgery and biportal endoscopic spine surgery. • In our clinic, we are using all of these interventions, and recently we started to perform biportal endoscopic spine surgery to lumbar disc herniation and spinal stenosis surgery cases.
Advantages • Wider viewing angle compared to the uniportal technique • The magnification of the surgical field is similar to that of microscopic spinal surgery.
Advantages • Enable to interbody fusion
Advantages • No muscular damage(especially M. Multifudys)
BESS Biportal endoscopic surgery 2 Uniportal endoscopic surgery 2 • Wider viewing angle • Suitable for more indication • Need for arthroscopy and endoscopy experience • Long learning curve • Bleeding control • Total laminectomy can be done • Possibility of TLIF implantation when necessary • • Narrow view angle Inability to do laminectomy Inability to do fusion More difficult to control bleeding 2. Hwa Eum J, Hwa Heo D et al. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine. 2016 Apr; 24(4): 602 -7. doi: 10. 3171/2015. 7. SPINE 15304. Epub 2016 Jan 1.
Required Equipments • Standard arthroscopy instruments • Kerrison roungers • Radiofrequency probe • Artropump • Disc forceps
Learning Curve • BESS had a relatively short learning curve and the complication rate in the first period of the learning curve was reported as 10. 3%. • This complication rate can also be reduced by controlling epidural hemorrhage (continuous and pressure saline irrigation).
Learning Curve • In this learning curve, we used a spine model and fresh sheep spine model with preserved paraspinal muscles and. • Cost-effective and useful to improve triangulation in the endoscope.
Our short case series • We perfomed this technique in 10 patients and in the first case the duration of the case was over 2 hours but as we progressed through the learning curve, It is decreasing. • We did not encounter any neurological or other complications. • Patients were discharged from the hospital on postoperative day 0.
Case 1 -32 Y M L 5 -S 1 disc herniation
Cleaning of dorsal surface of lamina with RF probe
Laminotomy
Excision of lig. flavum
Removing the herniated part of the disc
L 5 root and discectomy
Case 2 -36 F L 5 -S 1 sequestrated disc herniation
Postoperative MRI
Case 3 - 34 y M L 5 -S 1 sequestrated disc herniation
- Slides: 24