Journal List > J Korean Orthop Assoc > v.54(3) > 1127757

J Korean Orthop Assoc. 2019 Jun;54(3):211-218. Korean.
Published online Jun 19, 2019.
Copyright © 2019 by The Korean Orthopaedic Association
Biportal Endoscopic Spinal Surgery for Lumbar Intervertebral Disc Herniation
Ho-Jin Lee, M.D., Ph.D., Dae-Jung Choi, M.D.,* and Eugene J. Park, M.D.
Department of Orthopedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea.
*Spine Center, Himnaera Hospital, Busan, Korea.

Correspondence to: Eugene J. Park, M.D. Department of Orthopedic Surgery, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. TEL: +82-42-338-2480, FAX: +82-42-338-2482, Email:
Received Apr 13, 2018; Revised Sep 06, 2018; Accepted Oct 05, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.

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


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.
Click for larger image

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.
Click for larger image

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


CONFLICTS OF INTEREST:The authors have nothing to disclose.

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