Biportal Percutaneous Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Kang Taewook; Hyuck Lee Soon; Young Park Si

doi:10.4055/jkoa.2019.54.3.219

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Taewook, Soon, and Si: Biportal Percutaneous Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Original Article

J Korean Orthop Assoc 2019;54(3):219-226.

DOI: https://doi.org/10.4055/jkoa.2019.54.3.219

Biportal Percutaneous Endoscopic Spinal Surgery for Lumbar Spinal Stenosis

Kang Taewook, M.D., Hyuck Lee Soon, M.D., Ph.D., Young Park Si, M.D., Ph.D.

Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea

Correspondence to: Si Young Park, M.D., Ph.D. Department of Orthopaedic Surgery, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea TEL: +82-2-920-5925 FAX: +82-2-924-5271 E-mail: drspine90@kumc.or.kr ORCID: https://orcid.org/0000-0002-1216-901X

Received 12 March 201816 April 2018 Accepted 5 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lumbar decompressive surgery is a standard surgery for lumbar spinal stenosis. Many surgical techniques have been introduced, ranging from open surgery to percutaneous procedures. Minimally invasive techniques are preferred because of the less postoperative pain and shorter hospital stay. Uniportal percutaneous endoscopic decompression has technical difficulties due to the narrow field. Biportal percutaneous endoscopic decompression is a satisfactory technique that can compensate for the shortcomings and provide sufficient decompression.

Keywords: spinal stenosis, endoscopy, minimally invasive surgery

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Figure 1.

Kambin’s triangle: the exiting root is the hypotenuse, the superior border of the lower vertebral body is the base, and the height is the superior articular facet.

Figure 2.

Uniportal endoscopic surgery has restricted vision and technical difficulties because all the instruments use a single portal.

Figure 3.

Portal placement of the biportal arthroscopic approach: two separate 1 cm vertical incisions were made obliquely. Arrows: disc protrusion.

Figure 4.

One portal is used for arthroscopic viewing and continuous irrigation, and the other is used for the insertion and manipulation of instruments. Saline inflow through cranial viewing portal, and outflow through the caudal working portal allows continuous irrigation.

Figure 5.

Intraoperative arthroscopic view: standard arthroscopic instruments and conventional spinal instruments are used, such as Kerrison rongeur, high speed burr, pituitary forceps, and curette.

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