Posterior Inclinatory Approach for the Degenerative Foraminal Stenosis with the Biportal Endoscopic Technique: Clinical and Radiological Outcomes

Xu Z, Zhuolin Z, Jing X and Hu Q

Department of Spine, The Fourth Affiliated Hospital of Zhejiang University School of Medicine, China

^*Correspondance to: Qingfeng Hu 

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Abstract:

Objective: Biportal Endoscopic Spine Surgery (BESS) presents a multitude of advantages, including enhanced flexibility, improved magnification, and an expanded field of view. These characteristics render it particularly suitable for the performance of minimally invasive procedures targeting spinal stenosis. This study introduces an innovative approach termed Posterior Inclinatory Access by BESS technique (PIA-BESS), which is specifically designed for treating degenerative spinal foraminal stenosis. Methods: Between March 2021 and July 2023, a total of 19 patients presenting with symptomatic nerve root involvement due to foraminal stenosis underwent the PIA-BESS surgical procedure. Preoperative and postoperative assessments involved the acquisition of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans to measure changes in the cross-sectional area of the spinal canal and intervertebral foramen. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) scores and the Visual Analog Scale (VAS) scores for both buttock and radicular pain. The dynamic Intervertebral Angle (IVA) and vertebral slip rate, as determined from preoperative and postoperative X-rays, were employed to evaluate post-surgical vertebral stability. Results: The intervertebral foraminal increased from 32.26 ± 13.49 mm2 to 79.95 ± 19.78 mm2 (P<0.05). The area of the spinal canal increased from 105.37 ± 21.66 mm2 to 145.63 ± 17.86 mm2 (P<0.05). ODI scores reduced from 73.27 ± 13.21 to 9.26 ± 7.65 (P<0.05); VAS score reduced from 5.79 ± 1.08 to 0.84 ± 0.9 (P<0.05). There are significant differences between the pre-operation and post-operation. While the dynamic IVA and vertebral slip show no significant change. Conclusion: The PIA-BESS approach is an effective and low-complication method for addressing stenosis in the lower lumbar foraminal region. It provides effective decompression for bony stenosis or extruded and sequestered discs in the foraminal region while enabling simultaneous exploration of the exiting and traversing nerve roots. This approach allows for a good surgical field view while also aiming to preserve the facet joint as much as possible.

Keywords:

Foraminal stenosis; Biportal endoscopic technique; Posterior inclinatory approach; Nerve root lesion

Cite the Article:

Xu Z, Zhuolin Z, Jing X, Hu Q. Posterior Inclinatory Approach for the Degenerative Foraminal Stenosis with the Biportal Endoscopic Technique: Clinical and Radiological Outcomes. World J Surg Surgical Res. 2024; 7: 1546..