Abstract
Herniated lumbar disc (HLD) is a common indication for unilateral biportal endoscopic (UBE) spine surgery. In cases of non-responsiveness to conservative treatment or neurological emergency with concomitant radiologic findings, UBE discectomy can be considered as a treatment option regardless of the degree of migration and consistency of the disc. Level identification, working space preparation, laminectomy, and ligamentum flavum removal are performed similarly to UBE decompression of spinal stenosis. With careful tissue dissection and root protection using a retractor, disc removal can be accomplished under high-definition camera guidance. Because of the various advantages of UBE such as less muscle injury, easy manipulation of bone, and disc removal with conventional punches and forceps, physicians can expect better outcomes including less postoperative back pain, shorter hospital stay, and higher patient satisfaction. The authors are confident of the important role of UBE discectomy as a minimally invasive surgery for HLD. In this article, we describe in detail the surgical procedure for UBE discectomy in an effort to assist our colleagues who wish to incorporate this technique in their practices.
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References
Awad JN, Moskovich R. Lumbar disc herniations: surgical versus nonsurgical treatment. Clin Orthop Relat Res. 2006;443:183–97.
Gibson JNA, Subramanian AS, Scott CEH. A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy. Eur Spine J. 2017;26(3):847–56.
Barber SM, Nakhla J, Konakondla S, Fridley JS, Oyelese AA, Gokaslan ZL, et al. Outcomes of endoscopic discectomy compared with open microdiscectomy and tubular microdiscectomy for lumbar disc herniations: a meta-analysis. J Neurosurg Spine. 2019;31:1–14.
Kambin P, Nass. Arthroscopic microdiscectomy. Spine J. 2003;3(3 Suppl):60S–4S.
Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus. 2019;46(5):E9.
Kang T, Park SY, Park GW, Lee SH, Park JH, Suh SW. Biportal endoscopic discectomy for high-grade migrated lumbar disc herniation. J Neurosurg Spine. 2020;33:1–6.
Choi DJ, Jung JT, Lee SJ, Kim YS, Jang HJ, Yoo B. Biportal endoscopic spinal surgery for recurrent lumbar disc herniations. Clin Orthop Surg. 2016;8(3):325–9.
Choi DJ, Choi CM, Jung JT, Lee SJ, Kim YS. Learning curve associated with complications in biportal endoscopic spinal surgery: challenges and strategies. Asian Spine J. 2016;10(4):624–9.
Hong YH, Kim SK, Hwang J, Eum JH, Heo DH, Suh DW, et al. Water dynamics in unilateral biportal endoscopic spine surgery and its related factors: an in vivo proportional regression and proficiency-matched study. World Neurosurg. 2021;149:e836–e43.
Choi KC, Shim HK, Hwang JS, Shin SH, Lee DC, Jung HH, et al. Comparison of surgical invasiveness between microdiscectomy and 3 different endoscopic discectomy techniques for lumbar disc herniation. World Neurosurg. 2018;116:e750–e8.
Kim W, Kim SK, Kang SS, Park HJ, Han S, Lee SC. Pooled analysis of unsuccessful percutaneous biportal endoscopic surgery outcomes from a multi-institutional retrospective cohort of 797 cases. Acta Neurochir. 2020;162(2):279–87.
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1 Electronic Supplementary Material
Continuous saline flow during the UBE procedure is very important. A one-way flow cannula entering the endoscopic portal and exiting the working portal is ideal. This continuous saline flow should be maintained even when the instrument is inserted into the working portal, therefore, the use of a working cannula may be helpful (MP4 6114 kb)
Laminectomy, flavectomy, and discectomy with UBE. Please refer to Fig. 4.5 for the orientation of the surgical field (MP4 681798 kb)
Left axillary approach at L5/S1. Please refer to the first slide of the video for the orientation of the surgical field (MP4 84066 kb)
Left shoulder approach at L5/S1. Please refer to the first slide of the video for the orientation of the surgical field (MP4 185940 kb)
Left-sided contralateral approach to the right foramen at L2/3. Please refer to the first slide of the video for the orientation of the surgical field (MP4 314319 kb)
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Kim, S.K., Yi, S., Park, J.Y. (2022). Unilateral Biportal Endoscopy for Herniated Lumbar Disc. In: Heo, D.H., Park, C.W., Son, S.K., Eum, J.H. (eds) Unilateral Biportal Endoscopic Spine Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-16-8201-8_4
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DOI: https://doi.org/10.1007/978-981-16-8201-8_4
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