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How I do it: biportal endoscopic spinal surgery for revision of adjacent segment disease after instrumented lumbar fusion

  • How I Do it - Spine degenerative
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Abstract

Background

Lumbar fusion with rigid fixation can be complicated by adjacent segment degeneration, which may cause neurological deficits and back pain, and occasionally necessitates revision surgery. This type of revision surgery is difficult to perform in a minimally invasive manner because it requires the revision of the original internal fixation instruments.

Method

We describe a biportal endoscopic spinal surgery (BESS) procedure for revision surgery due to adjacent segment disease after lumbar fusion with rigid fixation instruments. The radiological images and complete surgical procedure are presented.

Conclusions

BESS effectively enabled nerve decompression, intervertebral fusion, and revision of lumbar fusion with fixation instruments in a minimally invasive manner.

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References

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Acknowledgements

We thank Medjaden Inc. for the scientific editing of this manuscript.

Funding

This work was supported by the Capital Health Research and Development of Special (SF No. 2022–2-6043).

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Authors and Affiliations

  1. Department of Orthopedics, Peking University Shougang Hospital, Shijingshan District, No. 9, Jinyuanzhuang Rd, Beijing, 100144, China

    Wenlong Wang, Pengfei Lyu & Zheng Liu

Authors
  1. Wenlong Wang
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  2. Pengfei Lyu
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  3. Zheng Liu
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Corresponding author

Correspondence to Zheng Liu.

Ethics declarations

Ethics approval and consent to participate

This study protocol was approved by the Ethics Committee of Peking University Shougang Hospital (No. 2021ZZCX07) and adhered to the guidelines of the Declaration of Helsinki. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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Key points

1. It is necessary to determine whether ASD is combined with instability and whether the original surgical level is fused.

2. ASD with instability requires spinal fusion, and a revision surgery of the original fixation instruments may be inevitable.

3. We successfully performed a revision surgery for ASD with rigid fixation by using the BESS technique, which provides a minimally invasive option for treating this disease.

4. The internal fixation instruments can be removed under endoscopic observation by exchanging the viewing portal and working portal.

5. For revision surgery performed using the BESS technique, the original surgical site need not be exposed, and this can reduce the risk of blood loss and surgical-site infection.

6. BESS has wide indications for decompression and fusion, and can be applied to a variety of ASDs.

7. A K-wire can be implanted through the quarterback incision to retract the dural sac and increase the efficiency of intervertebral space preparation.

8. The BESS technique can be used for a variety of complex spinal operations due to the separation of its viewing portal and working portal.

9. Owing to decreased surgical trauma to the back muscles and soft tissues, the postoperative back pain was mild, and the patient could achieve earlier postoperative ambulation.

This article is part of the Topical Collection on Spine degenerative

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Wang, W., Lyu, P. & Liu, Z. How I do it: biportal endoscopic spinal surgery for revision of adjacent segment disease after instrumented lumbar fusion. Acta Neurochir 164, 2337–2342 (2022). https://doi.org/10.1007/s00701-022-05318-3

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  • DOI: https://doi.org/10.1007/s00701-022-05318-3

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