Effective Biportal Endoscopic Spine Surgery Technique With Better Facet Joint Preserving for Lumbar Lateral Recess Stenosis

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Figure 1
Measurement of dural sac expansion areas, lateral recess angle (white arrowhead), and facet joint preservation volume (white arrow).
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Figure 2
Preoperative (A, C, and E) and postoperative (B, D, and F) magnetic resonance imaging findings of group B patient. (A and B) Showing good decompression of lateral recess area with both facet joint preservation. (C and D) Showing good decompression of the contralateral side lateral recess area. (E and F) Showing good decompression of ipsilateral side lateral recess area.
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Figure 3
Pre- and postoperative magnetic resonance imaging findings of foraminal area decompression in a group B patient. The surgery was performed by the left ipsilateral sublaminar approach, and both sides of the foramen were more decompressed than before surgery.

Table 1

Demographic data.

Abbreviations: BESS, biportal endoscopic spine surgery; LOS, Length of stay.
Note: Group A underwent conventional BESS technique. Group B underwent both-facet joint–preserving BESS technique. P < 0.05 was considered a statistically significant difference.

Table 2

Radiological outcomes.

Outcome Measure	Mean ± SD			P
Outcome Measure	Total (N = 48)	Group A (N = 24)	Group B (N = 24)	P
Diameter of dural sac, mm²
Preoperative	48.17 ± 20.05	41.79 ± 16.11	54.59 ± 25.97
Postoperative	83.69 ± 21.80	73.93 ± 16.41	95.49 ± 29.20
Expansion ratio of dural sac, %	195.21 ± 62.94	192.62 ± 49.39	197.74 ± 74.32	0.6994
Ipsilateral facet joint volume, mm²
Preoperative	10.09 ± 1.96	10.13 ± 1.98	10.06 ± 1.93
Postoperative	9.26 ± 1.87	9.23 ± 1.88	9.29 ± 1.85
Preservation ratio, %	91.01 ± 2.24	90.96 ± 2.88	92.15 ± 2.62	0.041
Contralateral facet joint volume, mm²
Preoperative	9.97 ± 2.08	10.07 ± 2.11	9.88 ± 2.05
Postoperative	9.36 ± 2.06	9.47 ± 2.12	9.26 ± 2.00
Preservation ratio (%)	93.63 ± 2.42	93.64 ± 2.61	93.61 ± 2.25	0.9443
Ipsilateral lateral recess angle (°)
Preoperative	26.59 ± 5.04	27.52 ± 4.41	25.67 ± 5.90
Postoperative	40.52 ± 5.24	40.89 ± 4.66	40.13 ± 5.78
Increasing ratio, %	153.28 ± 20.27	150.38 ± 15.91	156.11 ± 23.62	0.1777
Contralateral lateral recess angle, (°)
Preoperative	27.75 ± 4.66	28.57 ± 3.96	26.93 ± 5.38
Postoperative	43.76 ± 4.82	43.87 ± 3.95	43.66 ± 5.84
Increasing ratio, %	160.36 ± 19.87	155.22 ± 15.99	165.39 ± 22.07	0.0136

Abbreviation: BESS, biportal endoscopic spine surgery.
Note: Group A underwent conventional BESS technique. Group B underwent both-facet joint–preserving BESS technique. P < 0.05 was considered a statistically significant difference.

Table 3

Clinical outcomes—VAS score and medication use.

Abbreviations: BESS, biportal endoscopic spine surgery; VAS, visual analog scale.
Note: Group A underwent conventional BESS technique. Group B underwent both-facet joint–preserving BESS technique. P < 0.05 was considered a statistically significant difference.

Table 4

Clinical outcomes—modified MacNab criteria.

Abbreviation: BESS, biportal endoscopic spine surgery.
Note: Group A underwent conventional BESS technique. Group B underwent both-facet joint–preserving BESS technique. P < 0.05 was considered a statistically significant difference.