Elsevier

World Neurosurgery

Volume 125, May 2019, Pages 425-432
World Neurosurgery

Literature Review
A Systematic Review of Unilateral Biportal Endoscopic Spinal Surgery: Preliminary Clinical Results and Complications

https://doi.org/10.1016/j.wneu.2019.02.038Get rights and content

Objective

Unilateral biportal endoscopic spine surgery (UBE) for the treatment of lumbar spinal diseases has achieved favorable results. In this systematic review, the technical nuances, surgical outcomes, and complications of UBE are summarized.

Methods

A systematic review of the literature published to June 2018 was performed. Reported studies related to UBE were identified through searching the PubMed database. The outcomes measured included operative time, hospital stay, complications, visual analog scale (VAS), Oswestry Disability Index, and the Macnab criteria.

Results

A total of 556 patients and 679 levels were collected from the selected 11 studies. The mean follow-up was 15.2 months, the mean operative time was 81.3 minutes, and the mean length of hospital stay was 4.4 days. The mean overall complication rate was 6.7% (range, 0%–13.8%). The mean VAS score for leg pain decreased from preoperative 7.9 to 1.9 at final follow-up visit and the mean VAS score for back pain decreased from 5.7 to 1.8. The mean Oswestry Disability Index significantly improved from preoperative 63.7 to 18.6 at the final follow-up. The average satisfied outcome (excellent/good; based on the Macnab criteria) was 84.3% (range, 75.35%–95%). There were similar results between UBE for the treatment of lumbar disc herniation and stenosis, including operative time, length of hospital stay, complications, and satisfaction rate.

Conclusions

Although the existing studies are limited to small cohorts and short-term follow-up, based on the given preliminary results and experiences of current studies, UBE may be a feasible option for lumbar spinal surgery.

Introduction

Traditionally, open discectomy and the decompression procedure have been the most common techniques for lumbar disc herniation (LDH) and stenosis (without degenerative instability and spondylolisthesis).1, 2 Because they are minimally invasive spinal techniques, microscopic discectomy and decompression can reduce surgical trauma, reduce bleeding, and lead to quick recovery after surgery.3, 4 However, when a tubular approach is used in a microscopic setting, the ability to hand instruments might be restricted along with the vision. Percutaneous endoscopic surgery is one of the most common procedures for LDH and lumbar spinal stenosis. It is a minimally invasive procedure that includes a small incision, low blood loss, and early discharge.5, 6 Whether the transforaminal or the interlaminar approach is used, endoscopic spinal surgery is performed through a single portal involving light source, irrigation, visualization, and instrumentation. Despite use of a microscope or full-endoscope, visualization is restricted and there are also technical difficulties that may be encountered by surgeons, which are particularly relevant in severe stenosis or in cases in need of bilateral decompression.7, 8, 9, 10 Furthermore, surgeons need to be familiar with the full-endoscopic technique, which requires a steep learning curve. Unilateral biportal endoscopic spinal surgery (UBE), referred to with different names in reported studies, is the combination of integrated open and endoscopic spinal surgery, which can lessen the impact of the limitations.11, 12, 13

Although UBE has not yet become popular, it has attracted much interest. However, there is a lack of robust studies investigating the outcomes and efficacy of UBE. In this study, we review the literature and summarize the preliminary clinical outcomes and complications of this new technique in lumbar decompression surgery.

Section snippets

Search of Literature and Inclusion Criteria

This systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.14

A PubMed search of the English literature was performed on July 1, 2018 using the terms “bi-portal endoscopic spinal surgery” OR “two portal endoscopic spinal surgery.” Two independent reviewers performed a review of the literature and manual checks through the reference lists for identification. We included only studies of lumbar spinal discectomy and

Study Selection

A total of 35 studies were identified through the database search. After a title and abstract screening that excluded 20 irrelevant studies, the 15 potentially relevant studies that remained were retrieved.11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 After a detailed investigation of the full text, 8 studies met the inclusion criteria. The 7 studies that were excluded comprised 2 studies of technical note,23, 24 2 studies combined with fusion surgery,26, 27 1 in a cervical

Discussion

The transforaminal and interlaminar approaches are the 2 most widely and commonly used routes in endoscopic spinal surgery. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is advantageous for treating soft LDH, based on its small incision, rapid recovery, minimizing blood loss, preservation of posterior structures, direct fragmentectomy, and neural decompression, as well as its preservation of the central nucleus.30, 31, 32 However, there are disadvantages associated with the

Conclusions

The UBE technique for the treatment of LDH was different from conventional percutaneous endoscopic spinal surgery because of ligamentum flavum resection and bony resection. According to preliminary studies, there were similar results between UBE for the treatment of LDH and spinal stenosis, including operative time, length of stay in hospital, complication rate, and satisfaction rate. Existing studies, including some ongoing studies, are limited to small cohorts and a short-term follow-up;

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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