Shorter operation duration

Oct 13, 2025 by talynt.org 33 views

Differences in Clinical Open Laminectomy and Biportal Endoscopic Spine Surgery (BESS) in Lumbar Stenosis Management in Medan in December 2021-December 2022

Introduction

Lumbar spinal stenosis (LSS) is a degenerative process that affects the spine in the lumbar region, causing a range of symptoms including pain, numbness, and weakness in the legs. The condition occurs gradually, involving the enlargement of facet joints and ligament flavum, intervertebral discs, narrowing of the intervertebral space, and osteophyte formation. Over the years, Open Laminectomy has been considered the "gold standard" in treatment for LSS decompression. However, with technological advances, endoscopic decompression procedures have emerged as a more minimally invasive alternative to traditional open procedures. Biportal Endoscopic Spine Surgery (BESS) allows the use of conventional surgical instruments, making it safer than the Uniportal method.

The Evolution of Lumbar Spinal Stenosis Treatment

Lumbar spinal stenosis is a common condition that affects millions of people worldwide. The traditional treatment for LSS has been Open Laminectomy, which involves the removal of a portion of the vertebra to relieve pressure on the spinal cord and nerves. However, this procedure has several limitations, including a long recovery time, significant blood loss, and a high risk of complications. In recent years, Biportal Endoscopic Spine Surgery (BESS) has emerged as a more minimally invasive alternative to traditional open procedures. BESS involves the use of a small incision and a specialized endoscope to visualize the spine and nerves, allowing for a more precise and less invasive procedure.

Methods and Materials

This study was carried out prospectively by involving 86 LSS patients at one level, treated using BESS or Open Laminectomy. Of these, there were 27 patients in the BESS group with an average age of 60.70 ± 3.17 years, while 59 patients in the Open Laminectomy group with an average age of 61.68 ± 1.11 years. To assess the main clinical results, the Oswestry (ODI) inability index, the visual analog scale (VAS), and the 36 item (SF-36) health survey were used. Surgery time, lost blood volume, the number of normal solutions used, and complications were also recorded.

Results

In this analysis, there were no statistically significant differences between the BESS and Open Laminectomy groups in the values of VAS, ODI, and SF-36 on the follow-up of 6 months. However, a significant difference was found when comparing the duration of the procedure (156.67 ± 54.14 vs 181.02 ± 31.49 minutes; p = 0.008), the volume of blood lost (135.18 ± 45.60 vs 598.30 ± 151.98 ml; p <0.001), and the number of normal solutions used (11651.85 vs 2483.05 ml; p <0.001) between the BESS groups and Open Laminectomy.

Discussion

The standard treatment for LSS is the decompression of nerve structure with or without fusion. Open Laminectomy has been the main method for achieving this goal for years. However, in recent years, BESS has experienced rapid development. Various studies show that decompression assisted by endoscopy has the same effectiveness as Open Laminectomy in LSS management. One of the main advantages of BESS is its minimum invasive nature. This procedure not only reduces tissue trauma, but also offers faster recovery time for patients. The lack of blood loss and shorter operation duration is a significant added value. This is important in the context of public health, where operational efficiency can affect the overall capacity of health services.

The Benefits of Biportal Endoscopic Spine Surgery (BESS)

BESS offers a safe and innovative approach with clear visualization and broad endoscopic views, which allows better protection against nerves and spinal structures. BESS shows the effectiveness that is equivalent to Open Laminectomy in handling spinal lumbar stenosis, with minimal invasion benefits, shorter operation duration, and minimal bleeding. With the increase in the adoption of endoscopic technology in surgical practices, it is hoped that this procedure will be increasingly the first choice in the management of LSS.

Conclusion

In conclusion, BESS for the treatment of LSS offers a safe and innovative approach with clear visualization and broad endoscopic views, which allows better protection against nerves and spinal structures. BESS shows the effectiveness that is equivalent to Open Laminectomy in handling spinal lumbar stenosis, with minimal invasion benefits, shorter operation duration, and minimal bleeding. With the increase in the adoption of endoscopic technology in surgical practices, it is hoped that this procedure will be increasingly the first choice in the management of LSS.

Recommendations

Based on the findings of this study, the following recommendations are made:

BESS should be considered as a viable alternative to Open Laminectomy for the treatment of LSS.
Further studies should be conducted to evaluate the long-term outcomes of BESS in the management of LSS.
The adoption of endoscopic technology in surgical practices should be increased to improve the efficiency and effectiveness of LSS treatment.

Limitations

This study has several limitations, including:

The small sample size of the study.
The lack of long-term follow-up data.
The limited number of studies that have evaluated the effectiveness of BESS in the management of LSS.

Future Directions

The findings of this study suggest that BESS is a safe and effective alternative to Open Laminectomy for the treatment of LSS. Further studies should be conducted to evaluate the long-term outcomes of BESS in the management of LSS. Additionally, the adoption of endoscopic technology in surgical practices should be increased to improve the efficiency and effectiveness of LSS treatment.
Frequently Asked Questions (FAQs) about Biportal Endoscopic Spine Surgery (BESS) for Lumbar Spinal Stenosis (LSS)

Q: What is Biportal Endoscopic Spine Surgery (BESS)?

A: BESS is a minimally invasive surgical procedure that uses a small incision and a specialized endoscope to visualize the spine and nerves, allowing for a more precise and less invasive procedure.

Q: What is Lumbar Spinal Stenosis (LSS)?

A: LSS is a degenerative process that affects the spine in the lumbar region, causing a range of symptoms including pain, numbness, and weakness in the legs.

Q: What are the benefits of BESS compared to Open Laminectomy?

A: BESS offers several benefits compared to Open Laminectomy, including:

Less tissue trauma: BESS is a minimally invasive procedure that causes less tissue trauma compared to Open Laminectomy.
Faster recovery time: BESS allows for faster recovery time compared to Open Laminectomy.
Less blood loss: BESS results in less blood loss compared to Open Laminectomy.
Shorter operation duration: BESS is a faster procedure compared to Open Laminectomy.

Q: What are the risks and complications associated with BESS?

A: As with any surgical procedure, BESS carries risks and complications, including:

Infection: BESS carries a risk of infection, as with any surgical procedure.
Bleeding: BESS carries a risk of bleeding, as with any surgical procedure.
Nerve damage: BESS carries a risk of nerve damage, as with any surgical procedure.
Spinal instability: BESS carries a risk of spinal instability, as with any surgical procedure.

Q: Who is a good candidate for BESS?

A: BESS is typically recommended for patients with LSS who:

Have failed conservative treatment: Patients who have failed conservative treatment, such as physical therapy and medication, may be good candidates for BESS.
Have severe symptoms: Patients with severe symptoms, such as pain, numbness, and weakness in the legs, may be good candidates for BESS.
Have a high risk of complications: Patients with a high risk of complications, such as bleeding or nerve damage, may be good candidates for BESS.

Q: What are the potential outcomes of BESS?

A: The potential outcomes of BESS include:

Improved symptoms: BESS can improve symptoms, such as pain, numbness, and weakness in the legs.
Increased mobility: BESS can increase mobility and reduce stiffness in the spine.
Reduced risk of complications: BESS can reduce the risk of complications, such as bleeding and nerve damage.

Q: How long does it take to recover from BESS?

A: The recovery time from BESS varies depending on the individual patient, but most patients can return to their normal activities within 2-6 weeks.

Q: What are the costs associated with BESS?

A: The costs associated with BESS vary depending on the individual patient and the location of the procedure, but most patients can expect to pay between $10,000 to $50,000 for the procedure.

Q: What are the long-term outcomes of BESS?

A: The long-term outcomes of BESS are not well established, but most patients can expect to experience improved symptoms and increased mobility for several years after the procedure.

Q: What are the potential risks of BESS in the long term?

A: The potential risks of BESS in the long term include:

Spinal instability: BESS can lead to spinal instability, which can increase the risk of further complications.
Nerve damage: BESS can lead to nerve damage, which can increase the risk of further complications.
Infection: BESS can lead to infection, which can increase the risk of further complications.

Q: What are the potential benefits of BESS in the long term?

A: The potential benefits of BESS in the long term include:

Improved symptoms: BESS can improve symptoms, such as pain, numbness, and weakness in the legs.
Increased mobility: BESS can increase mobility and reduce stiffness in the spine.
Reduced risk of complications: BESS can reduce the risk of complications, such as bleeding and nerve damage.