Clinical outcomes and complications after biportal endoscopic spine surgery: a comprehensive systematic review and meta-analysis of 3673 cases

Don Y Park; Alexander Upfill-Brown; Nora Curtin; Christopher D Hamad; Akash Shah; Brian Kwon; Yong H Kim; Dong Hwa Heo; Cheol Woong Park; William L Sheppard

doi:10.1007/s00586-023-07701-9

Clinical outcomes and complications after biportal endoscopic spine surgery: a comprehensive systematic review and meta-analysis of 3673 cases

Eur Spine J. 2023 Aug;32(8):2637-2646. doi: 10.1007/s00586-023-07701-9. Epub 2023 Apr 20.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, 16th Street, Suite 3142, Los Angeles, Santa Monica, CA, 90404, USA. dypark@mednet.ucla.edu.
² Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, 16th Street, Suite 3142, Los Angeles, Santa Monica, CA, 90404, USA.
³ Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, 02120, USA.
⁴ Department of Orthopaedic Surgery, NYU Grossman School of Medicine, New York, NY, 10016, USA.
⁵ Department of Neurosurgery, Champodonamu Hospital, Seoul, South Korea.
⁶ Department of Neurosurgery, Woori Hospital, Seoul, South Korea.

PMID: 37079079
DOI: 10.1007/s00586-023-07701-9

Abstract

Purpose: Current literature suggests that biportal spinal endoscopy is safe and effective in treating lumbar spine pathology such as lumbar disc herniation, lumbar stenosis, and degenerative spondylolisthesis. No prior study has investigated the postoperative outcomes or complication profile of the technique as a whole. This study serves as the first comprehensive systematic review and meta-analysis of biportal spinal endoscopy in the lumbar spine.

Methods: A PubMed literature search provided over 100 studies. 42 papers were reviewed and 3673 cases were identified with average follow-up time of 12.5 months. Preoperative diagnoses consisted of acute disc herniation (1098), lumbar stenosis (2432), and degenerative spondylolisthesis (229). Demographics, operative details, complications, and perioperative outcome and satisfaction scores were analyzed.

Results: Average age was 61.32 years, 48% male. 2402 decompressions, 1056 discectomies, and 261 transforaminal lumbar Interbody fusions (TLIFs) were performed. Surgery was performed on 4376 lumbar levels, with L4-5 being most common(61.3%). 290 total complications occurred, 2.23% durotomies, 1.29% inadequate decompressions, 3.79% epidural hematomas, and < 1% transient nerve root injuries, infections, and iatrogenic instability. Significant improvement in VAS-Back, VAS-Leg, ODI, and Macnab Scores were seen across the cohort.

Conclusion: Biportal spinal endoscopy is a novel method to address pathology in the lumbar spine with direct visualization through an endoscopic approach. Complications are comparable to previously published rates. Clinical outcomes demonstrate effectiveness. Prospective studies are required to assess the efficacy of the technique as compared to traditional techniques. This study demonstrates that the technique can be successful in the lumbar spine.

Keywords: Biportal endoscopic spine surgery; Endoscopic spine surgery; Minimally invasive spine surgery.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Constriction, Pathologic
Endoscopy / adverse effects
Endoscopy / methods
Female
Humans
Intervertebral Disc Displacement* / surgery
Lumbar Vertebrae / surgery
Male
Middle Aged
Retrospective Studies
Spinal Fusion* / adverse effects
Spinal Fusion* / methods
Spinal Stenosis* / surgery
Spondylolisthesis* / surgery
Treatment Outcome