Park Sub-Ri, Choi Sung-Ryul, Kim Nam-Hoo, Kim Hak-Sun, Kwon Ji-Won, Suk Kyung-Soo, Moon Seong-Hwan, Park Si-Young, Shin Jae-Won, Lee Byung-Ho, Park Jin-Oh
Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16988, Republic of Korea.
Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea.
J Clin Med. 2025 Apr 15;14(8):2725. doi: 10.3390/jcm14082725.
This is a retrospective study. We aimed to identify an optimal biportal endoscopic spine surgery (BESS) technique that maximizes facet joint preservation while achieving sufficient decompression for central to extraforaminal lumbar stenosis across all spinal levels. We retrospectively analyzed the data of 46 patients who underwent surgery and assessed clinical outcomes (visual analogue scale scores for pain; pregabalin usage) and radiological changes (using computed tomography/magnetic resonance imaging) in the spinal canal; intervertebral foramen area expansion; facet joint preservation; and degenerative change. Using interlaminar and transforaminal approaches (two-way BESS decompression technique), the mean facet joint volume preservation ratio was 87%, and the mean facet joint length maintenance ratio was 90%, indicating a successful anatomical preservation compared with previous studies. Radiological outcomes revealed effective decompression (178% in the spinal canal; 245% in intervertebral foramen expansion). Additionally, all clinical outcome parameters significantly improved ( < 0.001). To the best of our knowledge, this study is the first to accurately estimate the degree of facet joint preservation using different methods after endoscopic surgery. The two-way BESS decompression technique maximized facet joint preservation with sufficient decompression and clinically improved central to extraforaminal stenosis across all lumbar levels. Therefore, this technique can sufficiently preserve facet joints to prevent rapid degenerative change after surgery.
这是一项回顾性研究。我们旨在确定一种最佳的双孔道内镜脊柱手术（BESS）技术，该技术在实现所有腰椎节段从中央到椎间孔外腰椎管狭窄充分减压的同时，能最大程度地保留小关节。我们回顾性分析了46例行手术患者的数据，并评估了临床结局（疼痛的视觉模拟评分；普瑞巴林使用情况）以及椎管内的影像学变化（使用计算机断层扫描/磁共振成像）；椎间孔面积扩大情况；小关节保留情况；以及退变改变。采用椎板间和经椎间孔入路（双向BESS减压技术），小关节体积保留率平均为87%，小关节长度维持率平均为90%，与既往研究相比显示出成功的解剖学保留。影像学结果显示减压有效（椎管内为178%；椎间孔扩大为245%）。此外，所有临床结局参数均有显著改善（<0.001）。据我们所知，本研究是首例在内镜手术后使用不同方法准确评估小关节保留程度的研究。双向BESS减压技术在充分减压的同时最大程度地保留了小关节，并在临床上改善了所有腰椎节段从中央到椎间孔外的狭窄情况。因此，该技术能够充分保留小关节以防止术后快速退变改变。
