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What is Biportal Endoscopic Spine Surgery?
Biportal endoscopic spine surgery (BESS) is a minimally invasive technique used to treat various spine conditions, including herniated discs, spinal stenosis, and degenerative disc disease. It involves using two small incisions or portals to access the spine. One portal is used to insert a camera (endoscope) for visualizing the surgical site, while the other portal allows for the insertion of miniature surgical instruments to perform the required repair.
Indications for Biportal Endoscopic Spine Surgery
Biportal endoscopic spine surgery is typically indicated for a range of spinal conditions, particularly those causing nerve compression or spinal instability. These conditions include:
- Lumbar Disc Herniation: When a herniated disc compresses nearby nerve roots, leading to pain, numbness, or weakness in the legs (sciatica).
- Spinal Stenosis: Narrowing of the spinal canal, causing pressure on the spinal cord and nerves, often leading to pain, weakness, or numbness in the lower extremities.
- Degenerative Disc Disease: This age-related condition leads to the deterioration of intervertebral discs, causing chronic back pain, which may be alleviated through decompression.
- Foraminal Stenosis: Narrowing of the foraminal canals (spaces through which nerves exit the spinal cord), which can compress nerves and cause symptoms like pain or weakness.
Preparation for Biportal Endoscopic Spine Surgery
In general, preparation for biportal endoscopic spine surgery may include the following:
- A detailed evaluation of the patient's medical history, symptoms, and previous treatments is conducted.
- A thorough neurological and physical examination of the patient to help assess the severity of the spinal condition.
- Imaging studies such as MRI, CT scans, or X-rays are used to pinpoint the exact location and extent of the spinal issue. These images guide the surgeon in planning the surgery.
- Laboratory studies such as blood work to assess the patient's general health and suitability for the procedure.
- Inform your provider about all the medications and supplements you are currently taking. Some may need to be discontinued or adjusted before surgery.
- Typically, you will be instructed not to eat or drink anything after midnight on the night before the surgery.
Procedure for Biportal Endoscopic Spine Surgery
Biportal endoscopic spine surgery is typically performed under general anesthesia and typically includes the following steps:
- The patient is positioned on their stomach (prone) or side, depending on the location of the spinal problem.
- Two small incisions, usually about 1 cm each, or portals are made on the skin at the surgical site.
- A high-definition endoscope is inserted through one of the portals. This provides real-time visualization of the spine, allowing the surgeon to clearly see the spinal structures.
- Using the endoscope for guidance, the surgeon accesses the affected part of the spine, such as a herniated disc or spinal stenosis.
- Specialized instruments are introduced through the second portal to perform the necessary surgical tasks, such as removing part of the herniated disc, trimming bone (lamina) in cases of stenosis, or freeing up compressed nerves (decompression).
- After the necessary decompression or repair is completed, the endoscope and instruments are removed.
- The small incisions are closed with sutures or steri-strips, and a sterile dressing is applied.
Postoperative Care and Recovery
After surgery, the patient is transferred to the recovery room, where they are monitored as they wake up from anesthesia. Due to the minimally invasive nature of BESS, postoperative pain is typically less than that of traditional open surgery, but medications may still be given. Patients are often encouraged to start walking a few hours after the procedure, depending on the extent of the surgery. In many cases, patients can go home the same day or the next day after surgery. Physical therapy may be recommended to help strengthen the back and improve mobility. Full recovery varies but is generally quicker compared to traditional surgery, with many patients returning to light activities within a few weeks.
Risks and Complications
As with any surgery, some risks and complications may occur such as:
- Infection
- Bleeding
- Nerve injury
- Postoperative pain
- Blood clots or deep vein thrombosis (DVT)
- General anesthesia risks
Benefits
Benefits of minimally invasive biportal endoscopic spine surgery include:
- Minimal muscle trauma
- Less blood loss
- Less scarring
- Less postoperative pain
- Reduced risk of infection
- Reduced hospital stay
- Faster recovery
