Perbedaan Luaran Klinis Open Laminectomy dan Biportal Endoscopic Spine Surgery (BESS) dalam Tatalaksana Stenosis Lumbal di Medan pada Desember 2021-Desember 2022

Abstract

Introduction Lumbar spinal stenosis (LSS) is a gradual degenerative process occurred in the lumbar spine, which include facet joints and ligamentum flavum hypertrophy, intervertebral disc herniation, narrowing of the intervertebral space, and osteophyte formation. Open laminectomy has long been considered the “gold standard” treatment for decompression of LSS. Technological advancement such as endoscopic decompression offers a minimally invasive alternative to traditional open procedure. The biportal endoscopic spine surgery (BESS) allow the utilization of conventional surgical instruments, thus make it safer than the uniportal method. Materials & Methods A prospective analysis of 86 single-level LSS patients treated by BESS or open laminectomy was performed. There were 27 patients in the BESS group with a mean age of 60.70 ± 3.17 years and 59 patients in the open laminectomy group with a mean age of 61.68 ± 1.11 years. Oswestry Disability Index (ODI), visual analog scale (VAS) score, and 36-item short-form health survey (SF-36) were used to assess the primary clinical outcomes. Surgery time, blood loss, amount of normal saline used, and complications were also reported. Results There was no significant difference statistically between BESS and open laminectomy group in the VAS score, ODI, and SF-36 at 6 months follow-up. Significant difference was found when comparing procedure duration (156.67 ± 54.14 vs 181.02 ± 31.49 minutes; p = 0.008), blood loss (135.18 ± 45.60 vs 598.30 ± 151.98 mL; p < 0.001), and amount of normal saline used (11651.85 vs 2483.05 mL; p < 0.001) in BESS and open laminectomy group. Discussion The gold standard treatment for LSS is decompression of the neural structure with or without fusion. Open laminectomy has long been the main method to achieve this goal. On the other hand, BESS has been improving rapidly in recent years. Multiple studies stated that endoscopic-assisted decompression has the same efficacy as open laminectomy in the management of LSS. Conclusions BESS for treatment of LSS provides a safe and innovative approach under clear visualization and wide endoscopic view, which allows better preservation of nerves and spinal structures. It had the same efficacy as open laminectomy for treatment of lumbar spinal stenosis, while had the advantages of minimal invasiveness, less duration of surgery, and minimal bleeding.