Daniel Park, MD, director of minimally invasive orthopedic spine surgery at Beaumont Hospital, Royal Oak (Mich.), has been using a new technique in his practice called biportal endoscopic spine surgery.
BESS, a recent addition to the minimally invasive spine space, can be used to treat a variety of spinal conditions, including herniated discs, lumbar spinal stenosis and lumbar interbody fusions.
The technique allows for increased versatility with the independent use of both hands and provides the same visual benefits of endoscopic spine surgery with traditional spine tools and instrumentation.
It doesn't require a significant capital investment like some of the endoscopic devices on the market as it combines traditional spine instruments with the those used by orthopedic surgeons for knee and shoulder surgeries.
Two 4mm incisions are typically used in the BESS approach, compared to one 6-8mm incision for endoscopic spine surgery.
BESS provides more flexibility with a shorter learning curve than uniportal endoscopic spine surgery, which also leads to low complication rates, decreased potential for long-term instability and less postoperative pain, according to Dr. Park.
A recent study conducted by Dae-Jung Choi, MD, et. al. demonstrated a 10.3 percent complication rate in the early learning curve, relating to nerve injury, postoperative hematoma and recurrent herniation. Just like any new procedure, the learning curve must be overcome to be an effective surgeon, according to Dr. Park.
However, patients can reap the benefits of minimally invasive spine surgery — less pain, less narcotics and quicker recovery — using smaller incisions than tubular surgery and having better visualization of the spinal elements than microscopy-based surgery.