Current Status of Biportal Endoscopic Decompression for Lumbar Foraminal Stenosis: Endoscopic Partial Facetectomy and Outcome Factors

Abstract

Degenerative lumbar foraminal stenosis is relatively common condition in which the circumferential narrowing of the space available for the nerve root leads to back pain and radicular symptoms. The preferred surgical treatment to relieve the compression of the nerve root has not been established yet. Recently, several reports have shown good clinical outcomes in patients who underwent biportal endoscopic decompression for the treatment of degenerative lumbar foraminal stenosis. The floating-type biportal endoscopic technique could be used with various surgical instruments without docking in the narrowed foramen, unlike the full-endoscopic technique. Multiple sites can be accessed with more freedom in the approaching angle through triangulation and portal switching. We reviewed articles to understand putative outcome factors and discuss the appropriate indications for biportal endoscopic foraminal decompression. Lumbar lordosis, degenerative lumbar scoliosis, height of the posterior intervertebral disc and level of procedure were all related to clinical outcomes. The best indications and contra-indications to the endoscopic foraminal decompression still depends on the surgeon’s skill level and evolving experience. However, we could suggest that biportal endoscopic spinal surgery is supposed to be an alternative treatment for foraminal decompression preserving motion and stability, and decreasing the need for fusion surgery in various lumbar degenerative disease.