Functional Outcome of Biportal Endoscopy Spine Surgery for Lumbar Disc Herniation Diseases

Authors

  • Ajid Risdianto Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
  • Erie Andar Neurosurgery Department, Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
  • Happy Kurnia Brotoarianto Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
  • Dody Priambada Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
  • Zainal Muttaqin Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
  • Krisna Tsaniadi Prihastomo Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
  • Yuriz Bakthiar Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang http://orcid.org/0000-0002-1535-1255 (unauthenticated)
  • Muhammad Thohar Arifin Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang

DOI:

https://doi.org/10.15395/mkb.v57.4128

Keywords:

Biportal endoscopy, lumbar disc herniation, MacNab scale score, visual analog scale

Abstract

Biportal endoscopic spine surgery (BESS) is an innovative, minimally invasive technique to treat lumbar disc herniation (LDH). BESS provides superior surgical visualization with minimal tissue dissection. However, its application requires a thorough understanding of endoscopic anatomy and adaptation of endoscopy equipment, which are key factors in achieving optimal functional outcomes post-surgery. This study aimed to evaluate the functional outcomes and complications of BESS performed on 49 patients between 2020 and 2022 at Dr. Kariadi Hospital, Semarang, Indonesia. The majority of patients (53%) had herniation at the L4-5 level, followed by L5-S1. Pain assessment using the Visual Analog Scale (VAS) demonstrated a significant reduction in pain, from 4.26 to 1.5, post-surgery. Functional outcomes, as evaluated using MacNab’s Criteria, revealed that 93.8% of patients achieved a satisfactory condition, with 36.7% reporting no pain and 57.1% experiencing occasional pain that did not affect their daily activities. Complications were minimal, with two cases of dural tears and intraoperative bleeding. The study concludes that BESS is a safe and effective procedure for LDH, resulting in significant pain relief and functional improvement, although certain technical challenges persist.

Author Biographies

  • Ajid Risdianto, Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
    Doctoral Study Program at Medical Science and Health Science, Universitas Diponegoro
  • Happy Kurnia Brotoarianto, Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
    Neurospine Surgery Division
  • Muhammad Thohar Arifin, Department of Neurosurgery, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi Hospital Semarang
    Neurospine Surgery Division

References

  1. Greenberg MS. Handbook of neurosurgery. 6th ed. New York: Thieme; 2006.
  2. Kang KB, Shin YS, Seo EM. Endoscopic Spinal Surgery (BESS and UESS) versus microscopic surgery in lumbar spinal stenosis: systematic review and meta-analysis. Global Spine J. 2022;12(8):1943–55. doi:10.1177/21925682221083271
  3. Kwon H, Park JY. The role and future of endoscopic spine surgery: a narrative review. Neurospine. 2023;20(1):43–55. doi:10.14245/ns.2346236.118
  4. Han H, Song Y, Li Y, Zhou H, Fu Y, Li J. Short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. J Orthop Surg Res. 2023;18(1):656. doi: 10.1186/s13018-023-04138-0
  5. Awuah WA, Adebusoye FT, Alshareefy Y, Cheng Ng J, Tomas Ferreira AL, Abdus Salam AL, et al. Biportal endoscopic surgery for lumbar spine herniated discs: a narrative review of its clinical application and outcomes. Annals Medicine Surgery. 2023;85(8):3965–73. doi: 10.1097/ms9.0000000000001053
  6. Choi CM. Biportal endoscopic spine surgery (Bess): Considering merits and pitfalls. J Spine Surg. 2020;6(2):457–65. doi: 10.21037/jss.2019.09.29
  7. Azharuddin A, Aryandono T, Magetsari R, Dwiprahasto I. Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia. Asian J Surg. 2022;45(1):277–83. doi:10.1016/j.asjsur.2021.05.015
  8. Sedighi M, Haghnegahdar A. Lumbar disk herniation surgery: outcome and predictors. Global Spine J. 2014;4(4):233–43. doi:10.1055/s-0034-1390010
  9. Battié MC, Videman T, Parent E. Lumbar disc degeneration. Spine (Phila Pa 1976). 2004;29(23):2679–90. doi:10.1097/01.brs.0000146457.83240.eb
  10. Kim JE, Choi DJ. Unilateral biportal endoscopic decompression by 30° endoscopy in lumbar spinal stenosis: Technical note and preliminary report. J Orthop. 2018;15(2):366–71. doi:10.1016/j.jor.2018.01.039
  11. Soliman HM. Irrigation endoscopic decompressive laminotomy. A new endoscopic approach for spinal stenosis decompression. Spine J. 2015;15(10):2282–9. doi:10.1016/j.spinee.2015.07.009
  12. Kim HS, You JD, Ju C Il. Predictive scoring and risk factors of early recurrence after percutaneous endoscopic lumbar discectomy. Biomed Res Int. 2019;2019(13):9–12. doi:10.1155/2019/6492675
  13. Eum JH, Heo DH, Son SK, Park CK. Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: A technical note and preliminary clinical results. J Neurosurg Spine. 2016;24(4):602–7. doi:10.3171/2015.7.SPINE15304
  14. Choi DJ, Kim JE. Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. CiOS Clinics in Orthopedic Surgery. 2019;11(1):82–8. doi:10.4055/cios.2019.11.1.82

Downloads

Published

2025-09-30

Issue

Vol. 57 No. 3 (2025)

Section

Articles

License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Under this license, authors retain copyright and grant Majalah Kedokteran Bandung the right of first publication. Others may share, remix, and adapt the work for non-commercial purposes, provided that appropriate credit is given to the author and to Majalah Kedokteran Bandung as the initial place of publication.

For details, please see: https://creativecommons.org/licenses/by-nc/4.0/

 

How to Cite

Functional Outcome of Biportal Endoscopy Spine Surgery for Lumbar Disc Herniation Diseases. (2025). Majalah Kedokteran Bandung, 57(3), 220-224. https://doi.org/10.15395/mkb.v57.4128