Percutaneous Biportal Endoscopic Decompression for Lumbar Central Stenosis and Foraminal Stenosis

Percutaneous biportal endoscopic surgery was a minimally invasive approach and used two portals or two channels during operation. One portal was used for endoscopy, and the other portal was used for working channel. Spinal instruments were used through working portal. Two portals should be joined around working area such as lamina or foramen. For the prevention of muscle injury, two portals should be made through loose epi-periosteal plane and inter-fascicular area. Continuous irrigation system must be used for clearing of surgical field and bleeding control. Irrigation fluid was drained from endoscopic portal to working portal. Radiofrequency systems were necessary for muscle dissection and bleeding control. Unilateral laminotomy with bilateral decompression can be achieved using percutaneous biportal endoscopic approach for the treatment of lumbar central and lateral recess stenosis. Biportal endoscopic approach can perform complete neural decompression like open surgery. Also, paraspinal Wiltse approach was attempted for lumbar foraminal stenosis. Full decompression of foraminal lesion can be achieved by percutaneous biportal endoscopic approach. The authors can achieve full neural decompression using biportal endoscopic surgery like conventional open surgery. Short learning curve and familial surgical anatomy are other merits of biportal endoscopic surgery.