Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report

Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This single-centered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, "excellent," "good," and "fair" results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.