A recent clinical evaluation has found that biportal endoscopic surgery provides clinical outcomes comparable to conventional open surgery while offering distinct advantages for wound healing. The findings suggest this minimally invasive technique should be strongly considered for patients who face a high burden of surgical recovery, such as older adults or those with underlying medical conditions.
On the 27th, the Patient-Centered Medical Technology Optimization Research Project Group (PACEN) of the National Evidence-based Healthcare Collaborating Agency (NECA) released these findings. The assessment was based on a study led by Professor Park Sang-min of Seoul National University Bundang Hospital, which compared the effectiveness and safety of endoscopic versus conventional surgery.
Understanding Slipped Discs and Spinal Stenosis
Lumbar disc herniation, commonly known as a "slipped disc," occurs when an intervertebral disc protrudes and compresses nerves, resulting in back pain or leg numbness. Spinal stenosis is a condition where the spinal canal narrows, leading to pain and gait disturbances. While medication and physical therapy are often the first line of defense, surgery becomes necessary when conservative treatments fail or nerve compression symptoms become severe.
The Biportal Endoscopic Approach
Biportal endoscopic surgery involves treating the spine through two small incisions. An endoscope is inserted through one portal to provide a clear view, while surgical instruments are operated through the second. Because the incisions are significantly smaller than those in conventional surgery, the technique minimizes damage to muscle and surrounding tissues.
Clinical Outcomes and Recovery Benefits
The research team conducted a multicenter randomized controlled trial to compare the two methods:
Lumbar Disc Herniation: Biportal endoscopic discectomy showed improvements in functional disability, pain reduction, and quality of life similar to conventional surgery. However, the endoscopic group saw significantly better results in wound-recovery indicators, including lower rates of wound dehiscence and reduced scarring.
Spinal Stenosis: The endoscopic group achieved functional gains comparable to conventional methods, with a notable trend toward better results in back pain reduction and surgical site recovery.
Cost-Effectiveness and Benefits for Older Adults
A cost-effectiveness analysis further supported the clinical utility of the endoscopic approach. While total medical costs were similar between the two methods, the overall health benefits were higher for biportal endoscopic surgery. These benefits were particularly pronounced in patients aged 65 and older, making it a valuable option as the elderly population continues to grow.
Selecting the Right Candidate
Based on the assessment, PACEN stated that biportal endoscopic surgery is a viable alternative to conventional surgery and may be prioritized for patients requiring early recovery or those with underlying risks.
However, experts emphasize that the procedure is not a universal solution. The choice of surgical approach must be made by a clinician after comprehensively considering the patient’s specific disease status, spinal anatomy, bleeding risk, and individual recovery needs.
“This assessment is meaningful in that it confirmed the clinical applicability of biportal endoscopic spine surgery,” said Heo Dae-seok, head of PACEN. “It demonstrates treatment effects similar to conventional surgery while showing clear advantages in wound recovery and cost-effectiveness.”
