1188 https://oamjms.eu/index.php/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2022 Apr 22; 10(B):1188-1194. https://doi.org/10.3889/oamjms.2022.9043 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Surgery Comparison of Microscopic Decompression and Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Canal Stenosis and Herniated Disc: A One-year Follow-up Didik Librianto 1,2,3 , Fachrisal Ipang 1,2,3 , Ifran Saleh 1 , Widyastuti Srie Utami 2 , Dina Aprilya 1 *, Rubiana Nurhayati 4 , Darma Imran 4 1 Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; 2 Jakarta Spine Center, Pondok Indah Hospital, Jakarta, Indonesia; 3 Department of Orthopedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia; 4 Department of Neurology, Pondok Indah Hospital, Jakarta, Indonesia Abstract BACKGROUND: Microscopic decompression (MD) has been widely used as an alternative to open decompression. Lately, biportal endoscopic spinal surgery (BESS) – a new approach in minimal-invasive spinal surgery – has also been used with good results. Although both groups can achieve adequate lumbar decompression, there is still a lack of evidence regarding their comparison. AIM: We aim to compare the outcomes of both techniques in a 1-year follow-up. METHODS: This is a retrospective study in 100 consecutive patients with symptomatic lumbar spine compression due to herniated nucleus pulposus and lumbar canal stenosis that was treated by either BESS or MD. Clinical evaluations using Visual Analog Score (VAS), Oswestry Disability Index (ODI), and SF-36 questionnaire were obtained. Objective data, such as surgery duration, amount of postoperative drain production, and hospital length of stay, were collected. Complications were noted throughout the follow-up time. RESULTS: The BESS group had a signifcantly lesser surgical duration, drain production, and length of stay. At 1-year follow-up, both groups achieved signifcant improvement in VAS, ODI, and SF-36 compared to the preoperative condition. Complications were not observed in the BESS group. CONCLUSIONS: Both procedures were comparably efective to treat lumbar stenosis. Although this study shows superiority with the BESS technique in immediate and long-term follow-up, the fnal choice may depend on the surgeon’s preference. Edited by: Ksenija Bogoeva-Kostovska Citation: Librianto D, Ipang F, Saleh I, Utami WS, Aprilya D, Nurhayati R, Imran D. Comparison of Microscopic Decompression and Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Canal Stenosis and Herniated Disc: A One-year Follow-up. Open Access Maced J Med Sci. 2022 Apr 22; 10(B):1188-1194. https://doi.org/10.3889/oamjms.2022.9043 Keywords: Lumbar spine; Lumbar canal stenosis; Herniated disc; Minimally invasive; Biportal endoscopic; Microscopic decompression *Correspondence: Dina Aprilya, Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. E-mail dina.cia.aprilya@gmail.com Received: 19-Feb-2022 Revised: 24-Mar-2022 Accepted: 12-Apr-2022 Copyright: © 2022 Didik Librianto, Fachrisal Ipang, Ifran Saleh, Widyastuti Srie Utami, Dina Aprilya, Rubiana Nurhayati, Darma Imran Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction Over the past few decades, minimally invasive spine surgery (MISS) has been developed as an alternative to traditional open surgery, to treat spinal problems with less injury to the muscles and other normal structures in the spine by directly going to the afected region by advanced technology [1]. Consequently, less postoperative pain, shorter hospital stays, and quicker recovery are expected [2]. MISS developed very extensively with numerous researches demonstrating their superiority over conventional open surgeries [3]. Endoscopic procedure in MISS was frstly described by Kambin et al. [4]. in 1988 and now has been developed by advance in technology to be carried out for discectomy, decompression, and even fusion surgery [3]. Microscopic decompression (MD) for the lumbar spine was frstly introduced by Caspar and Yasargil in 1977 [5]. Later on, the technique was refned by Foley and Smith in 1997 by using a tubular retractor system along with a microscope or endoscope and had gained its popularity for the treatment of lumbar decompression [6]. The development of endoscopic surgery in lumbar decompression also has become practical choice for decompression in herniated nucleus pulposus (HNP) as well as in degenerative lumbar canal stenosis (LCS), with various techniques being adopted to address underlying pathologies (uniportal vs. biportal, unilateral vs. bilateral decompression) [7], [8], [9]. A prospective study by Soliman and Ali [10] compares the outcome of LCS surgery using minimally invasive decompression with microscope and the conventional open laminectomy. They found that MD permits safe and acceptable spinal canal decompression in patients with LCS. More recently, biportal endoscopic spine surgery (BESS), which combines the concept of endoscopic surgery and microscopic surgery, has been introduced for lumbar discectomy, laminectomy, and foraminotomy and demonstrated satisfactory