7.1. Indications and Contraindications
@ProfFishchenkoIndications
I consider BESS/UBE decompression for symptomatic lateral recess stenosis when clinical manifestations correspond to MRI findings and symptoms persistently limit function despite adequate nonoperative treatment, or when a significant or progressive neurological deficit is present. MRI evidence of stenosis alone is not an indication for surgery.
• Unilateral lateral recess stenosis.
• Stenosis associated with degenerative scoliosis.
• Stenosis associated with degenerative spondylolisthesis.
In the presence of degenerative scoliosis or spondylolisthesis, I determine whether decompression alone is feasible after assessing segmental stability and the severity of deformity. I assess the need for additional stabilization individually.
Contraindications
The limitations below apply to the BESS/UBE decompression alone described here for degenerative stenosis, rather than to every endoscopic procedure.
• General contraindications to the selected type of anesthesia.
• Stenosis associated with dysplastic or spondylolytic (isthmic) spondylolisthesis.
• Segmental instability, high-grade spondylolisthesis, or marked deformity.
• Stenosis caused by a neoplastic process.
• Stenosis caused by an infectious process.
The lateral recess as a separate surgical target
In lateral recess stenosis, the nerve root is traced from its origin to its passage into the next intervertebral foramen. The structure causing compression is identified: the medial portion of the facet, ligamentum flavum, a disc component, or a combination of these. The area of narrowing must correspond to the side and level of neurological manifestations. This compression must be distinguished from involvement of the exiting nerve root in the foraminal zone because the direction of the approach and the limits of bone resection differ. When central stenosis is also present, decompression is planned as a coordinated release of both targets. With asymmetric anatomy, the feasibility of a contralateral approach and facet preservation is assessed separately. The extent of surgery is selected according to the extent of compression along the nerve root.
References
1. Heo DH, Park DY, Hong HJ, Hong YH, Chung H. Indications, Contraindications, and Complications of Biportal Endoscopic Decompressive Surgery for the Treatment of Lumbar Stenosis: A Systematic Review. World Neurosurg. 2022;168:411–420. DOI: 10.1016/j.wneu.2022.09.023.
2. Bui AT, Trinh GM, Wu MH, Hoang TT, Hu MH, Pao JL. Indications for and Outcomes of Three Unilateral Biportal Endoscopic Approaches for the Decompression of Degenerative Lumbar Spinal Stenosis: A Systematic Review. Diagnostics (Basel). 2023;13(6):1092. DOI: 10.3390/diagnostics13061092.
3. Sharif S, Shaikh Y, Bajamal AH, Costa F, Zileli M. Fusion Surgery for Lumbar Spinal Stenosis: WFNS Spine Committee Recommendations. World Neurosurg X. 2020;7:100077. DOI: 10.1016/j.wnsx.2020.100077.
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