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Ultra-Minimally Invasive Biportal Endoscopic Spine Surgery

Minimally Invasive Treatment Options Designed Around You

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Endoscopic spine surgery redefines the traditional minimally invasive approach. Many surgeons perform endoscopic spine surgery using a single portal. The problem with a single portal is that the surgeon is limited to what they can do, taking a three-dimensional operation and making it into a two-dimensional operation, limiting access to certain areas of the spine.

Biportal endoscopic spine surgery (BESS) utilizes two independent, exchangeable portals for viewing and working. This allows surgeons to maintain a certain distance from the bony and neural structures, which allows closer access to the target lesion through a magnified, panoramic view.

Advantages of Biportal Endoscopic Spine Surgery

BESS provides the surgeon with far better visualization and more flexibility, allowing them to treat many more pathologies than traditional, single portal endoscopic surgeries. In addition, BESS allows for continuous inflow and outflow irrigation to minimize the chance of infection, and a much better field for visualization.  

Traditional single portals may require the surgeon to inject a methylene blue dye into the spinal disc, allowing them to identify the problem disc. However, this blue type is toxic and can cause complications within the disc. Luckily, BESS removes the need for any methylene dye and improves visualization in the process. 

A summary of the advantages of BESS include: 

  • Excellent magnification
  • Increased flexibility
  • Far better access
  • More pathologies may be treated
  • Preserves stability
  • Motion sparing
  • Avoids fusion
  • Immediate recovery and back to normal life
  • Low complication rates
  • Decreased potential for long-term instability
  • Continuous irrigation to decrease infection rate

Dr. Melamed’s Revolutionary Approach to BESS Spinal Fusions

Over the years, Dr. Melamed was becoming unhappy and dissatisfied with the invasive spinal fusion approach and even some decompressions as he felt they were too invasive.  After much deliberation and research, Dr. Melamed learned about endoscopic spine surgery, more specifically, BESS. He took it upon himself to get educated and properly trained in this revolutionary approach by visiting master surgeons outside of the United States.

How is Biportal Endoscopic Spine Surgery Performed?

BESS is an ultra-minimally invasive approach to spine surgery. Two incisions, roughly a quarter to a third of an inch, are made considering the pathological lesion site and the patient’s anatomical variation.

Through one portal, which is one of the incisions, a very thin fiber-optic video camera is inserted into the body, allowing the surgeon to use one portal for viewing and the other portal (the other incision) for working. These can be exchanged as needed to maximize the outcome of the surgery.

The surgery is performed by passing instruments through the “working” portal just like a knee or shoulder arthroscopy to remove bone spurs or disc material. Essentially, the surgeon can bypass all the normal structures of the body, and the camera ends up in the exact area where the actual pathology is located.

Therefore, BESS preserves all the normal structures, which allows for far better long-term function and much less scarring. At the end of the procedure, the endoscope is removed and only a small bandage is needed to cover the incision area.

What Can BESS Treat?

Common conditions treated under biportal endoscopic spine surgery include:

  • Spinal stenosis
  • Foraminal stenosis
  • Lateral recess stenosis
  • Sciatica
  • Spondylolisthesis with severe nerve root compression
  • Radiculopathy
  • Radiculitis
  • Degenerative disc disease
  • Spondylosis
  • Spondylolysis
  • Disc herniation
  • Low back pain
  • Foot drop from pinched nerve
  • Back pain
  • Neurogenic claudication
  • Herniated disc
  • Pinched nerve
  • Far-out syndrome 

The BESS technique has been revolutionary in saving countless patients from having a fusion operation. It also allows far less dissection and is less invasive for decompression operations. BESS allows the surgeon to create a tunnel by removing the excess bone spur and/or herniated disc pinching the nerve when the disc spaces collapse. The surgeon is then able to decompress the nerve without sacrificing any of the stability.

The biportal technique also decompresses the spinal canal by bypassing all of the normal structures, shaving down the bone spurs and removing the herniated disc, but preserving all of the normal anatomy, which means a much higher long-term success rate. This has taken microdecompression operations to a whole new level.

What are the Potential Complications of BESS?

All surgeries, regardless of how minimally invasive, are still considered surgery and can have their own specific complications. When it comes to spine surgery, including BESS, complications, such as a spinal fluid leak, nerve injury, and reherniation, reoperation among others, although extremely small, can still occur. Please talk to your surgeon about any potential risks if you have chosen to have any kind of spine surgery including BESS.

What is the Recovery Time?

BESS is an advanced, state-of-the-art form of ultra minimally invasive spine surgery designed to provide patients with a shorter procedure and a quicker recovery time. Most patients go home the same day of surgery and typically require Tylenol and over the counter anti-inflammatories.

Patients will have a remarkably fast recovery, and may be able to drive within a couple of days and start physical therapy within two to three weeks after surgery. Patients may be back to full activity as soon as cleared by a physical therapist.

Learn More About Biportal Endoscopic Spine Surgery

If you are interested in learning more about BESS, fill out a contact form below and the team from The Spine Pro will be in touch shortly.

What is Biportal Endoscopic Spine Surgery aka BESS?

BESS is an ultra-minimally invasive spine surgery approach. Two incisions, roughly a quarter to a third of an inch, are made considering the pathological lesion site and the patient’s anatomical variation.

Through one portal which is one of the incisions, a very thin fiber-optic video camera, is inserted into the body, allowing the surgeon to use one portal for viewing and the other portal which is the other incision for working. Surgery is performed by passing instruments through the “working” endoscope to remove bone spurs or disc material. Essentially you end up bypassing all the normal structures of the body and the camera exactly ends up in the area where the actual pathology is. This way one preserves all the normal structures which allows long term far better function and much less scarring At the end of the procedure, the endoscope is removed and only a small bandage is needed to cover the incision area.

Common conditions treated under biportal endoscopic spine surgery include:

  • Spinal stenosis
  • Foraminal stenosis
  • Lateral recess stenosis
  • Sciatica
  • Spondylolisthesis
  • Radiculopathy
  • Radiculitis
  • Degenerative disc disease
  • Spondylosis
  • Spondylolysis
  • Disc herniation
  • Low back pain
  • Foot drop from pinched nerve
  • Back pain
  • Neurogenic claudication
  • Herniated disc
  • Pinched nerve

The BESS technique has been revolutionary in saving countless patients from having a fusion operation. The biportal endoscopic surgery allows the surgeon to create a tunnel by removing the excess bone spur and/or herniated disc pinching the nerve when the disc spaces collapse.

The surgeon is able to decompress the nerve without sacrificing any of the stability. The biportal technique also allows decompressing the spinal canal by bypassing all of the normal structure, shaving down the bone spurs and removing the herniated disc, but preserving all of the normal anatomy, which means a much higher long-term success rate. This has taken microdecompression operation to a whole new level and just cleaning out the excess bone spur and removing the herniated disc without sacrificing the normal anatomy and no retractors are needed.

What are the Potential Complications?

All surgeries, regardless of how minimally invasive, are still considered surgery and can have their own specific complications. When it comes to spine surgery including BESS complications even, such as a spinal fluid leak, nerve injury, and reherniation, reoperation among others, although extremely small, can still have risks. Please talk to your surgeon about any potential risks if you have chosen to have any kind of spine surgery including BESS.

What is the Recovery Time?

BESS is an advanced, state-of-the-art form of ULTRA minimally invasive spine surgery designed to provide patients with a shorter procedure and a quicker recovery time, with most patients going home the same day of surgery and perhaps only requiring Tylenol and over the counter anti-inflammatories.

Patients will have a remarkably fast recovery with driving within a couple of days and starting physical therapy within two-three weeks post-operation and back to full activity as soon as cleared by a physical therapist.

Learn More About Biportal Endoscopic Spine Surgery

If you are interested in learning more about BESS, call the SpinePro team of Dr. Hooman M. Melamed to start getting your life back on track.

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