New Surgery Method for Herniated Disc 'Bidirectional Endoscopy' Confirmed Safe: "Less Pain and Faster Recovery"

Recently, the world's first study proving the safety of biportal endoscopic surgery, a new surgical method gaining attention for treating herniated discs, also known as 'lumbar disc herniation,' has been published. Compared to the conventional microscopic surgery, it showed similar clinical outcomes while causing less muscle damage and postoperative pain, and enabling faster recovery. A research team led by Professor Sangmin Park from the Department of Orthopedics at Seoul National University Bundang Hospital confirmed this through a prospective study comparing patients who underwent biportal endoscopic surgery with those who received microscopic surgery.

Professor Sangmin Park, Department of Orthopedic Surgery, Bundang Seoul National University Hospital.

Approximately 2 million people visit hospitals annually due to lumbar disc herniation. Most cases improve by avoiding causative factors such as excessive exercise or improper posture and by taking adequate rest. However, patients should seek medical attention if severe pain persists or if symptoms of lower limb paralysis, which can cause permanent nerve damage, occur.

One of the representative treatments performed in hospitals is surgery to remove the herniated disc, primarily using microscopic surgery. This method has a high success rate as it reliably removes the disc and causes minimal soft tissue and blood loss. However, the surgery inevitably damages the muscles around the spine and involves removing part of the vertebrae, which weakens the back. Consequently, although effective, the hospitalization and recovery periods are relatively longer compared to other surgical methods.

Recently, another surgical method called 'biportal endoscopy' has been developed to treat lumbar disc herniation. South Korea is the country that uses this surgery the most worldwide. It is similar to the surgical method used in shoulder arthroscopy, making it easy to apply, and it uses a wide-view camera that allows both hands to be free, attracting attention. However, no prospective studies have yet been conducted to demonstrate the safety of biportal endoscopic surgery in patients who underwent this procedure.

When comparing the trend of decreasing Visual Analog Scale (VAS) scores according to the lumbar disc surgery methods, it can be seen that the biportal endoscopic surgery method (red) results in less pain over time compared to the microscopic surgery method (blue). [Data provided by Bundang Seoul National University Hospital]

Professor Park’s team compared and analyzed 32 patients who underwent biportal endoscopic surgery and 32 patients who underwent microscopic surgery. To ensure accurate results, biological factors such as age, gender, and body mass index (BMI) were matched, and only patients who had surgery between April 2019 and November 2020 were selected for consistent observation. Patients were examined postoperatively using computed tomography (CT) or magnetic resonance imaging (MRI), and follow-up observations utilized X-ray imaging. Pain-related surveys, including the Visual Analog Scale (VAS), were also conducted.

The study found that biportal endoscopic surgery caused less muscle damage and less postoperative pain compared to microscopic surgery, making recovery more favorable. Additionally, surgical scars were minimal. Other clinical outcomes such as side effects, recurrence rates, hospitalization duration, surgery time, and postoperative complications were similar. The research team emphasized the significance of being the first in the world to prove the safety of this surgery through a prospective clinical study on surgical patients. Professor Park stated, "Biportal endoscopic surgery is a clean and precise procedure that results in better patient prognosis than conventional surgery," adding, "We will conduct follow-up studies to verify the long-term safety of this surgical method and improve its shortcomings." This study was published in 'The Spine Journal,' the leading academic journal in the field of spine research.

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