Search

Biportal endoscopic spine surgery is gaining popularity in managing degenerative lumbar diseases and has optimal indications and contraindications. The perioperative complications related to the biportal endoscopic approach affect the postoperative outcomes. Therefore, this study aimed to review the indications, contraindications, and complications of biportal endoscopic decompression for lumbar stenosis.For this systematic review, articles on biportal endoscopic decompressive surgery for lumbar stenosis, including central, lateral recess and foraminal stenoses, were searched for and reviewed. Additionally, the complications, indications, and contraindications of biportal endoscopic surgery for lumbar stenosis were reviewed.Forty-one articles were included in this study. The indications for biportal endoscopic decompression are central lumbar stenosis, central stenosis with lipomatosis, lateral recess stenosis, foraminal stenosis, and the far-out syndrome. The contraindications include trauma, infection, tumor, instability, high-grade spondylolisthesis, isthmic spondylolisthesis, and severe scoliosis. Perioperative complications are typically minor; major complications include durotomy, epidural hematoma, incomplete decompression, infection, facet joint injury, neural injury, increased epidural pressure, and postoperative instability.Favorable indications for a biportal endoscopic approach are central lumbar, lateral recess, foraminal, extraforaminal stenoses, and the Bertolotti syndrome. Incidental durotomy and postoperative epidural hematomas are common complications of biportal endoscopic decompression.

Minimally invasive spine surgery (MISS) is an important option for spinal operations, with advantages including rapid recovery and preservation of normal structures. As the number of geriatric patients is increasing, the role of MISS might expand in the future. MISS techniques and approaches continue to be developed, and recent trends in MISS development include the refinement of surgical approaches and techniques, as well as systems related to newly developed techniques, rather than spinal implants. Among the various techniques for MISS, endoscopic spine surgery, including uniportal and biportal endoscopic approaches, is the focus of vigorous research efforts that may lead to further expansion of the indications of endoscopic spine surgery. Endoscopic spine surgery will be an important part of spine surgery. Lateral lumbar interbody fusion and endoscopic lumbar interbody fusion may play meaningful roles in the MISS fusion area. Robotics and augmented reality are also likely to be important technological modalities in spine surgery in the future.

Symptomatic intraspinal extradural cysts of the cervical spine are uncommon; however, they are usually treated using conventional posterior decompression. Biportal endoscopic surgery is widely used to treat degenerative cervical pathological conditions. This study presented an optimized surgical technique for a biportal endoscopic posterior approach for removal of cervical intraspinal extradural cysts that caused cervical radiculomyelopathy.A broad laminotomy was performed, which was wider than the outer contour of the cysts. The ligamentum flavum was detached from the bony margin and removed after an epidural dissection, and a dense adhesive tissue entrapped the extradural cysts. A spinal endoscope was placed close to the dissection plane and offered a high-resolution magnified view. The cyst capsule was safely dissected from the dura and removed en bloc without dural injury.Postoperatively, neurological deficits, including cervical myelopathy, radiating arm pain, and upper back pain improved in both patients.We successfully removed an extradural cervical cystic mass lesion by using a biportal endoscopic posterior cervical approach without complications. The biportal endoscopic approach may have advantages, such as minimizing trauma to the normal structures of the posterior cervical region, magnified endoscopic view, and early recovery after the surgery. Biportal endoscopy may be used as an alternative surgical treatment for symptomatic cervical intraspinal extradural cystic lesions.