Overview and Prevention of Complications During Biportal Endoscopic Cervical Spine Surgery

Purpose: Biportal endoscopic spine surgery is becoming popular for various spinal pathologies, including cervical and thoracic spine diseases. However, the safety of biportal endoscopic cervical spine surgery (BECSS) has not been fully investigated, and inexperienced surgeons can cause serious complications. The study aimed to evaluate the complications of BECSS and identify tips for preventing them through a literature review and retrospective analysis of case series. Methods: Articles on BECSS were electronically retrieved from multiple databases, with inclusion criteria including controlled and case series designs, detailed reporting of complications and/or reoperations, and the use of BECSS. The study excluded simple review articles and case reports. The clinical data of 45 patients who underwent BECSS at our institution were collected, and information was extracted on demographic features, surgery type, surgical level, surgery-related complications, and reoperations and their reasons.Results: The study retrieved a total of 67 studies from 5 databases, of which 6 were included after screening. In total, 227 cases of BECSS were identified, and the overall complication rate was 0%–14.3%. Complications included dura tearing, symptom recurrence, incomplete decompression, postoperative epidural hematoma, and transient paralysis. Reoperation was performed in 3 cases.Conclusion: BECSS has similar complication rates to those of other surgical techniques. It is important to provide extensive education, share knowledge and experience, and conduct further research to minimize complications and improve outcomes for patients, as is the case with other spinal surgical procedures.