Comprehensive Review of Biportal Endoscopic Spine Surgery: History, Techniques, and Implications in Minimally Invasive Spine Surgery.

Study design: Narrative review.

Objective: To provide an overview of the evolution of biportal endoscopic spine surgery (BE) and its role in addressing specific challenges in minimally invasive spinal procedures, focusing on its technical features and clinical applications.

Summary of background data: Minimally invasive spine surgery has gained momentum due to its ability to reduce tissue damage, postoperative pain, and recovery times compared to traditional open surgery. BE has emerged as an innovative technique, offering unique visualization and maneuverability that allow for addressing complex spinal pathologies with comparable outcomes to other minimally invasive techniques.

Methods: This review explores the development of BE, its advantages and disadvantages compared to traditional and full endoscopic spine surgery, and its application in various spinal conditions, based on current literature.

Results: BE facilitates enhanced visualization and maneuverability through the use of two independent portals, which allow for precise decompression, discectomy, and fusion procedures with minimal muscle disruption. Studies suggest that BE is well-suited for specific cases requiring delicate tissue handling and complex anatomical access. Studies report reduced postoperative pain, shorter hospital stays, and faster recovery compared to traditional methods. While challenges such as longer operation times and learning curves exist, BE offers a valuable alternative to other minimally invasive techniques in procedures like lumbar laminectomy, foraminotomy, and interbody fusion.

Conclusions: Biportal endoscopic spine surgery represents an important addition to the arsenal of minimally invasive spine techniques. Its flexibility and adaptability make it a promising option for specific spinal pathologies, particularly in cases where other techniques may pose limitations. Future research should focus on refining surgical protocols, enhancing training frameworks, and expanding the application of BE to other spinal regions and complex conditions.