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Review
. 2026 Feb 28;15(5):1843.
doi: 10.3390/jcm15051843.

Biportal Endoscopic Spine Surgery: Evolution of Techniques, Indications, and Influential Literature

Kareem S Mohamed  1 , Mark Kurapatti  1 , Ethan Yang  2 , Husni Alasadi  1   2 , Wasil Ahmed  1 , Ryan A Lamidi  1 , Suhas K Etigunta  1 , Akiro H Duey  1 , Bashar Zaidat  1 , Brian H Cho  1 , Daniel C Berman  1 , Joshua Lee  1 , Junho Song  1 , Samuel K Cho  1
Affiliations
Review

Biportal Endoscopic Spine Surgery: Evolution of Techniques, Indications, and Influential Literature

Kareem S Mohamed et al. J Clin Med. .

Abstract

Biportal endoscopic (BE) spine surgery has gained increasing attention as a minimally invasive alternative to conventional spinal procedures, yet the distribution of procedural applications and anatomic targets within influential BE-specific publications has not been clearly synthesized. This study aimed to synthesize influential publications on BE spine surgery to describe the evolution of procedural applications, anatomic focus, and clinically relevant themes reflected in the literature. A comprehensive search of the Web of Science database was performed using terms related to biportal and multiportal endoscopic spine techniques. Influential articles were identified using citation frequency as a screening criterion, and relevant study characteristics, including publication year, authorship, institutional affiliation, geographic region, journal, and spinal region addressed, were extracted. Full-text screening confirmed inclusion of true biportal endoscopic spinal procedures and categorized the anatomical region and surgical technique addressed. Publications spanned 1997 to 2023, with a marked increase after 2018 and peak productivity in 2022. Influential publications were most frequently published in World Neurosurgery, with substantial contributions originating from South Korea, including work by Dae-Jung Choi. Most studies focused on lumbar procedures, primarily decompression techniques and transforaminal lumbar interbody fusion. Overall, this review highlights the rapid clinical growth of BE spine surgery, with influential literature emphasizing lumbar applications and underscoring the need for further research on outcomes, learning curves, and broader international adoption.

Keywords: biportal endoscopic spine surgery; lumbar spine; minimally invasive spine surgery; scoping review; spinal decompression; unilateral biportal endoscopy.

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Conflict of interest statement

Samuel Kang-Wook Cho, MD, FAAOS reports the following relationships: board or committee membership with the American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AOSpine North America, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society; intellectual property royalties and fellowship support from Globus Medical; paid consultancy with Stryker; and fellowship support from Cerapedics. The remaining authors, Kareem S. Mohamed, Mark Kurapatti, Ethan Yang, Husni Alasadi, Wasil Ahmed, Ryan A. Lamidi, Akiro H. Duey, Bashar Zaidat, Suhas K. Etigunta, Brian H. Cho, Daniel C. Berman, Joshua Lee, and Junho Song declare no conflicts of interest or sources of support relevant to this work.

Figures

Figure 1
Figure 1
PRISMA-ScR flow diagram of study selection.
Figure 2
Figure 2
Temporal distribution of influential papers in biportal endoscopic spine surgery.
Figure 3
Figure 3
Countries contributing to influential papers in biportal endoscopic spine surgery.
Figure 4
Figure 4
Distribution of included publications by journal.
Figure 5
Figure 5
Technique applications of the included publications.
See this image and copyright information in PMC

References

    1. Szpalski M., Gunzburg R. Lumbar spinal stenosis in the elderly: An overview. Eur. Spine J. 2003;12:S170–S175. doi: 10.1007/s00586-003-0612-1. - DOI - PMC - PubMed
    1. Schroeder G., Guyre C., Vaccaro A. The epidemiology and pathophysiology of lumbar disc herniations. Semin. Spine Surg. 2016;28:2–7. doi: 10.1053/j.semss.2015.08.003. - DOI
    1. Hu Z.J., Fang X.Q., Zhou Z.J., Wang J.Y., Zhao F.D., Fan S.W. Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery. J. Bone Jt. Surg. Am. 2013;95:e192. doi: 10.2106/JBJS.L.01607. - DOI - PubMed
    1. Celik S.E., Celik S., Göksu K., Kara A., Ince I. Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis. J. Spinal Disord. Tech. 2010;23:229–235. doi: 10.1097/BSD.0b013e3181a3d889. - DOI - PubMed
    1. Thomé C., Zevgaridis D., Leheta O., Bäzner H., Pöckler-Schöniger C., Wöhrle J., Schmiedek P. Outcome after less-invasive decompression of lumbar spinal stenosis: A randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J. Neurosurg. Spine. 2005;3:129–141. doi: 10.3171/spi.2005.3.2.0129. - DOI - PubMed

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