Research Fellow University of Texas Health at Houston, Department of Neurosurgery Houston, TX, US
Introduction: The adoption of Biportal and Uniportal Endoscopic Spine Surgery (ESS) reflects a shift towards minimally invasive approaches in spine surgery. Despite global adoption, the U.S. has been slower to embrace ESS. This review assesses Biportal Endoscopy (BE) as a preferred method for spine surgeons transitioning from open techniques due to its flexibility and shorter learning curve compared to Uniportal Endoscopy (UE).
Methods: A comprehensive literature review was conducted comparing BE and UE outcomes including operative time, complication rates, learning curves, and economic factors. Studies included systematic reviews, retrospective cohorts, and meta-analyses covering clinical efficacy and safety in various surgical contexts.
Results: BE demonstrated advantages over UE in several studies. For instance, BE showed a significantly shorter operative time, with He et al. reporting an average of 57.1 minutes for BE versus 67.8 minutes for UE (p < 0.001) in lumbar decompression surgeries. Kang et al. found BE required 70.9 minutes compared to 78.6 minutes for UE in posterior cervical foraminotomy (p = 0.036). Additionally, BE has been associated with fewer intraoperative complications, with Wu et al. observing a 0% complication rate in BE versus 13.4% in UE (p < 0.05). Studies also indicate that proficiency in BE is achieved in approximately 47 cases on average, whereas UE may require up to 100 cases, underscoring BE's shorter learning curve. BE is also more cost-effective due to the use of standard surgical instruments rather than specialized tools, which are necessary for UE.
Conclusion : Biportal Endoscopy is an advantageous choice for surgeons transitioning to endoscopic spine surgery, offering a shorter learning curve, improved visualization, and cost-effectiveness. This review supports the broader adoption of BE in North American training programs to enhance surgical outcomes and accessibility to ESS.
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