Asian Spine J.  2025 Apr;19(2):267-274. 10.31616/asj.2024.0532.

Advanced technique of biportal endoscopic transforaminal lumbar interbody fusion for revision surgery: a technical note

Affiliations
  • 1Endoscopic Spine Surgery Center, Daechan Hospital, Incheon, Korea
  • 2Department of Himchan UHS Spine and Joint Centre, University Hospital Sharjah, Sharjah, United Arab Emirates
  • 3Department of spine surgery, Baro Seogu Hospital, Incheon, Korea

Abstract

The application area of biportal endoscopic spine surgery (BESS) is gradually expanding. Compared with conventional fusion surgery, transforaminal interbody fusion (TLIF) using BESS (BESS-TLIF) has the advantages of less bleeding, minimal postoperative pain, and faster recovery. This technical note highlights its application in managing complex conditions such as scar tissue adhesion, altered anatomy, and implant removal, common in reoperations. The method focuses on precise dissection, endoscopic visualization, and careful tissue handling to ensure effective decompression and stabilization. Three representative cases, including reoperations for recurrent disc herniation, adjacent segment disease (ASD) following prior fusion, and ASD with nonunion of the prior fusion site requiring fusion extension, were described. All three cases exhibited clinical improvement following surgery. BESS is an effective and safe method for spinal revision surgery not only in simple decompression surgery but also in cases that required fusion surgery. As BESS is advancing, its role in complex spinal surgeries is expected to expand, potentially setting new standards in minimally invasive spine surgery.

Keyword

Biportal endoscopic spine surgery; Adjacent segment degeneration; Transforaminal lumbar interbody fusion; Revision Spine surgery; Minimally invasive spine surgery
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