Uniportal versus biportal endoscopic spine surgery: a comprehensive review

ABSTRACT

Introduction

Endoscopic spine surgery techniques are minimally invasive alternatives to conventional open surgery for degenerative spinal diseases. Clinical studies and meta-analyses have proven the usefulness of uniportal full-endoscopic spine procedures. However, a steep learning curve is a critical barrier for endoscopic procedures. Recently, biportal endoscopic spine surgeries have been developed to make it easier for spine surgeons to learn and perform. Consequently, the biportal approach has gained popularity among aspiring endoscopic spine surgeons. This review compared the characteristics of uniportal and biportal surgeries to help spine surgeons perform endoscopic procedures more effectively.

Area covered

The review analyzed English-language clinical literature in Core databases and compared uniportal and biportal endoscopic spine surgery techniques. Clinical studies have compared the technical principles of both techniques, and the authors suggested appropriate strategies for learning and practicing endoscopic procedures.

Expert opinion

Uniportal, full-endoscopic spine surgery is a minimally invasive procedure that preserves muscles and uses a keyhole approach under local anesthesia. In contrast, biportal surgery is more familiar to a surgeon and can be performed more widely, although the keyhole approach is limited. Aspiring endoscopic spine surgeons can learn either method according to the surgeon’s preference and the clinical situation.

KEYWORDS:

• Biportal
• decompression
• endoscopic
• percutaneous
• spinal surgery
• uniportal

Article highlights

• Endoscopic spine surgery has been developed as a minimally invasive alternative to open surgery for degenerative spinal diseases.

• Uniportal, full-endoscopic spine surgery has gained effectiveness, proven by randomized trials and meta-analyses.

• Biportal endoscopic spine surgery has recently emerged because of its familiarity and practical usefulness.

• This review compares the characteristics of the uniportal and biportal endoscopic systems and may help surgeons perform endoscopic spine surgeries in actual cases.

• Uniportal, full-endoscopic spine surgery has both the benefits of muscle preservation and a keyhole approach under local anesthesia despite a steep learning curve.

• Biportal endoscopic spine surgery is relatively familiar to standard spine surgeons and can be performed using standard surgical instruments.

• Aspiring endoscopic spine surgeons can learn either method according to the surgeon’s preference and the clinical situation.

Acknowledgments

The authors would like to thank Hwa Young Kim and Jae Min Son for their support and assistance with this review.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.