A systematic review of biportal endoscopic spinal surgery with interbody fusion

Biportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. De...

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Main Authors: Wongthawat Liawrungrueang, Ho-Jin Lee, Sang Bum Kim, Sang-Min Park, Watcharaporn Cholamjiak, Hyun-Jin Park
Format: Article
Language:English
Published: Korean Spine Society 2025-04-01
Series:Asian Spine Journal
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Online Access:http://asianspinejournal.org/upload/pdf/asj-2024-0425.pdf
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author Wongthawat Liawrungrueang
Ho-Jin Lee
Sang Bum Kim
Sang-Min Park
Watcharaporn Cholamjiak
Hyun-Jin Park
author_facet Wongthawat Liawrungrueang
Ho-Jin Lee
Sang Bum Kim
Sang-Min Park
Watcharaporn Cholamjiak
Hyun-Jin Park
author_sort Wongthawat Liawrungrueang
collection DOAJ
description Biportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. Despite the growing interest in BESS, a comprehensive analysis of its effectiveness, complication rates, and long-term outcomes remains lacking. This systematic review evaluated the clinical outcomes, surgical efficacy, and complication rates of BESS with interbody fusion for lumbar degenerative diseases. Recent literature on endoscopic lumbar interbody fusion was included to expand the scope and gain new perspectives, thereby, providing a comparative analysis that highlighted the advantages, limitations, and emerging trends in minimally invasive spine surgery. This review synthesized current evidence to guide future research and clinical applications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a combination of MeSH (Medical Subject Headings) terms and relevant keywords, PubMed/Medline and Scopus databases were systematically searched for studies published between January 2000 and September 2024. The studies were assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool to determine the risk of bias. From the 12 studies that provided clinical evidence, the data extracted were patient demographics; operative time; blood loss; clinical outcomes, such as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and fusion rates; and complications. The mean operative time ranged from 98 to 206 minutes, with fusion rates between 70% and 95%. Most studies reported significant improvements in VAS scores for back and leg pain and ODI scores. Complications, including dural tears (2.9%–6.4%) and hematomas (1.4%–4.3%), were infrequent but notable. BESS with interbody fusion demonstrated excellent clinical outcomes, high fusion rates, and few complications. Although these results are promising, more randomized controlled trials and long-term studies are required to confirm the broader applicability, particularly in more complex or multilevel spinal pathologies.
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1976-7846
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spelling doaj-art-8da3b29c92074b3b98891cbb03bee7992025-08-20T03:54:01ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462025-04-0119227529110.31616/asj.2024.04251732A systematic review of biportal endoscopic spinal surgery with interbody fusionWongthawat Liawrungrueang0Ho-Jin Lee1Sang Bum Kim2Sang-Min Park3Watcharaporn Cholamjiak4Hyun-Jin Park5 Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand Department of Orthopaedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea Department of Orthopaedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea Spine Center and Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea Department of Mathematics, School of Science, University of Phayao, Phayao, Thailand Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, KoreaBiportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. Despite the growing interest in BESS, a comprehensive analysis of its effectiveness, complication rates, and long-term outcomes remains lacking. This systematic review evaluated the clinical outcomes, surgical efficacy, and complication rates of BESS with interbody fusion for lumbar degenerative diseases. Recent literature on endoscopic lumbar interbody fusion was included to expand the scope and gain new perspectives, thereby, providing a comparative analysis that highlighted the advantages, limitations, and emerging trends in minimally invasive spine surgery. This review synthesized current evidence to guide future research and clinical applications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a combination of MeSH (Medical Subject Headings) terms and relevant keywords, PubMed/Medline and Scopus databases were systematically searched for studies published between January 2000 and September 2024. The studies were assessed using the ROBINS-I (Risk of Bias in Non-randomized Studies of Interventions) tool to determine the risk of bias. From the 12 studies that provided clinical evidence, the data extracted were patient demographics; operative time; blood loss; clinical outcomes, such as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and fusion rates; and complications. The mean operative time ranged from 98 to 206 minutes, with fusion rates between 70% and 95%. Most studies reported significant improvements in VAS scores for back and leg pain and ODI scores. Complications, including dural tears (2.9%–6.4%) and hematomas (1.4%–4.3%), were infrequent but notable. BESS with interbody fusion demonstrated excellent clinical outcomes, high fusion rates, and few complications. Although these results are promising, more randomized controlled trials and long-term studies are required to confirm the broader applicability, particularly in more complex or multilevel spinal pathologies.http://asianspinejournal.org/upload/pdf/asj-2024-0425.pdfendoscopylumbar vertebraespinal fusionminimally invasive surgerydegeneration
spellingShingle Wongthawat Liawrungrueang
Ho-Jin Lee
Sang Bum Kim
Sang-Min Park
Watcharaporn Cholamjiak
Hyun-Jin Park
A systematic review of biportal endoscopic spinal surgery with interbody fusion
Asian Spine Journal
endoscopy
lumbar vertebrae
spinal fusion
minimally invasive surgery
degeneration
title A systematic review of biportal endoscopic spinal surgery with interbody fusion
title_full A systematic review of biportal endoscopic spinal surgery with interbody fusion
title_fullStr A systematic review of biportal endoscopic spinal surgery with interbody fusion
title_full_unstemmed A systematic review of biportal endoscopic spinal surgery with interbody fusion
title_short A systematic review of biportal endoscopic spinal surgery with interbody fusion
title_sort systematic review of biportal endoscopic spinal surgery with interbody fusion
topic endoscopy
lumbar vertebrae
spinal fusion
minimally invasive surgery
degeneration
url http://asianspinejournal.org/upload/pdf/asj-2024-0425.pdf
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