Clinical Experiences of 3-Dimensional Biportal Endoscopic Spine Surgery for Lumbar Degenerative Disease

Oper Neurosurg (Hagerstown). 2022 Apr 1;22(4):231-238. doi: 10.1227/ONS.0000000000000090.


Background: The lack of stereoscopic vision in endoscopic spine surgery may lead to a risk of neural or vascular injury during endoscopic surgery. Three-dimensional (3D) endoscopy has not yet been attempted in the field of spinal endoscopic surgery.

Objective: To present the technique, clinical efficacy, and safety of the 3D biportal endoscopic approach for the treatment of lumbar degenerative disease.

Methods: We attempted 3D biportal endoscopic surgery for lumbar degenerative disease in a series of patients. Clinical outcomes and complications were evaluated postoperatively using a short questionnaire about 3D biportal endoscopic spine surgery that solicited respondents' opinions on the advantages and disadvantages of 3D biportal endoscopic surgery compared to the conventional 2D biportal endoscopic approach.

Results: We performed 3D biportal endoscopic spine surgery in 38 patients with lumbar degenerative disease. Optimal neural decompression was revealed by postoperative magnetic resonance imaging in all enrolled patients. The 3D endoscopic vision clearly demonstrated the surgical anatomy starting with the exposure of ligamentum flavum, dura, and nerve root, and 3D endoscopy precisely depicted pathologic lesions such as bony osteophytes and ruptured disc herniation. There were no major complications including neural injury or durotomy.

Conclusion: The 3D endoscope may be able to distinguish between normal structures and lesions. The stereognosis and depth sensation of 3D biportal endoscopic spinal surgery might have a favorable impact on the safety of patients during endoscopic spine surgery.

MeSH terms

  • Decompression, Surgical / methods
  • Endoscopy / methods
  • Humans
  • Intervertebral Disc Displacement* / surgery
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery
  • Spinal Stenosis* / diagnostic imaging
  • Spinal Stenosis* / surgery