Complications of Unilateral Biportal Endoscopic Lumbar Discectomy: A Systematic Review

World Neurosurg. 2022 Dec;168:359-368.e2. doi: 10.1016/j.wneu.2022.10.038.


Objective: In recent years, biportal endoscopic surgery has gained popularity, and the number of publications on it has also increased. We herein aimed to investigate the complications of biportal endoscopic surgery. In this study, the available literature was reviewed systematically and the published complications of discectomy in biportal endoscopic spinal surgery were summarized.

Methods: A systematic search of the literature published until December 31, 2021, was performed using the PubMed, Cochrane Library, Embase, and Web of Science databases. Studies on spinal discectomy using the biportal method were included.

Results: Twenty-two articles were finally included for review. The reported complication rate of this procedure was 0%-23.6% (radiological hematoma). In most studies, the complication rate was less than 11%. The mean complication rate was 5.37% when 596 patients (from 16 studies) underwent unilateral biportal endoscopic discectomy for the treatment of lumbar disk herniation. The reported complications of this procedure included dural tear, hematoma, incomplete decompression, recurrence, instability, neurological complications (post-op paresthesia, dysthesia or numbness, or root injury), pseudomeningocele, ascites, infection, retinal hemorrhage, and burn injury. The complication rate was higher in the early learning curve.

Conclusions: Unilateral biportal endoscopic discectomy has an acceptable complication rate. Knowing the possible complications and risks of this procedure could help surgeons in taking measures to avoid common complications.

Keywords: Complications; Lumbar discectomy; Unilateral biportal endoscopic spine surgery.

Publication types

  • Systematic Review

MeSH terms

  • Diskectomy / adverse effects
  • Diskectomy / methods
  • Endoscopy / adverse effects
  • Endoscopy / methods
  • Hematoma / surgery
  • Humans
  • Lumbar Vertebrae* / surgery
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Postoperative Complications* / surgery
  • Treatment Outcome