{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:02:53Z","timestamp":1793368973906,"version":"4.5.0"},"reference-count":19,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: This is a retrospective study. We aimed to identify an optimal biportal endoscopic spine surgery (BESS) technique that maximizes facet joint preservation while achieving sufficient decompression for central to extraforaminal lumbar stenosis across all spinal levels. Methods: We retrospectively analyzed the data of 46 patients who underwent surgery and assessed clinical outcomes (visual analogue scale scores for pain; pregabalin usage) and radiological changes (using computed tomography\/magnetic resonance imaging) in the spinal canal; intervertebral foramen area expansion; facet joint preservation; and degenerative change. Results: Using interlaminar and transforaminal approaches (two-way BESS decompression technique), the mean facet joint volume preservation ratio was 87%, and the mean facet joint length maintenance ratio was 90%, indicating a successful anatomical preservation compared with previous studies. Radiological outcomes revealed effective decompression (178% in the spinal canal; 245% in intervertebral foramen expansion). Additionally, all clinical outcome parameters significantly improved (p &lt; 0.001). Conclusions: To the best of our knowledge, this study is the first to accurately estimate the degree of facet joint preservation using different methods after endoscopic surgery. The two-way BESS decompression technique maximized facet joint preservation with sufficient decompression and clinically improved central to extraforaminal stenosis across all lumbar levels. Therefore, this technique can sufficiently preserve facet joints to prevent rapid degenerative change after surgery.<\/jats:p>","DOI":"10.3390\/jcm14082725","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T04:05:31Z","timestamp":1744776331000},"page":"2725","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Biportal Endoscopic Decompression with Maximized Facet Joint Preservation for Central to Extraforaminal Lumbar Stenosis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8869-9810","authenticated-orcid":false,"given":"Sub-Ri","family":"Park","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16988, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Ryul","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam-Hoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16988, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hak-Sun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4880-5310","authenticated-orcid":false,"given":"Ji-Won","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyung-Soo","family":"Suk","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Hwan","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Si-Young","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae-Won","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7235-4981","authenticated-orcid":false,"given":"Byung-Ho","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Oh","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si 16988, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.31616\/asj.2022.0366","article-title":"Lumbar Spinal Stenosis: Review Update 2022","volume":"16","author":"Kwon","year":"2022","journal-title":"Asian Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"392","DOI":"10.31616\/asj.2022.0227","article-title":"Oblique Lumbar Interbody Fusion with Selective Biportal Endoscopic Posterior Decompression for Multilevel Lumbar Degenerative Diseases","volume":"17","author":"Lee","year":"2023","journal-title":"Asian Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"492","DOI":"10.3171\/2017.8.SPINE17771","article-title":"Extraforaminal approach of biportal endoscopic spinal surgery: A new endoscopic technique for transforaminal decompression and discectomy","volume":"28","author":"Ahn","year":"2018","journal-title":"J. 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