{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:55:29Z","timestamp":1790913329023,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"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>Biportal endoscopic (BE) spine surgery has gained increasing attention as a minimally invasive alternative to conventional spinal procedures, yet the distribution of procedural applications and anatomic targets within influential BE-specific publications has not been clearly synthesized. This study aimed to synthesize influential publications on BE spine surgery to describe the evolution of procedural applications, anatomic focus, and clinically relevant themes reflected in the literature. A comprehensive search of the Web of Science database was performed using terms related to biportal and multiportal endoscopic spine techniques. Influential articles were identified using citation frequency as a screening criterion, and relevant study characteristics, including publication year, authorship, institutional affiliation, geographic region, journal, and spinal region addressed, were extracted. Full-text screening confirmed inclusion of true biportal endoscopic spinal procedures and categorized the anatomical region and surgical technique addressed. Publications spanned 1997 to 2023, with a marked increase after 2018 and peak productivity in 2022. Influential publications were most frequently published in World Neurosurgery, with substantial contributions originating from South Korea, including work by Dae-Jung Choi. Most studies focused on lumbar procedures, primarily decompression techniques and transforaminal lumbar interbody fusion. Overall, this review highlights the rapid clinical growth of BE spine surgery, with influential literature emphasizing lumbar applications and underscoring the need for further research on outcomes, learning curves, and broader international adoption.<\/jats:p>","DOI":"10.3390\/jcm15051843","type":"journal-article","created":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:24:34Z","timestamp":1772447074000},"page":"1843","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Biportal Endoscopic Spine Surgery: Evolution of Techniques, Indications, and Influential Literature"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9667-704X","authenticated-orcid":false,"given":"Kareem S.","family":"Mohamed","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Kurapatti","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3292-5904","authenticated-orcid":false,"given":"Ethan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husni","family":"Alasadi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Department of Orthopaedics, University of Maryland Medical Center, Baltimore, MD 21201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wasil","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan A.","family":"Lamidi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhas K.","family":"Etigunta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiro H.","family":"Duey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashar","family":"Zaidat","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8763-8992","authenticated-orcid":false,"given":"Brian H.","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0191-474X","authenticated-orcid":false,"given":"Daniel C.","family":"Berman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2647-8019","authenticated-orcid":false,"given":"Joshua","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4853-4736","authenticated-orcid":false,"given":"Junho","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel K.","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S170","DOI":"10.1007\/s00586-003-0612-1","article-title":"Lumbar spinal stenosis in the elderly: An overview","volume":"12","author":"Szpalski","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1053\/j.semss.2015.08.003","article-title":"The epidemiology and pathophysiology of lumbar disc herniations","volume":"28","author":"Schroeder","year":"2016","journal-title":"Semin. Spine Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.2106\/JBJS.L.01607","article-title":"Effect and possible mechanism of muscle-splitting approach on multifidus muscle injury and atrophy after posterior lumbar spine surgery","volume":"95","author":"Hu","year":"2013","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/BSD.0b013e3181a3d889","article-title":"Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis","volume":"23","author":"Celik","year":"2010","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3171\/spi.2005.3.2.0129","article-title":"Outcome after less-invasive decompression of lumbar spinal stenosis: A randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy","volume":"3","author":"Zevgaridis","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4583943","DOI":"10.1155\/2019\/4583943","article-title":"A History of Endoscopic Lumbar Spine Surgery: What Have We Learnt?","volume":"2019","author":"Mayer","year":"2019","journal-title":"BioMed Res. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s00701-015-2670-7","article-title":"How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis","volume":"158","author":"Choi","year":"2016","journal-title":"Acta Neurochir."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"334","DOI":"10.31616\/asj.2018.0210","article-title":"Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis","volume":"13","author":"Kim","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Xu, W.B., Kotheeranurak, V., Zhang, H.L., Chen, Z.-X., Wu, H.-J., Chen, C.-M., Lin, G.-X., and Rui, G. (2022). Is Biportal Endoscopic Spine Surgery More Advantageous Than Uniportal for the Treatment of Lumbar Degenerative Disease? A Meta-Analysis. Medicina, 58.","DOI":"10.3390\/medicina58111523"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e15451","DOI":"10.1097\/MD.0000000000015451","article-title":"Is biportal technique\/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?: A prospective randomized comparative study","volume":"98","author":"Kang","year":"2019","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6","DOI":"10.14245\/ns.1836322.161","article-title":"Evolution of Spinal Endoscopic Surgery","volume":"16","author":"Kim","year":"2019","journal-title":"Neurospine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e684","DOI":"10.1016\/j.wneu.2018.08.144","article-title":"Can Percutaneous Biportal Endoscopic Surgery Achieve Enough Canal Decompression for Degenerative Lumbar Stenosis? Prospective Case-Control Study","volume":"120","author":"Heo","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.spinee.2021.07.004","article-title":"Spinal endoscopy: Evidence, techniques, global trends, and future projections","volume":"22","author":"Simpson","year":"2022","journal-title":"Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1007\/s00586-023-07699-0","article-title":"Economic comparisons of endoscopic spine surgery: A systematic review","volume":"32","author":"Golan","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.spinee.2023.12.009","article-title":"Full-endoscopic versus microscopic spinal decompression for lumbar spinal stenosis: A systematic review & meta-analysis","volume":"24","author":"Chin","year":"2024","journal-title":"Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1177\/21925682221083271","article-title":"Endoscopic Spinal Surgery (BESS and UESS) Versus Microscopic Surgery in Lumbar Spinal Stenosis: Systematic Review and Meta-Analysis","volume":"12","author":"Kang","year":"2022","journal-title":"Glob. Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.14444\/8160","article-title":"Rationale and Advantages of Endoscopic Spine Surgery","volume":"15","author":"Jang","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"212","DOI":"10.14245\/ns.2142942.471","article-title":"Comparative Analysis of 3 Types of Minimally Invasive Posterior Cervical Foraminotomy for Foraminal Stenosis, Uniportal-, Biportal Endoscopy, and Microsurgery: Radiologic and Midterm Clinical Outcomes","volume":"19","author":"Kim","year":"2022","journal-title":"Neurospine"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2071","DOI":"10.1007\/s00264-022-05484-0","article-title":"Unilateral biportal endoscopic decompression for symptomatic thoracic ossification of the ligamentum flavum: A case control study","volume":"46","author":"Deng","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e91","DOI":"10.1016\/j.wneu.2021.12.005","article-title":"Efficacy and Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review","volume":"159","author":"Liang","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4055\/cios.2019.11.1.82","article-title":"Efficacy of Biportal Endoscopic Spine Surgery for Lumbar Spinal Stenosis","volume":"11","author":"Choi","year":"2019","journal-title":"Clin. Orthop. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1016\/j.jos.2019.05.022","article-title":"Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis","volume":"25","author":"Min","year":"2020","journal-title":"J. Orthop. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00586-019-06171-2","article-title":"Worldwide research productivity in the field of full-endoscopic spine surgery: A bibliometric study","volume":"29","author":"Lin","year":"2020","journal-title":"Eur. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1097\/00007632-200204010-00009","article-title":"Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases","volume":"27","author":"Yeung","year":"2002","journal-title":"Spine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1177\/2192568220934740","article-title":"The 100 Most-Cited Publications in Endoscopic Spine Surgery Research","volume":"11","author":"Zhao","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1080\/17434440.2023.2214678","article-title":"Uniportal versus biportal endoscopic spine surgery: A comprehensive review","volume":"20","author":"Ahn","year":"2023","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lee, D.G., Jang, J.W., and Park, C.K. (2023). History and basic concepts of unilateral biportal endoscopic surgery (UBE). Core Techniques of Minimally Invasive Spine Surgery, Springer Nature.","DOI":"10.1007\/978-981-19-9849-2_13"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S145","DOI":"10.14245\/ns.2040228.114","article-title":"The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results","volume":"17","author":"Song","year":"2020","journal-title":"Neurospine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e779","DOI":"10.3928\/01477447-20170531-02","article-title":"Posterior Percutaneous Endoscopic Cervical Foraminotomy and Diskectomy with Unilateral Biportal Endoscopy","volume":"40","author":"Park","year":"2017","journal-title":"Orthopedics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00701-021-05031-7","article-title":"How i do it: Biportal endoscopic thoracic decompression for ossification of the ligamentum flavum","volume":"164","author":"Kang","year":"2022","journal-title":"Acta Neurochir."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13018-018-0725-1","article-title":"Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: A multicenter, retrospective analysis","volume":"13","author":"Kim","year":"2018","journal-title":"J. Orthop. Surg Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"602","DOI":"10.3171\/2015.7.SPINE15304","article-title":"Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: A technical note and preliminary clinical results","volume":"24","author":"Hwa","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e345","DOI":"10.1016\/j.wneu.2023.05.061","article-title":"Global Research Trends of Neurosurgery: A Comprehensive Bibliometric and Visualized Analysis of Systematic Reviews","volume":"176","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1007\/s00586-016-4442-3","article-title":"Worldwide research productivity in the field of spine surgery: A 10-year bibliometric analysis","volume":"25","author":"Wei","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"325","DOI":"10.4055\/cios.2016.8.3.325","article-title":"Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc Herniations","volume":"8","author":"Choi","year":"2016","journal-title":"Clin. Orthop. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1097\/BRS.0b013e3181b20250","article-title":"Comparative study of neck pain in relation to increase of cervical epidural pressure during percutaneous endoscopic lumbar discectomy","volume":"34","author":"Joh","year":"2009","journal-title":"Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E1349","DOI":"10.1097\/BRS.0000000000003585","article-title":"Safety Evaluation of Biportal Endoscopic Lumbar Discectomy: Assessment of Cervical Epidural Pressure During Surgery","volume":"45","author":"Kang","year":"2020","journal-title":"Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.14444\/8161","article-title":"Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery","volume":"15","author":"Lewandrowski","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1097\/BRS.0000000000001138","article-title":"An Updated Meta-Analysis Comparing Artificial Cervical Disc Arthroplasty (CDA) Versus Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Cervical Degenerative Disc Disease (CDDD)","volume":"40","author":"Gao","year":"2015","journal-title":"Spine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1186\/s40064-016-2851-8","article-title":"Cervical disc arthroplasty (CDA) versus anterior cervical discectomy and fusion (ACDF) in symptomatic cervical degenerative disc diseases (CDDDs): An updated meta-analysis of prospective randomized controlled trials (RCTs)","volume":"5","author":"Xie","year":"2016","journal-title":"SpringerPlus"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/os.13216","article-title":"Global and Current Research Trends of Unilateral Biportal Endoscopy\/Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Degenerative Diseases: A Bibliometric and Visualization Study","volume":"14","author":"Chu","year":"2022","journal-title":"Orthop. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S84","DOI":"10.21182\/jmisst.2020.00024","article-title":"Overview of tips in overcoming learning curve in uniportal and biportal endoscopic spine surgery","volume":"6","author":"Wu","year":"2021","journal-title":"J. Minim. Invasive Spine Surg. Tech."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"624","DOI":"10.4184\/asj.2016.10.4.624","article-title":"Learning Curve Associated with Complications in Biportal Endoscopic Spinal Surgery: Challenges and Strategies","volume":"10","author":"Choi","year":"2016","journal-title":"Asian Spine J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1843\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T10:47:38Z","timestamp":1772448458000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051843"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051843","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}