{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T09:42:59Z","timestamp":1790674979595,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Biportal endoscopic spine surgery (BESS) is a promising technique that can be applied for the treatment of various spinal diseases. However, traditional BESS procedures require multiple, separate incisions. We present, herein, various techniques to reduce the number of incisions in multi-level surgery and their clinical outcomes. Materials and Methods: Three different techniques were used to reduce the number of incisions for the preservation of normal tissue associated with BESS: the step-ladder technique, employing a common portal for the scope and instruments; the portal change technique employing a two-level procedure with two incisions; and the tilting technique, employing more than three levels. Pain (Visual Analog Scale), disability (Oswestry Disability Index), and patient satisfaction were evaluated before and 12 months after the procedure. Results: Among the 122 cases of multilevel spine surgery, 1.43 incisions per level were employed for multilevel BESS. Pain and disability showed significant improvement. Patient satisfaction showed favorable results. Conclusions: Combining multiple techniques during biportal surgery could decrease the number of incisions needed and preserve musculature with favorable clinical outcomes.<\/jats:p>","DOI":"10.3390\/medicina60030514","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T11:37:22Z","timestamp":1711021042000},"page":"514","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Minimizing Tissue Injury and Incisions in Multilevel Biportal Endoscopic Spine Surgery: Technical Note and Preliminary Results"],"prefix":"10.3390","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4632-521X","authenticated-orcid":false,"given":"Seung-Kook","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Spine Center, SNU Seoul Hospital, Gonghangdae-ro 237, Gangseo-gu, Seoul 08703, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e709","DOI":"10.1016\/j.wneu.2019.04.240","article-title":"Is the use of a unilateral biportal endoscopic approach associated with rapid recovery after lumbar decompressive laminectomy? A preliminary analysis of a prospective randomized controlled trial","volume":"128","author":"Park","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3965","DOI":"10.1097\/MS9.0000000000001053","article-title":"Biportal endoscopic surgery for lumbar spine herniated discs: A narrative review of its clinical application and outcomes","volume":"85","author":"Awuah","year":"2023","journal-title":"Ann. Med. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"248","DOI":"10.4055\/cios.2018.10.2.248","article-title":"Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy","volume":"10","author":"Kim","year":"2018","journal-title":"Clin. Orthop. 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Orthop."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/3\/514\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:17:29Z","timestamp":1760105849000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/3\/514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,21]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["medicina60030514"],"URL":"https:\/\/doi.org\/10.3390\/medicina60030514","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,21]]}}}