How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis.

BACKGROUND: Prevalent endoscopic spine surgeries have shown limitations especially in spinal stenosis (Ahn in Neurosurgery 75(2):124-133, 2014). Biportal endoscopic surgery is introduced to manage central and foraminal stenosis with its wide range of access angle and clear view.

METHODS: The authors provide an introduction of this technique followed by a description of the surgical anatomy with discussion on its indications and advantages. In particular, tricks to avoid complications are also presented.

CONCLUSIONS: Effective circumferential and focal decompression were achieved in most cases without damage to the spinal structural integrity with preservation of muscular and ligamentous attachments. The biportal endoscopic spinal surgery (BESS) may be safely used as an alternative minimally invasive procedure for lumbar spinal stenosis (Figs. 1 and 2).