Biportal Endoscopic Spine Surgery: Evolution of Techniques, Indications, and Influential Literature

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.