Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Neurosurgery. Spine



Biportal endoscopic spine surgery (BESS) is a minimally invasive spinal surgery which has gained increased traction for lumbar laminectomy and discectomy. To justify the transition from tubular or open surgery to BESS, BESS outcomes and surgical learning curve should be known. The primary goal of this study is to evaluate rates of complications with BESS as well as how these rates change with increased surgeon experience, especially in the US environment.


A United States Fellowship trained orthopaedic surgeon's clinical practice database was interrogated for consecutive patients who underwent BESS at a single institution. Patients aged greater than 18 years who underwent BESS for lumbar laminectomy and discectomy were included. Patients with prior lumbar spine surgery or who underwent BESS for fusion were excluded. Demographics, length of surgery, intra-op blood loss, intra-op complications, post-op complications, reoperation. Patients were distributed into a learning phase group and a mastery phase group based on a cumulative summation analysis based on operative time.


A total of 49 patients who underwent BESS for lumbar laminectomy and discectomy were included. There were 31 patients in the learning phase group, and 18 patients in the mastery phase group. There was no difference in age, gender, or BMI between groups (p>0.05). The total average operative time was 76 minutes, with an average operative time of 87 minutes and 56 minutes for the learning phase and mastery phase groups, respectively. Conversion to open decreased from 3 to 0 cases (p=0.1803), intraoperative complications decreased from 3 to 0 (p=0.1803), post-operative complications decreased from 8 to 2 (p=0.017), and rates of reoperation decreased from 5 to 0 (p=0.0281). No patient received a lumbar drain and there were no cases of post-op epidural hematoma. Blood loss and length of hospital stay were not statistically significant between the two groups.


This study suggests a learning curve of 31 cases for adequate performance of BESS for lumbar laminectomy and discectomy.





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Lumbar Spine Research Society 16th Annual Scientific Meeting, May 11-12, 2023, Chicago, IL