Purpose
Revision lumbar surgery following posterior decompression is technically challenging because epidural adhesions and altered anatomy increase the risk of complications during posterior re-entry. Surgical approaches that avoid the previously operated corridor may reduce these risks. Biportal endoscopic lumbar interbody fusion using an extraforaminal approach allows direct neural decompression and interbody fusion through a new surgical corridor, which may be advantageous in revision settings. However, clinical evidence regarding this technique in revision surgery remains limited. To evaluate the clinical and radiological outcomes of biportal endoscopic revision extraforaminal lumbar interbody fusion (BE-REFLIF) performed at lumbar segments previously treated with central decompression.
Materials and Methods
This study is Single-center retrospective case series.We retrospectively reviewed 20 consecutive patients who underwent single-level BE-REFLIF as revision surgery after prior central decompression between September 2017 and June 2024. Clinical outcomes were assessed using the visual analogue scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the EuroQol-5D (EQ-5D). Radiological outcomes included disc height, segmental alignment, lumbar lordosis, fusion status, and cage subsidence. Perioperative data and postoperative complications were also analyzed.
Results
Significant improvements were observed in all clinical outcome measures during follow-up. Mean VAS scores for back and leg pain and ODI decreased significantly over time (p < 0.001). Radiological analysis demonstrated significant restoration of disc height, improvement in segmental alignment, and maintenance of lumbar lordosis. Solid fusion was achieved in 85% of patients at the final follow-up, and cage subsidence occurred in 25% of cases without the need for reoperation. Perioperative complications included dural tears in 10% of patients, epidural hematoma in 5%, and surgical site infection in 5%, with no instrumentation-related failures.
Conclusions
Biportal endoscopic revision extraforaminal lumbar interbody fusion demonstrated favorable clinical and radiological outcomes in patients undergoing revision surgery after previous central decompression. By utilizing an extraforaminal corridor that avoids scarred posterior tissues, BE-REFLIF allows effective direct decompression and interbody fusion with an acceptable complication profile. This technique may represent a viable and less invasive option for selected patients requiring revision lumbar fusion.

Recently, favorable results of minimally invasive spinal surgery have been reported in comparison to the open decompression or fusion surgery. Biportal endoscopic spine surgery (BESS) has several benefits and Indications for BESS are nearly identical to those for general open spinal surgery. However, it remains a challenging procedure even for an experienced endoscopic surgeon. because it takes a a long operation time while early learning period. If the operation time is prolonged, the advantages of endoscopic surgery are reduced and the incidence of complications can be increased. Therefore, we will investigate the factors affecting the operation time and how to minimize it before and during operation.

Purpose
of Study: Purpose of this study is to summarize the technique of UBE surgery in lumbar interbody fusion and review the clinical outcomes and complications of UBE surgery in lumbar interbody fusion.
Materials and Methods
Medical databases were searched for the key words of unilateral biportal endoscopic surgery and lumbar spinal stenosis using PubMed from 2005 to the present.
Conclusion
UBE spinal surgery is a new technique that can be a feasible alternative and an effective treatment modality for spinal degenerative diseases and can achieve the necessary surgical skills for experienced microscopic surgeons, which is still expanding the indications for lumbar spinal surgery.

Purpose
of study: The purpose of this study is to understand the biomechanics of interspinous devices in lumbar spinal surgery and to review the effectiveness of the devices for lumbar spinal stenosis through recent related articles.
Materials and Methods
Medical databases were searched for the key words of interspinous device and lumbar spinal stenosis using PubMed from 2010 to the present.
Results
Several studies have shown sustained symptomatic improvements after interspinous device insertion. However, most of the prospective, randomized, double-blinded studies have shown that it is not superior to conventional laminectomy from a statistical perspective. Furthermore, interspinous device insertion has been shown to have a higher reoperation rate and to be less cost effective.
Conclusions
A large prospective cohort study with a longer follow-up period comparing decompressive surgery alone versus interspinous device insertion for the treatment of lumbar spinal stenosis is needed to conclusively determine whether the interspinous device is beneficial.

Neurological complications related to spinal surgery are not common, but can result in catastrophic clinical failures. The ultimate goal during the operation should be to try to reduce and prevent a severe neurologic complication by careful preoperative planning and attention to trivial details related to the patients and their pathologies. It is very critical and important to understand the potential neurological complications that can occur during the operation and to manage them if they should happen. In our review article, general principles associated with various neurologic complications are reviewed and discussed.