Biportal endoscopic spine surgery for removal of pedicle fixation hardware

Biportal endoscopic spine surgery (BESS) represents an evolution in the realm of minimally invasive spinal procedures. By utilizing two independent working and viewing portals, BESS provides a surgical environment that approximates the triangulated manoeuvrability of open procedures, while minimising tissue disruption [[1], [2], [3]]. Recently, its indications have expanded from discectomies and laminectomies to transforaminal interbody fusions and increasingly, complex revision procedures involving instrumentation [[4], [5], [6], [7]]. Hardware-related complications following lumbar fusion, such as screw prominence and facet joint impingement, may cause pain and neurological symptoms. Traditional open revision approaches are associated with more muscle dissection and delayed postoperative recovery. BESS offers a minimally invasive, tissue-sparing alternative for hardware removal, particularly in patients with a stable anterior column. The precise anatomical visualization offered by endoscopy enables surgeons to operate within a magnified, haemostatic, and fluid-maintained environment [4,8,9,10].