Biportal Endoscopic Lumbar Ponte Osteotomy for Kyphosis: A Technical Note

Biportal endoscopic lumbar Ponte osteotomy (BELPO) is an innovative technique for correcting kyphotic deformities. Unlike the original technique, which maintains an intact anterior column, BELPO involves the endoscopic release of the anterior elements in addition to the endoscopic resection of the posterior elements in interbody fusion. BELPO is performed using unilateral biportal endoscopy with the patient in a prone position. First, a small incision is made in the midline over the interspinous gap. Through this gap, a generous portion of the spinous processes and interspinous ligament is removed. Using this incision as both the viewing and working portal, complete facetectomy and partial laminectomy are performed. Posterior compression is then applied to achieve the desired lordosis. Pedicle screws are fixed with cement augmentation. A 71-year-old female patient presented with low back pain and positive sagittal imbalance. She had a rigid posttraumatic kyphosis at L2–3 due to an old compression fracture at L3. After BELPO, the kyphosis at L2–3 improved from 21º to 2º. BELPO is a promising novel method of minimally invasive deformity correction, offering particular advantages for frail, osteoporotic patients.