Biportal Endoscopic Interlaminar Resection of Lumbar Facet Cyst: A Technical Note

Asrafi Rizki Gatam,1– 3 Luthfi Gatam,1– 3 Ajiantoro Ajiantoro,3 Omar Luthfi,3 Phedy Phedy,1,2 Harmantya Mahadhipta,1 Syafrudin Husin,1 Ilham Suryo Wibowo Antono,4 Erwin Ardian Noor,2 Karina Sylvana Gani,1 Mitchel Mitchel,1 Erica Kholinne1,5 1Department of Orthopedic and Traumatology, Gatam Institute Eka Hospital, Jakarta, Indonesia; 2Department of Orthopedic and Traumatology department, Fatmawati Hospital, Jakarta, Indonesia; 3Department of Orthopedic and Traumatology Department, Premier Bintaro Hospital, Jakarta, Indonesia; 4Orthopaedi dan Traumatologi Department, Faculty of Medicine Universitas Indonesia– Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; 5Department of Surgery, Faculty of Medicine, Universitas Trisakti, Jakarta, IndonesiaCorrespondence: Erica Kholinne, Department of Surgery, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia, Tel +628118682265, Email [email protected]: Facet cysts are degenerative lesions near the facet joints, often seen in older adults with lumbar or radicular pain. They can compress nerves and cause significant morbidity. Treatment options range from conservative care to surgery. This article outlines the Biportal Endoscopic Spine Surgery (BESS) technique using interlaminar ipsilateral or contralateral approaches for symptom relief.Methods: This paper outlines the surgical techniques of Biportal Endoscopic Spine Surgery (BESS), utilizing both ipsilateral and contralateral interlaminar approaches. The choice of approach was determined by the location and characteristics of the synovial cyst. It details the surgical process, including portal placement, visualization, trajectory differences between approaches, and steps for cyst removal.Results: Biportal endoscopic spine surgery is a safe and effective minimally invasive treatment for symptomatic lumbar facet cysts, especially in elderly patients. The contralateral approach offers better visualization, improved dural dissection, and greater facet joint preservation, making it ideal for medial or adherent cysts. It also reduces nerve root manipulation and postoperative instability. In contrast, the ipsilateral approach is more suitable for lateral cysts.Conclusion: The choice between contralateral and ipsilateral approaches in biportal endoscopic facet cyst removal depends on cyst location and anatomical considerations. The contralateral approach is better suited for medial or adherent cysts, offering improved access with less facet disruption. Meanwhile, the ipsilateral approach provides a direct path for lateral cysts but may require more nerve manipulation and facet joint resection. A personalized surgical strategy is essential to optimize access, ensure nerve safety, and maintain spinal stability.Keywords: biportal endoscopic, contralateral, ipsilateral, interlaminar approach, facet cyst, lumbar