Functional Outcome of Biportal Endoscopic Spine Surgery Versus Destandau Endoscopic Spine Surgery: A Structured Narrative Review

Minimally invasive spine surgery (MISS) has revolutionized the management of degenerative spinal disorders by reducing surgical morbidity and accelerating recovery. Biportal endoscopic spine surgery (BESS) and Destandau endoscopic spine surgery (DESS) are two advanced minimally invasive techniques for managing lumbar degenerative conditions, including lumbar disc herniation (LDH) and spinal stenosis, which have gained prominence. BESS utilizes two separate portals for endoscopic visualization and instrumentation, providing a wider operative field and greater flexibility in addressing complex pathologies. In contrast, DESS employs a single-port system with a rigid endoscope, known for its simplicity and shorter learning curve. This review evaluates and compares these techniques based on functional outcomes, perioperative characteristics, and complications. Studies consistently report significant postoperative improvements in pain relief and functional disability scores (e.g., Visual Analog Scale (VAS), Oswestry Disability Index (ODI)) with both techniques. BESS, however, shows a trend toward faster recovery, reduced postoperative pain, and earlier return to normal activities compared to DESS. Complication rates are low and comparable for both approaches, although technical challenges with BESS, such as longer operative time and steeper learning curve, are noted in early stages of adoption. DESS is often preferred in cases requiring straightforward decompression due to its ease of execution. Both techniques minimize tissue trauma, preserve spinal stability, and reduce the risk of postoperative infections. This review aims to guide clinicians in choosing the optimal technique based on patient and procedural factors. This article was conducted as a structured narrative review utilizing a comprehensive literature search methodology.