Objective: With the latest advances and innovations in field of spine surgery, the new generation of spine surgeons has been increasingly preferring the endoscopic lumbar interbody fusion technique to treat the pathology of lumbar degenerative disease. The aim of this study was to elucidate the clinical and radiologic outcomes of biportal endoscopic lumbar interbody fusion with a long polyetheretherketone (PEEK) cage.Methods: This study included 40 patients treated by biportal endoscopic lumbar interbody fusion with a long PEEK cage between January 2020 and December 2021. The clinical evaluation was conducted using improvements in visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores. Radiological outcomes were evaluated by changes in disc height and segmental and lumbar lordosis. Fusion was assessed based on computed tomography scans using the Bridewell criteria. Surgical parameters (e.g., operative duration, blood loss and complications) were noted.Results: Of the 40 patients in this study, 13 were male and 27 were female. Most patients had significant clinical improvement as indicated by improvements in VAS and ODI scores (p < 0.05). Disc height, segmental lordosis, and lumbar lordosis showed significant improvements (p < 0.05). The mean surgical duration was 180 minutes, and the mean blood loss was 80 mL. All patients had grade 1 or 2 fusion.Conclusion: Biportal endoscopic fusion using a long PEEK cage is an excellent option for achieving good interbody fusion when indicated. A long-term follow-up study would be needed to fully clarify the effectiveness of this procedure.

Foraminal disc herniation at the C2–3 level is a very rare entity, for which a consensus treatment protocol has not been established. This case report explains that unilateral biportal endoscopic foraminotomy is a very effective, minimally invasive, and safe procedure for this condition. A 62-year-old woman presented to our clinic with complaints of a 6-week history of posterior axial neck pain and sudden onset of hypoesthesia over the right periauricular region, face and lip. Magnetic resonance imaging (MRI) revealed C2–3 right foraminal disc herniation, and posterior cervical foraminotomy was done using the unilateral biportal endoscopic technique. The patient reported complete relief of the axial neck pain soon after surgery and gradual improvement of the hypoesthesia. Postoperative MRI showed complete removal of the compressing disc fragment. In conclusion, this case shows that a minimally invasive biportal endoscopic procedure can be a better choice for decompression than many extensive and destructive procedures. This is the first case report in the literature describing the management of C2–3 foraminal disc herniation by posterior cervical unilateral biportal endoscopic foraminotomy.