Abstract
INTRODUCTION: 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.