Biportal endoscopy shows promise for canine L7–S1 foraminotomy: full analysis

A newly published Veterinary Surgery study offers one of the clearest signs yet that biportal endoscopic spine surgery is moving from experimental technique toward real clinical use in dogs. Published online ahead of print on March 12, 2026, the paper describes biportal endoscopic foraminotomy of the L7–S1 neuroforamen and compares it directly with conventional open dorsolateral foraminotomy, while also reporting the first client-owned dog treated with the approach. In the head-to-head cadaveric comparison, the arthroscope-based biportal technique outperformed the open approach on visualization and achieved greater neuroforaminal enlargement. (pubmed.ncbi.nlm.nih.gov)

The clinical target here is lumbosacral foraminal stenosis, a subtype of degenerative lumbosacral disease that can compress the exiting L7 nerve root and cause pain, root-signature signs, and pelvic limb dysfunction. Conventional decompression options, including dorsal and lateral approaches, can be effective, but they come with tradeoffs: restricted exposure in a difficult anatomic region, substantial paraspinal muscle dissection, and concern for postoperative pain, instability, or prolonged recovery. Those limitations have fueled interest in endoscopic alternatives for years, including an earlier 2004 report of endoscopic-assisted lumbosacral foraminotomy in dogs. (pmc.ncbi.nlm.nih.gov)

In the new study, the investigators developed two biportal techniques in cadavers, one using a 3.0 mm 30° arthroscope and one using a 1.9 mm 0° needle arthroscope, then compared both with standard dorsolateral foraminotomy. Across 12 cadaveric spinal specimens, covering 24 neuroforamina, all three methods significantly enlarged the foramen. Mean enlargement across procedures was 58% overall, but the arthroscope-based biportal approach achieved the largest increase, at 81.3%, versus 59.7% for open dorsolateral foraminotomy and 51.1% for the needle arthroscope approach. The arthroscope-based method also provided significantly better visualization, and no iatrogenic nerve root damage was seen in any group. (pubmed.ncbi.nlm.nih.gov)

That result lands in the middle of a fast-developing body of veterinary literature around unilateral biportal endoscopy. A 2025 cadaveric study of biportal endoscopic lumbosacral foraminotomy likewise found the approach technically feasible, with significant CT-measured enlargement at the entry, middle, and exit zones of the foramen and no damage to critical structures. Separate 2025 work in Veterinary Surgery extended UBE into thoracolumbar mini-hemilaminectomy, where investigators reported better visualization with optimized portal placement and stable epidural pressure in live dog models. Another recent canine study evaluated unilateral biportal endoscopic partial cervical laminectomy and facetectomy as a minimally invasive option for dorsal cervical decompression. Taken together, these reports suggest veterinary spine surgeons are not looking at a one-off trick, but at a platform approach that may be adaptable across spinal regions. (pubmed.ncbi.nlm.nih.gov)

The broader human spine literature helps explain the enthusiasm, even if direct translation to dogs has limits. Human meta-analyses have found unilateral biportal endoscopy can offer comparable decompression with less tissue trauma than more traditional approaches in selected lumbar stenosis cases, though outcomes depend heavily on indication, surgeon experience, and complication management. The canine authors make a similar point indirectly: better visualization and less soft tissue disruption are attractive, but anatomy differs, especially around the canine iliac wing and lumbosacral biomechanics, so veterinary-specific technique development matters. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary professionals, the practical significance is less about replacing open lumbosacral surgery tomorrow and more about where referral-level spine care may be heading. If larger clinical studies confirm similar decompression with less tissue disruption, biportal endoscopy could become an option for selected dogs with foraminal stenosis, particularly where pain, return-to-function, and surgical morbidity are major considerations. It may be especially relevant in working or performance dogs, a population already highlighted in the lumbosacral literature because faster recovery can carry outsized value. But this is still an early-evidence moment. The new paper includes one clinical case, not a case series, and the related cadaveric studies themselves note that procedures on normal specimens may underestimate the difficulty of operating in dogs with true pathologic stenosis. (pubmed.ncbi.nlm.nih.gov)

There’s also an implementation question. Biportal techniques demand endoscopic equipment, fluoroscopic or advanced imaging familiarity, and a real learning curve. Human studies have specifically examined UBE learning curves, underscoring that technical success is tied to training and repetition. In veterinary medicine, that likely means adoption will remain concentrated in academic centers and high-end specialty practices until training pathways, case selection criteria, and outcome data mature. (pubmed.ncbi.nlm.nih.gov)

What to watch: The key next milestone is not another cadaver paper, but multi-case clinical follow-up: complication rates, neurologic and pain outcomes, revision frequency, recurrence, cost, and time to functional recovery versus open surgery. If those data arrive over the next few years, biportal endoscopy could shift from an intriguing technical advance to a credible referral option for canine lumbosacral decompression. (pubmed.ncbi.nlm.nih.gov)