Study details biportal endoscopic L7–S1 foraminotomy in dogs: full analysis

Version 2 — Full analysis

A newly published Veterinary Surgery paper puts a sharper point on minimally invasive canine spine surgery, describing biportal endoscopic foraminotomy of the L7–S1 neuroforamen in dogs and comparing it with conventional open dorsolateral foraminotomy. In the ex vivo portion of the study, the biportal technique performed with a 3.0 mm arthroscope produced superior visualization and greater foraminal enlargement than the open approach, and the authors also report successful use in the first client-owned dog treated with the method. The article was published online ahead of print on March 12, 2026. (pubmed.ncbi.nlm.nih.gov)

The work builds on a longer arc of efforts to improve surgical treatment for canine lumbosacral foraminal stenosis. Conventional decompressive surgery is well established, but exposure can be limited and soft tissue disruption can be substantial. Earlier veterinary work from 2004 showed that endoscopic-assisted lumbosacral foraminotomy was feasible in clinically normal dogs and could enlarge parts of the foramen, although some loss of that enlargement occurred by 12 weeks. More recent reports have continued to highlight both the clinical importance of L7 nerve root compression and the difficulty of standardizing outcome assessment in dogs with lumbosacral pain. (pubmed.ncbi.nlm.nih.gov)

In the Zurich-led study, investigators set out to do three things: establish a surgical technique for minimally invasive biportal endoscopic foraminotomy, compare it with dorsolateral foraminotomy, and report the first clinical case. According to the conference abstract that preceded the full paper, the ex vivo comparison used 12 spinal specimens and evaluated three approaches: open dorsolateral foraminotomy, biportal endoscopic foraminotomy with a 3.0 mm arthroscope, and biportal endoscopic foraminotomy with a 1.9 mm NanoNeedle scope. The 3.0 mm arthroscope approach achieved a mean neuroforaminal enlargement of 76% ± 33%, compared with 46% ± 23% for the open approach, and it required less manipulation of the L7 nerve root while providing better visualization. (academic.oup.com)

That detail matters because the instrumentation appears to be part of the story. The authors’ PubMed abstract highlights superiority for the arthroscope-based version of the technique, not simply for “endoscopy” in general. That aligns with other recent canine spine studies suggesting that portal placement, optics, and working space can materially affect what surgeons can safely accomplish through minimally invasive approaches. In 2025, a separate cadaveric Frontiers study on biportal endoscopic lumbosacral foraminotomy in dogs similarly positioned unilateral biportal endoscopy as a way to improve visualization while limiting surgical trauma. Other groups have reported feasibility for biportal endoscopic cervical decompression and endoscopic thoracolumbar procedures, reinforcing that this is becoming a broader platform in veterinary spinal surgery rather than a single isolated technique. (pubmed.ncbi.nlm.nih.gov)

Direct outside commentary on this specific paper appears limited so far, which isn’t unusual for a newly published veterinary surgery study. But the wider literature offers a consistent rationale for why surgeons are interested. Reviews and comparative studies in both veterinary and human spine surgery have associated minimally invasive and biportal approaches with improved visualization and potentially less soft tissue morbidity, even as they also point to learning-curve and case-selection issues. In other words, the enthusiasm is real, but it’s still tied to technical execution and evidence development. (sciencedirect.com)

Why it matters: For veterinary professionals, this paper is less about replacing open surgery tomorrow and more about expanding the toolkit for a difficult subset of lumbosacral disease. Foraminal stenosis can be frustrating to treat because the pathology is anatomically constrained, imaging findings don’t always map cleanly to pain, and durable decompression is not guaranteed. A technique that improves visualization and enlarges the neuroforamen more effectively in an ex vivo model could translate into less nerve root handling, smaller approaches, and potentially faster recovery for selected dogs. But the evidence base is still early: this report includes cadaveric work and a single clinical case, so questions around repeatability, complications, training requirements, operative time, cost, and long-term outcomes remain open. (pubmed.ncbi.nlm.nih.gov)

This also lands in the context of a broader shift in referral practice. As more specialty centers adopt arthroscopy towers, high-definition imaging, and surgeons cross-trained in minimally invasive orthopedics or neurosurgery, procedures like biportal endoscopic foraminotomy may become more realistic in advanced settings. That said, the practical barriers are obvious: equipment investment, case volume, and the need for procedural training may limit uptake outside referral hospitals in the near term. That makes careful patient selection and transparent conversations with pet parents especially important if interest in these procedures grows. This last point is an inference based on the technical demands and equipment described across the emerging literature. (pubmed.ncbi.nlm.nih.gov)

What to watch: Watch for larger prospective clinical series, outcome measures that better capture lumbosacral pain and function, and whether centers publishing on cervical and thoracolumbar endoscopic techniques begin reporting multi-procedure spine programs in dogs over the next 12 to 24 months. (frontiersin.org)