What is biportal endoscopic spine surgery?
Unilateral biportal endoscopy (UBE) is an advanced surgical technique that can be used to treat various degenerative problems of the spine. It is a minimally invasive procedure, using small incisions, offering many advantages over traditional open surgery.
What does this technique consist of?
In biportal endoscopy, the surgeon makes two small incisions in the skin in order to insert a tiny camera and the necessary surgical instruments. Constant irrigation with sterile saline solution during the procedure provides an aquatic environment in which the camera moves easily, giving a clear view of the interior of the spine shown on a high-resolution screen, thus allowing the surgeon to work with great precision. For this reason, spinal endoscopy is referred to as surgery focused on a specific target.
This method offers several advantages for the patient:
1. Less postoperative pain
As it is a less aggressive technique involving less manipulation of the surrounding muscles, the pain of the surgery is significantly less than with open surgery.
2. Faster recovery
Most patients can return to their daily activities sooner than with traditional surgery. In fact, the patient is typically discharged 24 hours after the surgery, and is able to return home walking without support, and can expect to get back to their normal daily activities in 1 or 2 weeks.
3. Lower risk of complications
Minimally invasive surgery reduces the risk of infections, blood loss, muscle pain, and other postoperative problems.
4. Lower risk of spinal instability
As it is a minimally invasive surgical technique, there is less work affecting the bone structures, especially the facet joints. This decreases the risk of iatrogenic spinal instability, which, in turn, reduces the likelihood of needing fusion or arthrodesis surgery in the future.
5. Reduces the need for spinal arthrodesis/fusion surgery
Since it is a targeted procedure (aimed at a specific goal such as a disc hernia or a localized stenosis), in some cases this technique can avoid the need to perform major surgery with the risk of instability that entails, and thus reduces the need for intervertebral cages and/or screws.
6. Lower risk of CSF fistula
Because the incisions are so small, it is highly unlikely that cerebrospinal fluid (CSF) will leak through the incisions in the event of an unintentional tear in the dura mater.
What pathologies is it used for?
Unilateral biportal endoscopy is used to treat various conditions such as disc herniation:
- Disc herniation (central, foraminal, and extraforaminal)
- Lumbar canal stenosis (central, lateral recess, and foraminal)
- Joint cysts
- Adjacent segment disease
- Reoperations for previous open surgery
Because unilateral biportal endoscopy offers fewer complications and a shorter recovery time, it is a particularly useful and effective alternative for a wide range of patients: from elderly people with comorbidities who cannot be subjected to aggressive surgeries, to athletes in high-level competitive sports who need to return to their sports activities as soon as possible.
Biportal endoscopy can be used not only for certain pathologies in the lumbar spine, but also the cervical and thoracic spine, in appropriate cases.
In selected cases, when fusion surgery is required, the biportal endoscopy technique can also be used (placement of a titanium or PEEK interbody cage between two vertebrae), with the consequent advantage of minimal damage to the muscles and bone structures, reducing the pain typically associated with instrumented surgery. In this case, the interbody cage is placed endoscopically and the screws can be placed percutaneously assisted by neuronavigation.
Which patients are eligible for this surgery?
Not all patients are ideal candidates for this type of surgery. It is important for each person's case to be evaluated by an expert specialist to determine if this technique is the most appropriate. However, in general, patients suffering from disc herniation or compression of nerve structures (stenosis) whose pain has not responded to conservative treatments could benefit from this procedure.
Conclusion
Unilateral biportal endoscopy is an innovative surgical technique that offers a safe and effective alternative for treating various spinal conditions. With reduced pain, faster recovery, and a lower risk of complications, it represents an important advance in the field of spinal surgery and improves the patient's quality of life.
At Instituto Clavel we have extensive experience in this novel procedure, so if you have back pain or spinal problems and are considering haing surgery, you can talk to one of our specialists about whether this technique could be right for you.
Instituto Clavel, specialists in pathologies of the spine
At Instituto Clavel, we have a team of neurosurgeons who are experts in the treatment of spinal pathologies.
If you have more questions about endoscopic spine surgery or would like to make an appointment with one of our specialist doctors, please don’t hesitate to contact us.
Dr. Xavier Augusto Santander
Neurosurgeon
Specialist in minimally invasive and biportal endoscopic spine surgery.
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