Unilateral Biportal Endoscopy (UBE) – Latest endoscopic technique for spine discectomy and decompression

Unilateral Biportal Endoscopy (UBE) – Latest endoscopic technique for spine discectomy and decompression 

Surgical management after failed conservative methods for lumbar disc herniation and severe canal stenosis has evolved from open and microscopic decompression methods to advanced minimally invasive techniques. Traditionally, a facet preserving laminectomy is considered the best management option for patients with degenerative lumbar canal stenosis without instability and microdiscectomy is still the gold standard. 

Newer minimally invasive techniques preserve the spinal integrity and minimise tissue damage by limiting bony decompression and avoids removal of the midline structures. Endoscopic spine surgery has in itself evolved over the past decade with first and second generation transforaminal and interlaminar methods to the latest third/fourth generation techniques. Unilateral Biportal Endoscopy (UBE) technique is one such rapidly evolving technique and results from South east Asian countries who have pioneered in this method are encouraging. 

Unilateral biportal endoscopic (UBE) decompression is a minimally invasive approach performed in a clear and magnified surgical field with proper control of normal saline flow. It is performed using two small incisions of 5mm and discectomy/decompression is done under endoscopic vision using zero-degree endoscope with minimal bony work involved. As a spine surgeon with experience in traditional open, microscopic and tubular discectomy methods with good outcomes over a long term and with Orthopedic surgery background experienced in arthroscopy of knee, the learning curve for this technique was straight forward and comes with certain key advantages. 

We have evaluated patients who underwent single level discectomy or decompression by UBE technique and compared with microdiscectomy cohort performed earlier. Patient outcomes were assessed with operation time, hospital stay, complications and total hospitalization cost. We analysed the results and could conclude that UBE is a safe and effective technique for decompression in patients with degenerative lumbar canal stenosis. Compared to the microscopic and PELD techniques, continuous saline flow helps to keep the vision clear, the lens location is closer and deeper, being a semi tubular and biportal system helps the hands to move more independently. 

Compared to conventional laminectomy, preserving midline structures limits the soft tissue damage and minimal facet joint destruction helps maintain spinal stability. Being minimally invasive, it provides operational flexibility with a clear surgical field and reduced infection risk thereby making it a safe and effective alternative to other techniques. 

We share a couple of case examples from the spectrum managed using this latest technique. 

Case 1 – A 30-year-old software professional came with severe left leg pain after lifting heavy weight at the gym. MRI showed a disc protrusion at L45 with left sided root compression. He tried conservative methods of rest, medications and physiotherapy with no relief. He underwent UBE discectomy and got complete pain relief immediately and could walk home the same day. He resumed his work within couple of weeks and has no recurrence/complications on long term followup.

Image shows the large protruded disc being removed under endoscopic vision using UBE technique.

Case 2 – A 65-year-old lady was suffering from severe neurogenic claudication with difficulty in standing for 5 mins or walking for even 100m. She did not have much of back pain. MRI showed severe lumbar canal stenosis, a common problem due to age related degeneration of the spine. Traditionally, she would have to undergo an open laminectomy or a spinal fusion surgery for this problem. UBE helped us to manage with a keyhole surgery to efficiently decompress the spinal canal and her symptoms resolved completely. She can now go for regular walks daily and stand for long time in the kitchen comfortably and is extremely satisfied with the outcome. 

With very few centers in South India using this latest technique, we at Apollo BG road are privileged to offer advanced procedures with higher safety and efficiency so that patients can get back on their feet early, improve their activities of daily living and lead a pain free life.