{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T20:55:34Z","timestamp":1790974534297,"version":"4.1.0"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>The treatment for lumbar spinal stenosis has advanced through the use of minimally invasive surgery techniques. Endoscopic methods go even further, with studies showing that both uniportal and biportal endoscopic techniques have outcomes comparable to traditional approaches. However, there is limited knowledge of the step-by-step decompression process when using the unilateral biportal endoscopic (UBE). To address this, the authors introduce the five steps in the \"Z\" sequence, which aims to reduce surgical time and complications.<\/jats:p>\n                  <jats:p>\n                    The video can be found here:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/stream.cadmore.media\/r10.3171\/2024.1.FOCVID23182\">https:\/\/stream.cadmore.media\/r10.3171\/2024.1.FOCVID23182<\/jats:ext-link>\n                  <\/jats:p>","DOI":"10.3171\/2024.1.focvid23182","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T03:00:44Z","timestamp":1711940444000},"page":"V3","source":"Crossref","is-referenced-by-count":10,"title":["Five-step unilateral biportal endoscopic surgery for central lumbar canal stenosis: \"Z\" technique nuance"],"prefix":"10.3171","volume":"10","author":[{"given":"Ariel","family":"Kaen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Virgen del Roc\u00edo, Seville, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier","family":"Quillo-Olvera","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Spine Center, Hospital Angeles Centro Sur, Quer\u00e9taro City, Mexico;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man Kyu","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Good Gangan Hospital, Busan, Korea; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Rocha","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Virgen del Roc\u00edo, Seville, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Durand","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Virgen del Roc\u00edo, Seville, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Virgen del Roc\u00edo, Seville, Spain;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Kyu","family":"Son","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Good Moonhwa Hospital, Busan, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Clin Spine Surg","first-page":"E162","article-title":"Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches","volume":"30","author":"Bresnahan LE","year":"2017","unstructured":"Bresnahan LE, Smith JS, Ogden AT,  Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches. Clin Spine Surg. 2017;30(3):E162\u2013E168."},{"issue":"5","key":"b2","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery","volume":"46","author":"Heo DH","year":"2019","unstructured":"Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus. 2019;46(5):E9."},{"key":"b3","series-title":"Front Surg","first-page":"1061566","article-title":"Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis","volume":"9","author":"Hu Y","year":"2023","unstructured":"Hu Y, Fu H, Yang D, Xu W. Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis. Front Surg. 2023;9:1061566."},{"issue":"8","key":"b4","series-title":"Eur Spine J","first-page":"2717","article-title":"Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis","volume":"32","author":"Kaen A","year":"2023","unstructured":"Kaen A, Park MK, Son SK. Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis. Eur Spine J. 2023;32(8):2717\u20132725."},{"key":"b5","series-title":"Unilateral Biportal Endoscopy of the Spine: An Atlas of Surgical Techniques","first-page":"205","article-title":"Unilateral biportal endoscopy for complex lumbar disc herniations","author":"Kaen A","year":"2022","unstructured":"Kaen A, Yoshimizu T, Durand Neyra F. Unilateral biportal endoscopy for complex lumbar disc herniations. In: Quillo-Olvera J, Quillo-Olvera D, Quillo-Res\u00e9ndiz J, Mayer M, eds .Unilateral Biportal Endoscopy of the Spine: An Atlas of Surgical Techniques. Springer International Publishing; 2022:205\u2013225."},{"issue":"24","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"1756","article-title":"Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis","volume":"43","author":"Lee CH","year":"2018","unstructured":"Lee CH, Choi M, Ryu DS,  Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis. Spine (Phila Pa 1976). 2018;43(24):1756\u20131764."},{"issue":"4","key":"b7","series-title":"J Neurosurg Spine","first-page":"491","article-title":"Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression","volume":"30","author":"McGrath LB","year":"2019","unstructured":"McGrath LB, White-Dzuro GA, Hofstetter CP. Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. J Neurosurg Spine. 2019;30(4):491\u2013499."},{"issue":"4","key":"b8","series-title":"Eur J Orthop Surg Traumatol","first-page":"595","article-title":"Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis","volume":"30","author":"Pairuchvej S","year":"2020","unstructured":"Pairuchvej S, Muljadi JA, Ho JC, Arirachakaran A, Kongtharvonskul J. Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2020;30(4):595\u2013611."},{"issue":"2","key":"b9","series-title":"Spine J","first-page":"156","article-title":"Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial","volume":"20","author":"Park SM","year":"2020","unstructured":"Park SM, Park J, Jang HS,  Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial. Spine J. 2020;20(2):156\u2013165."},{"key":"b10","series-title":"Front Surg","first-page":"873691","article-title":"The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis","volume":"9","author":"Chen L","year":"2022","unstructured":"Chen L, Zhu B, Zhong HZ,  The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis. Front Surg. 2022;9:873691."},{"key":"b11","series-title":"World Neurosurg","first-page":"e371","article-title":"Complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: a meta-analysis and systematic review","volume":"170","author":"Chen Z","year":"2023","unstructured":"Chen Z, Zhou H, Wang X, Liu Z, Liu W, Luo J. Complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: a meta-analysis and systematic review. World Neurosurg. 2023;170:e371\u2013e379."},{"issue":"3","key":"b1","series-title":"Clin Spine Surg","first-page":"E162","article-title":"Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches","volume":"30","author":"Bresnahan LE","year":"2017","unstructured":"Bresnahan LE, Smith JS, Ogden AT,  Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches. Clin Spine Surg. 2017;30(3):E162\u2013E168."},{"issue":"5","key":"b2","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery","volume":"46","author":"Heo DH","year":"2019","unstructured":"Heo DH, Lee DC, Park CK. Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus. 2019;46(5):E9."},{"key":"b3","series-title":"Front Surg","first-page":"1061566","article-title":"Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis","volume":"9","author":"Hu Y","year":"2023","unstructured":"Hu Y, Fu H, Yang D, Xu W. Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis. Front Surg. 2023;9:1061566."},{"issue":"8","key":"b4","series-title":"Eur Spine J","first-page":"2717","article-title":"Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis","volume":"32","author":"Kaen A","year":"2023","unstructured":"Kaen A, Park MK, Son SK. Clinical outcomes of uniportal compared with biportal endoscopic decompression for the treatment of lumbar spinal stenosis: a systematic review and meta-analysis. Eur Spine J. 2023;32(8):2717\u20132725."},{"key":"b5","series-title":"Unilateral Biportal Endoscopy of the Spine: An Atlas of Surgical Techniques","first-page":"205","article-title":"Unilateral biportal endoscopy for complex lumbar disc herniations","author":"Kaen A","year":"2022","unstructured":"Kaen A, Yoshimizu T, Durand Neyra F. Unilateral biportal endoscopy for complex lumbar disc herniations. In: Quillo-Olvera J, Quillo-Olvera D, Quillo-Res\u00e9ndiz J, Mayer M, eds .Unilateral Biportal Endoscopy of the Spine: An Atlas of Surgical Techniques. Springer International Publishing; 2022:205\u2013225."},{"issue":"24","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"1756","article-title":"Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis","volume":"43","author":"Lee CH","year":"2018","unstructured":"Lee CH, Choi M, Ryu DS,  Efficacy and safety of full-endoscopic decompression via interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine: a meta-analysis. Spine (Phila Pa 1976). 2018;43(24):1756\u20131764."},{"issue":"4","key":"b7","series-title":"J Neurosurg Spine","first-page":"491","article-title":"Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression","volume":"30","author":"McGrath LB","year":"2019","unstructured":"McGrath LB, White-Dzuro GA, Hofstetter CP. Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression. J Neurosurg Spine. 2019;30(4):491\u2013499."},{"issue":"4","key":"b8","series-title":"Eur J Orthop Surg Traumatol","first-page":"595","article-title":"Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis","volume":"30","author":"Pairuchvej S","year":"2020","unstructured":"Pairuchvej S, Muljadi JA, Ho JC, Arirachakaran A, Kongtharvonskul J. Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis. Eur J Orthop Surg Traumatol. 2020;30(4):595\u2013611."},{"issue":"2","key":"b9","series-title":"Spine J","first-page":"156","article-title":"Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial","volume":"20","author":"Park SM","year":"2020","unstructured":"Park SM, Park J, Jang HS,  Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial. Spine J. 2020;20(2):156\u2013165."},{"key":"b10","series-title":"Front Surg","first-page":"873691","article-title":"The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis","volume":"9","author":"Chen L","year":"2022","unstructured":"Chen L, Zhu B, Zhong HZ,  The learning curve of unilateral biportal endoscopic (UBE) spinal surgery by CUSUM analysis. Front Surg. 2022;9:873691."},{"key":"b11","series-title":"World Neurosurg","first-page":"e371","article-title":"Complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: a meta-analysis and systematic review","volume":"170","author":"Chen Z","year":"2023","unstructured":"Chen Z, Zhou H, Wang X, Liu Z, Liu W, Luo J. Complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: a meta-analysis and systematic review. 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