{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:26Z","timestamp":1776096506273,"version":"3.50.1"},"reference-count":38,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"15","license":[{"start":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T00:00:00Z","timestamp":1776038400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,4,13]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Unilateral biportal endoscopic (UBE) spine surgery is an ultra\u2013minimally invasive technique that provides enhanced visualization while minimizing the tissue disruption associated with traditional open surgery. It utilizes separate portals for visualization and instrumentation, which allows for tactile feedback and freedom of movement similar to open procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>Despite these advantages, a significant barrier to the widespread adoption of endoscopic spine surgery can be capital expense for specialized endoscopic systems. This technical paper aims to overcome that barrier by providing a detailed, step-by-step guide for performing a UBE microdiscectomy utilizing standard arthroscopic and basic spine equipment that are widely available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The authors describe patient positioning, operating room setup, portal placement, fluid management, and a systematic approach to decompression. Key steps, including establishing the visualization window and managing hemostasis, are detailed. The authors also discuss postoperative considerations and provide technical tips to shorten the learning curve. By leveraging standard instrumentation, this technique makes the benefits of UBE surgery more accessible to surgeons and institutions, thereby lowering the financial barrier to adoption without compromising surgical goals.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE2678\">https:\/\/thejns.org\/doi\/10.3171\/CASE2678<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case2678","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:27:33Z","timestamp":1776094053000},"source":"Crossref","is-referenced-by-count":0,"title":["Cost-effective unilateral biportal endoscopic microdiscectomy: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Shivani","family":"Mody","sequence":"first","affiliation":[{"name":"Edward Via College of Osteopathic Medicine\u2013Virginia Campus, Blacksburg, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomo","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, US Naval Hospital Okinawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler C.","family":"Steed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, US Naval Hospital Okinawa, Japan"},{"name":"Department of Neurosurgery, Naval Medical Center San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ki-Eun","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Naval Medical Center San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6874-9307","authenticated-orcid":true,"given":"Michael H.","family":"Lawless DO","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, US Naval Hospital Okinawa, Japan"},{"name":"Department of Neurosurgery, Naval Medical Center San Diego, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"BMJ Open","first-page":"e064119","article-title":"Clinical and economic burden of low back pain in low- and middle-income countries: a systematic review","volume":"13","author":"Fatoye","year":"2023","unstructured":"Fatoye FGebrye TMbada CEUseh U.Clinical and economic burden of low back pain in low- and middle-income countries: a systematic review. BMJ Open. 2023;13(4):e064119. doi:10.1136\/bmjopen-2022-064119."},{"issue":"18","key":"bib2","series-title":"Spine (Phila Pa 1976)","first-page":"1492","article-title":"The incidence of low back pain in active duty United States military service members","volume":"36","author":"Knox","year":"2011","unstructured":"Knox JOrchowski JScher DLOwens BDBurks RBelmont PJ.The incidence of low back pain in active duty United States military service members. Spine (Phila Pa 1976). 2011;36(18):1492-1500. doi:10.1097\/BRS.0b013e3181f40ddd"},{"issue":"suppl 2","key":"bib3","series-title":"Pain Med","first-page":"S45","article-title":"Resolving the burden of low back pain in military service members and veterans (RESOLVE): protocol for a multisite pragmatic clinical trial","volume":"21","author":"Farrokhi","year":"2020","unstructured":"Farrokhi SRussell Esposito EMcPherson DResolving the burden of low back pain in military service members and veterans (RESOLVE): protocol for a multisite pragmatic clinical trial. Pain Med. 2020;21(suppl 2):S45-S52. doi:10.1093\/pm\/pnaa367"},{"issue":"1","key":"bib4","series-title":"J Orthop","first-page":"13","article-title":"Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis","volume":"10","author":"Polikandriotis","year":"2013","unstructured":"Polikandriotis JAHudak EMPerry MW.Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. 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Spine J. 2019;19(7):1162-1169. doi:10.1016\/j.spinee.2019.02.003"},{"key":"bib13","series-title":"Singapore Med J","article-title":"Lumbar endoscopic discectomy versus minimally invasive microdiscectomy: a retrospective cost-effectiveness study","author":"Wan","year":"2025","unstructured":"Wan JYJTan YYKoh LYRChew ZTeo HLT.Lumbar endoscopic discectomy versus minimally invasive microdiscectomy: a retrospective cost-effectiveness study. Singapore Med J. 2025. doi:10.4103\/singaporemedj.SMJ-2024-070"},{"issue":"3","key":"bib14","series-title":"Spine J","first-page":"438","article-title":"What is the learning curve for endoscopic spine surgery? A comprehensive systematic review","volume":"26","author":"Chan","year":"2025","unstructured":"Chan JPOlson TGabriel BWhat is the learning curve for endoscopic spine surgery? A comprehensive systematic review. Spine J. 2025;26(3):438-449. doi:10.1016\/j.spinee.2025.01.004"},{"issue":"1","key":"bib15","series-title":"Neurosurg Rev","first-page":"588","article-title":"Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of far-lateral lumbar disc herniation","volume":"48","author":"Qiao","year":"2025","unstructured":"Qiao HMa HShen MTang ZTan J.Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of far-lateral lumbar disc herniation. Neurosurg Rev. 2025;48(1):588. doi:10.1007\/s10143-025-03748-y"},{"issue":"3","key":"bib16","series-title":"J Neurosurg Spine","first-page":"351","article-title":"Comparison of lumbar microdiscectomy and unilateral biportal endoscopic discectomy outcomes: a single-center experience","volume":"40","author":"\u00d6zer","year":"2024","unstructured":"\u00d6zer M\u0130Demirta\u015f OK.Comparison of lumbar microdiscectomy and unilateral biportal endoscopic discectomy outcomes: a single-center experience. J Neurosurg Spine. 2024;40(3):351-358. doi:10.3171\/2023.10.SPINE23718"},{"issue":"6","key":"bib17","series-title":"Int J Spine Surg","first-page":"858","article-title":"Biportal endoscopic approach for lumbar degenerative disease in the ambulatory outpatient vs inpatient setting: a comparative study","volume":"17","author":"Park","year":"2023","unstructured":"Park DYOlson TEUpfill-Brown ABiportal endoscopic approach for lumbar degenerative disease in the ambulatory outpatient vs inpatient setting: a comparative study. Int J Spine Surg. 2023;17(6):858-865. doi:10.14444\/8545."},{"issue":"8","key":"bib18","series-title":"Eur Spine J","first-page":"2637","article-title":"Clinical outcomes and complications after biportal endoscopic spine surgery: a comprehensive systematic review and meta-analysis of 3673 cases","volume":"32","author":"Park","year":"2023","unstructured":"Park DYUpfill-Brown ACurtin NClinical outcomes and complications after biportal endoscopic spine surgery: a comprehensive systematic review and meta-analysis of 3673 cases. Eur Spine J. 2023;32(8):2637-2646. doi:10.1007\/s00586-023-07701-9"},{"key":"bib19","series-title":"World Neurosurg","first-page":"411","article-title":"Indications, contraindications, and complications of biportal endoscopic decompressive surgery for the treatment of lumbar stenosis: a systematic review","volume":"168","author":"Heo","year":"2022","unstructured":"Heo DHPark DYHong HJHong YHChung H.Indications, contraindications, and complications of biportal endoscopic decompressive surgery for the treatment of lumbar stenosis: a systematic review. 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Spine (Phila Pa 1976). 2011;36(18):1492-1500. doi:10.1097\/BRS.0b013e3181f40ddd"},{"issue":"suppl 2","key":"bib3","series-title":"Pain Med","first-page":"S45","article-title":"Resolving the burden of low back pain in military service members and veterans (RESOLVE): protocol for a multisite pragmatic clinical trial","volume":"21","author":"Farrokhi","year":"2020","unstructured":"Farrokhi SRussell Esposito EMcPherson DResolving the burden of low back pain in military service members and veterans (RESOLVE): protocol for a multisite pragmatic clinical trial. Pain Med. 2020;21(suppl 2):S45-S52. doi:10.1093\/pm\/pnaa367"},{"issue":"1","key":"bib4","series-title":"J Orthop","first-page":"13","article-title":"Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis","volume":"10","author":"Polikandriotis","year":"2013","unstructured":"Polikandriotis JAHudak EMPerry MW.Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop. 2013;10(1):13-16. doi:10.1016\/j.jor.2013.01.006"},{"issue":"5","key":"bib5","series-title":"Cureus","first-page":"e25202","article-title":"Evaluation of endoscopic versus open lumbar discectomy: a multi-center retrospective review utilizing the American College of Surgeons\u2019 National Surgical Quality Improvement Program (ACS-NSQIP) database","volume":"14","author":"Page","year":"2022","unstructured":"Page PSAmmanuel SGJosiah DT.Evaluation of endoscopic versus open lumbar discectomy: a multi-center retrospective review utilizing the American College of Surgeons\u2019 National Surgical Quality Improvement Program (ACS-NSQIP) database. Cureus. 2022;14(5):e25202. doi:10.7759\/cureus.25202"},{"issue":"9","key":"bib6","series-title":"Spine (Phila Pa 1976)","first-page":"931","article-title":"Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study","volume":"33","author":"Ruetten","year":"2008","unstructured":"Ruetten SKomp MMerk HGodolias G.Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008;33(9):931-939. doi:10.1097\/BRS.0b013e31816c8af7"},{"issue":"2","key":"bib7","series-title":"Int J Spine Surg","first-page":"173","article-title":"Endoscopic spine surgery: a French national survey on practices, motivations, and challenges","volume":"19","author":"Castel","year":"2025","unstructured":"Castel XSzadkowski Md\u2019Astorg H.Endoscopic spine surgery: a French national survey on practices, motivations, and challenges. Int J Spine Surg. 2025;19(2):173-178. doi:10.14444\/8722"},{"issue":"3","key":"bib8","series-title":"JB JS Open Access","first-page":"e22.00152","article-title":"Development of an endoscopic spine surgery program: overview and basic considerations for implementation","volume":"8","author":"Stone","year":"2023","unstructured":"Stone BKParadkar RAnderson GMDevelopment of an endoscopic spine surgery program: overview and basic considerations for implementation. JB JS Open Access. 2023;8(3):e22.00152. doi:10.2106\/JBJS.OA.22.00152"},{"issue":"1","key":"bib9","series-title":"J Neurosurg Spine","first-page":"77","article-title":"Hospital cost differences between open and endoscopic lumbar spine decompression surgery","volume":"40","author":"Findlay","year":"2023","unstructured":"Findlay MCHamrick FAKim RBTwitchell SMahan MA.Hospital cost differences between open and endoscopic lumbar spine decompression surgery. J Neurosurg Spine. 2023;40(1):77-83. doi:10.3171\/2023.8.SPINE23439"},{"key":"bib10","series-title":"J Clin Neurosci","article-title":"Fluid and thermal dynamics in endoscopic spine surgery: what surgeons need to know","volume":"136","author":"Kim","year":"2025","unstructured":"Kim DHKim SDKim JYHong JTHur JW.Fluid and thermal dynamics in endoscopic spine surgery: what surgeons need to know. 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Spine J. 2019;19(7):1162-1169. doi:10.1016\/j.spinee.2019.02.003"},{"key":"bib13","series-title":"Singapore Med J","article-title":"Lumbar endoscopic discectomy versus minimally invasive microdiscectomy: a retrospective cost-effectiveness study","author":"Wan","year":"2025","unstructured":"Wan JYJTan YYKoh LYRChew ZTeo HLT.Lumbar endoscopic discectomy versus minimally invasive microdiscectomy: a retrospective cost-effectiveness study. Singapore Med J. 2025. doi:10.4103\/singaporemedj.SMJ-2024-070"},{"issue":"3","key":"bib14","series-title":"Spine J","first-page":"438","article-title":"What is the learning curve for endoscopic spine surgery? A comprehensive systematic review","volume":"26","author":"Chan","year":"2025","unstructured":"Chan JPOlson TGabriel BWhat is the learning curve for endoscopic spine surgery? A comprehensive systematic review. Spine J. 2025;26(3):438-449. doi:10.1016\/j.spinee.2025.01.004"},{"issue":"1","key":"bib15","series-title":"Neurosurg Rev","first-page":"588","article-title":"Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of far-lateral lumbar disc herniation","volume":"48","author":"Qiao","year":"2025","unstructured":"Qiao HMa HShen MTang ZTan J.Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of far-lateral lumbar disc herniation. Neurosurg Rev. 2025;48(1):588. doi:10.1007\/s10143-025-03748-y"},{"issue":"3","key":"bib16","series-title":"J Neurosurg Spine","first-page":"351","article-title":"Comparison of lumbar microdiscectomy and unilateral biportal endoscopic discectomy outcomes: a single-center experience","volume":"40","author":"\u00d6zer","year":"2024","unstructured":"\u00d6zer M\u0130Demirta\u015f OK.Comparison of lumbar microdiscectomy and unilateral biportal endoscopic discectomy outcomes: a single-center experience. 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