From Conventional to Biportal Endoscopic Surgery: The Transition Observed by an Expert Surgeon

Low back pain is the leading cause of years lost to disability worldwide. New technologies have made an advancement in minimally invasive spine surgery techniques indicated for degenerative spinal conditions and disc herniation, with various techniques emerging as alternatives to conventional microscopic surgery, including the unilateral biportal endoscopic (UBE) surgical technique. Clinical evidence indicates that endoscopic techniques are a better alternative to achieve faster pain relief and restore spinal stability when compared to microscopic techniques. However, the degree of preservation of paraspinal structures and neural decompression in endoscopic surgery often depends on the proficiency of surgeons, where outcomes of both uniportal and biportal endoscopic techniques can be assessed by the applied pathology. As surgeons attain more experience with endoscopic spine surgery, the projected expansion of indications and utility with good clinical outcomes will increase over open spine surgery approaches. This expert description presents the transition, future perspectives, and current development of endoscopic spine surgery.