Unilateral Biportal Endoscopy for Complex Lumbar Disc Herniations

Abstract

When applied to symptomatic lumbar disc herniation, unilateral biportal endoscopic (UBE) surgery can achieve the same surgical anatomy as microsurgery with a minimal footprint, regardless of aggressiveness. The spectrum of endoscopic discectomy is expanding gradually, with some past contraindications now becoming indications. UBE has been showing similar clinical outcomes compared with microscopic surgery, but it also showed improved blood loss, reduced length of hospital stay, and reduced postoperative pain. Most spinal surgeons start their surgical training with a lumbar disc herniation (LDH) recommended in endoscopic surgery. However, a herniated disc should not be underestimated since it can sometimes represent a very complex surgery, with high risks of complications such as a dural tear, neurological injury, or insufficient decompression. Throughout this chapter, we continue with the approaches to complex LDH. It is essential to identify the factors that increase the difficulty when performing surgery. The concept of “complex” LDH depends on numerous factors, not only on the surgeon’s experience but also on the degenerative diseases associated with herniated discs. As we will observe in the clinical cases of the chapter, a herniated disc can be simple, but if it is related to severe lumbar canal stenosis or some sign of instability, the difficulty increases. The outcome of our patient requires correct preoperative planning, perfect intraoperative execution, and meticulous care after the surgical intervention.