UNILATERAL BIPORTAL ENDOSCOPIC DISCECTOMY FOR LUMBAR DISC HERNIATION: CURRENT EVIDENCE, MORPHOLOGY-ORIENTED SURGICAL STRATEGY, AND A PROPOSED UBE-MAP FRAMEWORK

Abstract

Background. Unilateral biportal endoscopic discectomy (UBED) has emerged as a tissue-preserving alternative to microscopic and uniportal endoscopic surgery for lumbar disc herniation. Its independent visualization and working portals permit bimanual instrumentation, panoramic epidural inspection, targeted laminotomy, and adaptable fragment retrieval during continuous irrigation.

Materials and methods. Peer-reviewed clinical trials, comparative cohorts, technical studies, and complication analyses published through July 2026 were examined. Evidence was organized according to herniation location, migration grade, access corridor, neural decompression, preservation of the facet–lamina complex, perioperative outcomes, and failure mechanisms.

Results. Randomized and comparative investigations demonstrate that UBED provides leg-pain relief, disability improvement, and quality-of-life recovery comparable to microscopic discectomy and other endoscopic techniques. Potential advantages include reduced paraspinal muscle injury, limited cutaneous trauma, enhanced visualization, shorter hospitalization, and versatile access to central, paracentral, migrated, foraminal, extraforaminal, upper-lumbar, and recurrent fragments. These benefits are technique-dependent rather than automatic. Inadequate localization, excessive facet resection, uncontrolled irrigation, epidural bleeding, dural injury, postoperative hematoma, dysesthesia, and recurrent herniation remain relevant. Learning-curve studies indicate that structured training, progressive case selection, and standardized portal geometry are essential.

Conclusion. UBED should be considered a platform rather than a single operation. Optimal results require phenotype-based approach selection, low-pressure irrigation, complete neural decompression, preservation of stabilizing anatomy, meticulous hemostasis, and postoperative surveillance. The proposed framework links disc morphology to portal placement, decompression endpoint, complication prevention, and outcome assessment.