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Case Reports
. 2025 Jan;15(1):67-72.
doi: 10.13107/jocr.2025.v15.i01.5128.

Transformative Spinal Surgery: Lateral Position Unilateral Biportal Endoscopic Discectomy

Jipin Gopi  1 , Sharafuddeen Mammu  2 , Aarabhy Jayan  3 , Jamshad O P  2 , Fijad N R  1 , Vaisakh Vk  1
Affiliations
Case Reports

Transformative Spinal Surgery: Lateral Position Unilateral Biportal Endoscopic Discectomy

Jipin Gopi et al. J Orthop Case Rep. 2025 Jan.

Abstract

Introduction: Endoscopic spine surgery (ESS) is a minimally invasive technique that allows for direct visualization of spinal pathologies and has become a safe and effective alternative to traditional open spine surgery. Conventionally performed in the prone position, biportal endoscopy can also be done in the lateral position to avoid prone-associated complications. To our knowledge, the use of unilateral biportal endoscopy (UBE) in the lateral position has not been previously reported.

Case report: We present the case of a 53-year-old male who experienced severe low back pain and right-sided radiculopathy due to a disc protrusion at the L4-L5 level. The patient was managed surgically using UBE in the lateral position once the conservative management was ineffective. This innovative approach aimed to minimize the complications associated with the prone position typically used in such procedures.

Conclusion: The successful management of L4-L5 intervertebral disc prolapse using UBE in the lateral position in this case demonstrates the potential of this technique as an effective and minimally invasive alternative to conventional surgical methods. This approach could offer a viable solution for treating degenerative spinal diseases while mitigating the steep learning curve associated with ESS. Further research and clinical studies are necessary to validate and optimize this technique.

Keywords: Biportal endoscopy; disc prolapse; discectomy; lateral position.

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Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
(a and b) Magnetic resonance imaging illustrating a right paracentral disc protrusion at the L4–L5 level.
Figure 2
Figure 2
Unilateral biportal endoscopy performed in the lateral position.
Figure 3
Figure 3
Patient positioned in the left lateral position.
Figure 4
Figure 4
Marking of the midline and medial pedicular line under C-arm guidance.
Figure 5
Figure 5
Working portal created in line with the lower endplate.
Figure 6
Figure 6
Marking of the portals.
Figure 7
Figure 7
Delineation of the spinolaminar junction and inferior articular process of L4 using a radiofrequency probe.
See this image and copyright information in PMC

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