Decompression After Posterior Lumbar Interbody Fusion without Moving Implant via Unilateral Biportal Endoscopic Technique

The complexity and diversity of reasons for revising posterior lumbar interbody fusion (PLIF) are well-documented. Common triggers include weak initial surgical indications, delayed intervention, diagnostic oversights or misjudgments, insufficient decompression, internal fixation complications, postoperative disease progression or recurrence, and adjacent segment degeneration. Pathological drivers such as intervertebral disc degeneration, facet joint degeneration, spinal instability, and spondylolisthesis in operated segments frequently cause nerve compression, spinal cord injury, or vertebral fractures. These conditions manifest as low back pain, radiating nerve pain, and intermittent claudication. Critical determinants for revision include patient age, surgical technique, number of operated PPPP segments, age at initial surgery, and prior laminectomy status. Traditional revision involves open surgery to remove fixation rods, followed by decompression and re-instrumentation. However, surgical site adhesions increase procedural complexity, risking dural tears and nerve root injuries during direct visualization. Minimally invasive unilateral biportal endoscopic (UBE) decompression has emerged to address unilateral nerve root canal stenosis post fusion without hardware removal. While UBE has demonstrated safety and efficacy, its adoption remains limited by high technical demands, restricting patient access. This paper explores the role of UBE in revision surgery, emphasizing its ability to achieve neural decompression while preserving instrumentation. The technique's steep learning curve necessitates specialized training, contributing to geographic disparities in availability. To broaden access, the authors advocate clarifying rationale and defining dissemination strategies of UBE, including standardized training, explicit surgical indications, and outcome assessment frameworks. Addressing these challenges could improve patient outcomes and advance minimally invasive spinal care, particularly in revision contexts where traditional approaches pose higher morbidity risks. Democratizing the benefits of UBE requires structured efforts to mitigate technical barriers and foster interdisciplinary collaboration, ensuring equitable integration of this innovation.