Cost-effective unilateral biportal endoscopic microdiscectomy: illustrative case

BACKGROUND: Unilateral biportal endoscopic (UBE) spine surgery is an ultra-minimally invasive technique that provides enhanced visualization while minimizing the tissue disruption associated with traditional open surgery. It utilizes separate portals for visualization and instrumentation, which allows for tactile feedback and freedom of movement similar to open procedures. OBSERVATIONS: Despite these advantages, a significant barrier to the widespread adoption of endoscopic spine surgery can be capital expense for specialized endoscopic systems. This technical paper aims to overcome that barrier by providing a detailed, step-by-step guide for performing a UBE microdiscectomy utilizing standard arthroscopic and basic spine equipment that are widely available. LESSONS: The authors describe patient positioning, operating room setup, portal placement, fluid management, and a systematic approach to decompression. Key steps, including establishing the visualization window and managing hemostasis, are detailed. The authors also discuss postoperative considerations and provide technical tips to shorten the learning curve. By leveraging standard instrumentation, this technique makes the benefits of UBE surgery more accessible to surgeons and institutions, thereby lowering the financial barrier to adoption without compromising surgical goals. https://thejns.org/doi/10.3171/CASE2678.