Among endoscopic spine techniques, unilateral biportal endoscopy (UBE), also called biportal endoscopic spine surgery (BESS), has become one of the most versatile. It is the technique I use for most endoscopic decompressions, and I co-authored a primer on it for surgeons in 2026 ("Primer on Unilateral Biportal Endoscopic Spine Surgery"). This post is the patient version.
Two small portals, two separate jobs
The defining idea of the biportal technique is simple: separate the camera from the instruments.
Through one incision of about 7 to 10 millimeters, a high-definition endoscope streams a magnified view of the spine to a monitor. Through a second, similar incision, standard surgical instruments do the work: removing the disc fragment, bone spur, or thickened ligament pressing on the nerve.
Continuous saline irrigation flows through the surgical field, keeping the view clear and gently expanding the working space.
Why two portals instead of one?
Single-portal (uniportal) endoscopy passes the camera and instruments down the same narrow channel, which constrains the instruments that can be used. With two portals, the instrument hand moves freely and independently of the camera, so the surgeon keeps the fluency of traditional surgery while operating through openings smaller than a dime.
For patients, the practical benefits are the ones that come with the endoscopic category:
- Muscles are dilated, not stripped from bone
- Blood loss is typically minimal
- Most decompressions are same-day procedures
- Recovery is usually measured in weeks
What UBE can treat
The biportal technique handles many of the most common degenerative spine problems:
- Lumbar disc herniations and sciatica, via endoscopic microdiscectomy
- Spinal stenosis, through endoscopic laminectomy and decompression
- Cervical nerve compression, via posterior cervical endoscopic decompression
- Instability requiring fusion, in selected patients, via endoscopic TLIF
Does the evidence support it?
For appropriately selected patients, published studies report that biportal endoscopic decompression achieves nerve-decompression results comparable to open and microscopic techniques, with less blood loss, shorter stays, and faster early recovery. As with any technique, results depend on patient selection and surgical experience.
Learning more
The endoscopic spine surgery guide on this site covers the technique in more depth, including a side-by-side comparison with open surgery and answers to the questions patients ask most. If you are wondering whether your MRI findings are treatable this way, request a consultation at NYU Langone in New York City. I review every patient's imaging personally.
This post is general education, not medical advice.
Written by Erick R. Kazarian, MD · endoscopic spine surgery, BESS, UBE, biportal