Unilateral biportal endoscopy: review and detailed surgical approach to extraforaminal approach

Foraminal and extraforaminal lumbar disc herniations are common sources of pain and disability. Classic surgical treatments, such as open approach through Witsel technique, often involve resection of the superior articular process to decompress the foraminal space. Unilateral biportal endoscopy (UBE) has emerged as a minimally invasive alternative, providing enhanced visualization and precision while minimizing soft tissue damage. The extraforaminal approach using UBE offers a more effective solution for extraforaminal herniations, requiring less bone resection, reducing the risk of pars fracture and enhancing visualization. This article presents a comprehensive methodology for the extraforaminal approach, supported by an illustrated guide, surgical tips and highlights of UBE's advantages over traditional techniques.