Unilateral Biportal Endoscopy in Spinal Surgery:Current Evidence, Surgical Techniques, Clinical Outcomes, Complications, Learning Curve, and Future Perspectives

Abstract

Unilateral biportal endoscopy (UBE), also termed biportal endoscopic spine surgery, has emerged as a versatile minimally invasive platform for lumbar decompression, discectomy, and interbody fusion. Separate viewing and working portals combine endoscopic visualization with independent manipulation of conventional spinal instruments.Methods.A focused narrative review of PubMed-indexed randomized controlled trials, comparative cohort studies, systematic reviews, meta-analyses, and recent studies was undertaken. Evidence was synthesized regarding technical principles, indications, lumbar decompression and discectomy, foraminal disease, lumbar interbody fusion, cervical applications, complications, learning curve, and comparisons with microscopic and uniportal endoscopic surgery.Results.Current evidence supports UBE as an effective option for lumbar disc herniation and degenerative lumbar spinal stenosis. Randomized trials demonstrate clinical outcomes comparable to microscopic discectomy and decompression. Potential perioperative advantages include reduced early surgical-site pain, lower muscle injury markers, less blood loss, and shorter hospitalization. Meta-analyses comparing UBE with uniportal endoscopy generally show comparable pain, disability, and complication outcomes, although perioperative advantages vary. UBE-based lumbar interbody fusion Received: September03 2026Revised:September272026Accepted: October06 2026Published: October282026Citation:Murat Çiçeklidağ, Çağatay Delice, Orkun Büyüksayın, Ahmet Toygun Tor, Abdullah Enes Uğuz, Mehmet Surubasi, Hilmi Burak Şengül, Gökberk Baki, Alim Can Baymurat. Unilateral Biportal Endoscopy in Spinal Surgery:Current Evidence, Surgical Techniques, ClinicalOutcomes, Complications, Learning Curve, and Future Perspectives. Trauma & Ortho Kaz, 2026, 77 (5), jto068.https://doi.org/10.52889/1684-9280-2026-77-5-jto068This work is licensed under a Creative Commons Attribution 4.0 International License Trauma & Ortho Kaz, 2026, 77(5)https://doi.org/10.52889/1684-9280-2026-77-5-jto068demonstrates comparable fusion and complication rates to minimally invasive fusion techniques, while cervical applications remain less mature. Dural tear is among the most consistently reported complications. Contemporary learning-curve studies commonly identify approximately 30–40 cases as a proficiency range, although thresholds vary by procedure and endpoint.Conclusions.UBE should be regarded as a versatile minimally invasive platform rather than simply an alternative to microscopic or uniportal surgery. The strongest evidence supports lumbar decompression and discectomy, whereas fusion and cervical applications remain promising but require higher-quality prospective evidence. Patient selection, adequate decompression, preservation of spinal stability, irrigation control, and surgeon experience remain the principal determinants of safety and outcome.