What Is Uniportal Endoscopic Spine Surgery?

Uniportal endoscopic spine surgery is one of the most tissue-sparing forms of modern minimally invasive spinal procedures.

During the procedure, the pathological lesion is removed through a single small incision (approximately 1.5 cm) using a working channel (single-port technique) under continuous endoscopic (camera) visualization.

The Goals of the Procedure Are

  • to relieve nerve compression
  • to reduce or eliminate pain
  • to preserve spinal stability as much as possible
  • to ensure rapid recovery

The Procedure

  • is performed under conscious sedation (twilight anesthesia), so deep general anesthesia is not required
  • involves only an approximately 1.5 cm skin incision
  • causes minimal tissue trauma
  • is performed as a same-day surgical procedure
  • typically lasts 60–120 minutes
  • allows the patient to return home on the same day

When Is It Recommended?

The procedure is primarily indicated in the following cases:

1. Lumbar Disc Herniation

  • lumbar disc herniation
  • leg pain (radicular pain)
  • numbness or sensory disturbances
  • lower limb muscle weakness
  • symptoms not responding to conservative treatment

In these cases, an endoscopic discectomy is performed, during which the herniated disc fragment is removed and the affected nerve is decompressed.

2. Certain Types of Spinal Canal Stenosis

(unilateral lateral recess stenosis, foraminal stenosis)

  • pain increasing with physical activity
  • leg pain
  • numbness or sensory disturbances
  • lower limb weakness
  • radiologically confirmed bony or soft tissue narrowing

In such cases, endoscopic decompression is performed to relieve the compressed neural structures.

Why Is This Procedure Particularly Gentle?

  • Single-port technique – only one entry point
  • 1.5 cm incision
  • No muscle detachment, only atraumatic passage through the muscles
  • Minimal blood loss
  • Rapid mobilization
  • Short observation period

Important Advantage

The procedure does not require general anesthesia.
It is performed under light sedation with spontaneous breathing.

This Means:

  • lower anesthetic risk
  • faster recovery from sedation
  • patients with significant internal medical conditions and higher anesthesia risk can also undergo surgery

How Is the Procedure Performed?

  • Conducted in an operating room under sterile conditions
  • The patient lies in the prone position
  • Light sedation is administered
  • Continuous monitoring of ECG, blood pressure, and oxygen saturation
  • The endoscope is introduced through a 1.5 cm incision
  • Fluoroscopy (C-arm) is used to precisely identify the target area
  • Specialized instruments are used to remove the herniation or decompress the nerve
  • The wound is closed and covered with a sterile dressing

The procedure usually takes 60–120 minutes.

What Happens After the Procedure at Our Institute?

  • Short (few hours) observation
  • Early mobilization
  • The patient may return home on the same day

Most Patients:

  • experience immediate or within-days pain relief
  • return to daily activities faster than after traditional surgery, as there is little or no pain related to surgical exposure

What Are the Possible Risks?

As with any surgical procedure, complications may occur, although they are rare. Mild, temporary symptoms (transient numbness, minor bleeding, wound healing disturbance) occur in less than 3–5% of cases.

More serious complications are rare, occurring in less than 1–2% of cases. These may include infection, nerve injury, persistent sensory disturbance or muscle weakness, and cerebrospinal fluid leakage.

Overall, the procedure is safe, and its complication rate is not higher than that of conventional microsurgical (microscope-assisted) procedures1,2.

How Should You Prepare for the Procedure?

1. Preoperative Evaluation

  • detailed specialist examination
  • MRI (CT if necessary)
  • laboratory tests
  • anesthesiology consultation (arranged by our institute)

2. Medications

  • Blood thinners require prior consultation
  • Certain anti-inflammatory medications may need temporary discontinuation
  • Do not stop medications on your own

3. Eating and Drinking

  • Do not eat 6 hours before the procedure
  • You may drink water up to 2 hours before

4. On the Day of Surgery

  • A companion is recommended
  • Wear comfortable clothing
  • Inform us if you have fever, chills, or signs of infection

What Should I Expect After the Procedure?

  • Immediate or within-days significant reduction of leg pain
  • Improvement in low back pain is also expected. If low back pain originates from musculoskeletal structures (ligaments or facet joints), additional regenerative treatment may be recommended.
  • Because surgical exposure pain is minimal and radicular pain significantly decreases, careful spinal protection is essential to allow proper healing of the disc tissues.

At Home

  • Protect your spine; avoid prolonged sitting and driving
  • Light walking is recommended
  • Gradual return to activity
  • Start physiotherapy
  • Swimming may begin approximately 10 days after surgery

Return to Normal Activity

  • Usually after 4–6 weeks
  • Sports activity may resume after 6 weeks, gradually rebuilding core strength (especially deep abdominal muscles)

How Long Does Improvement Last?

If nerve compression is fully relieved, pain reduction may be long-lasting or permanent.

Long-term outcome depends on:

  • the underlying condition
  • overall spinal health
  • lifestyle and weight management
  • adherence to rehabilitation

Important Information

Uniportal endoscopic spine surgery:

  • is a highly minimally invasive technique for disc removal and selected spinal stenosis decompression
  • uses a single-port approach
  • involves a 1.5 cm incision
  • does not require general anesthesia
  • is performed as same-day surgery
  • allows discharge on the same day

Suitability for treatment and expected outcomes are always determined individually after consultation.

Source:

Among numerous available studies, two high-level (Level 1) evidence studies demonstrate that endoscopic disc removal is equally effective as the “classical” microsurgical technique in terms of pain reduction and functional recovery of back and leg pain. However, the endoscopic approach offers advantages in tissue preservation and faster return to work. Patients report quicker subjective recovery.

1. Chen, Yuchun, Zerui Zhuang, Weili Qi, et al. ‘A Three-Dimensional Study of the Atlantodental Interval in a Normal Chinese Population Using Reformatted Computed Tomography’. Surgical and Radiologic Anatomy 33, no. 9 (2011): 801–6. https://doi.org/10.1007/s00276-011-0817-7.

2. Gadjradj PS, Harhangi BS, Amelink J, van Susante J, Kamper S, van Tulder M, Peul WC, Vleggeert-Lankamp C, Rubinstein SM. Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976). 2021 Apr 15;46(8):538-549. doi: 10.1097/BRS.0000000000003843. PMID: 33290374; PMCID: PMC7993912.