Advanced Technique of Unilateral Biportal Endoscopy on Revision Surgery for Recurred Herniated Interverbral Disc: A Technical Note.

Introduction: Revision surgery in the spine poses considerable challenges due to the presence of scar tissue and structural differences, necessitating careful surgical planning and precise techniques. In this technical note, we focus on lumbar unilateral biportal endoscopy (UBE) for single-level reoperations, outlining principles and methods for handling soft tissue in such cases. Materials and Methods: We reviewed our surgical approach for lumbar reoperations with UBE, emphasizing the importance of meticulous preoperative planning and bone-centered manipulation. Our technique involves utilizing biportal endoscopy for enhanced visualization and employing specific strategies for managing scar tissue, including the "pull-and-cut technique." We present two illustrative cases to demonstrate the application of our method. Results: The described approach yielded successful outcomes in both cases presented. Case 1 involved a posterior interlaminar approach for a recurrent disc at the L4-5 level, while Case 2 utilized a far lateral approach for recurrent disc herniation at the L4-5 level. Both surgeries were completed with relatively short operation time, minimal blood loss, and immediate improvement in symptoms postoperatively. Conclusion: Lumbar UBE offers a promising option for safe and effective reoperation in spinal surgery. Our technique, emphasizing bone-centered manipulation and specific strategies for scar tissue management, provides excellent visibility and enables precise tissue handling. Overall, UBE facilitates relatively simple and safe reoperations, contributing to improved patient outcomes in the challenging field of spinal surgery.