SPINE
Biportal Endoscopic Spine Surgery
Two accesses of a few millimeters: the camera enters through one, the instruments through the other.
Book an evaluationMasked surgeon operating a 3D image-guided navigation device in an operating room
Dr. Victor BatistelaNeurosurgeonCRM-PR 35044 · RQE 30580 (Brazilian medical registration)
What it is
One incision to see, another to work
In biportal endoscopic surgery, the surgeon reaches the spine through two small accesses, close to each other. The camera enters through one of them, with light and continuous saline irrigation; the instruments enter through the other. The two paths meet at the same point of the spine, and the surgeon operates while looking at the monitor, with the image magnified.
Separating the camera from the instruments gives freedom of movement: the hands work in a way similar to conventional surgery, but through openings of a few millimeters, passing between the muscle fibers instead of widely retracting them.
"Biportal" describes the number of accesses, not a specific procedure. The technique can be used to remove a herniated fragment, decompress a narrowed canal or, in selected cases, as part of a spinal fixation.
Conditions that can be treated
Herniation, stenosis and disc degeneration, in selected cases
The biportal route may be indicated, in selected cases, for a herniated disc that compresses a nerve and does not improve with conservative treatment; for spinal stenosis, including when the narrowing involves the central canal and calls for a wider decompression; and for degenerative disc disease in specific situations, evaluated at the appointment.
In some cases, spinal fusion — the fixation of a segment of the spine — can also be performed with biportal endoscopic support, reducing the opening required. This indication is restricted and depends on the level, the anatomy and the cause of the instability.
- Herniated disc
- Spinal stenosis
- Degenerative disc disease
- Endoscopically assisted spinal fusion, in selected cases
Anatomy
Where the two accesses go in
The two points are beside the spine, at the same level, a few centimeters apart. One carries the camera, the other, the instruments.
- 1
Camera access
The incision through which the endoscope enters, with light and irrigation. It shows the surgeon what the other access is doing.
- 2
Instrument access
The second incision, close to the first. Through it pass the instruments that remove the herniation or widen the canal.
- 3
Intervertebral disc
The cushion between two vertebrae. The herniation is the part of it that has moved out of place and presses on the nerve.
- 4
Nerve root
The nerve that exits the spine at each level. When compressed, it causes the pain that radiates to the leg or arm.
What the path looks like
Four steps, in this order
The technique is defined at the end of the process, not at the beginning. Before it come the conversation, the examination and the imaging.
Step 01
Appointment and physical examination
Where the pain starts, where it goes, what makes it worse. Strength, sensation and reflexes locate the affected nerve.
Step 02
Imaging tests
The MRI shows the type and position of the herniation or narrowing — data that weigh on the choice of route.
Step 03
Discussion of the plan
Conservative treatment first, except in cases of neurological deficit. If surgery is indicated, the route is defined: biportal, uniportal, microdiscectomy or another.
Step 04
Follow-up
Gradual return to activities and guided rehabilitation. Follow-up visits check pain and function.
What changes in the approach
Biportal or uniportal
Both are endoscopic techniques and treat the same problems. The difference lies in the number of accesses and the way of working.
Biportal
- Two small accesses, close to each other
- Camera through one access, instruments through the other
- Instruments similar to those of conventional surgery
- Indicated in selected cases, depending on level and anatomy
Uniportal
- A single access of a few millimeters
- Camera and instruments pass through the same tube
- Fine instruments, adapted to the working channel
- Indicated in selected cases, depending on level and anatomy
Neither is superior to the other in all cases. The choice depends on the problem, the spinal level and the team's experience with each technique — and is made during the evaluation.
When not to wait
Signs that should not wait for an appointment
These signs call for the emergency room, not an elective appointment.
- sudden loss of strength in the leg or arm
- difficulty controlling urine or bowel
- numbness between the legs
- severe pain after trauma
Frequently asked questions
- The number of accesses. In the biportal technique, there are two small incisions: one for the camera, another for the instruments. In the uniportal technique, camera and instruments pass through a single tube, through one incision. The choice between them is made during the evaluation.
- Not necessarily. Both incisions are a few millimeters long and the path passes between the muscle fibers. What defines the size of the surgery is the problem being treated, not the number of accesses.
- No. It may be considered in selected cases, depending on the extent of the narrowing, the number of levels involved and the presence or absence of instability. Extensive stenosis or stenosis with instability usually calls for another technique.
- It varies according to the procedure and each person's progress. In general, the hospital stay for endoscopic surgeries is short; the exact time is discussed before surgery, not promised.
- Yes. As with any technique for treating a herniated disc, there is a possibility of recurrence. Follow-up and rehabilitation help reduce this risk, but it is not zero.
Read also
Book an evaluation
The appointment serves to understand the condition and define the next step. Not every condition requires surgery.
This channel is not a substitute for emergency care. In an emergency, go to the nearest emergency room.
