Areas of Practice.
An overview of surgical and procedural techniques routinely performed in the management of degenerative spinal disease. Indications, alternatives, and contraindications are determined on an individualized clinical basis. Citations refer to representative peer-reviewed publications.
Biportal Endoscopic Spine Surgery (UBE)
Biportal endoscopic spine surgery, also known as unilateral biportal endoscopy (UBE), is a minimally invasive technique utilizing two adjacent percutaneous portals under continuous saline irrigation. The independent endoscope and working-instrument portals provide wide visualization and triangulation comparable to open microscopic surgery. The approach is applied across the cervical, thoracic, and lumbar spine for both decompressive and reconstructive procedures.
UBE Lumbar Decompression
Indicated for symptomatic lumbar spinal stenosis—central, lateral recess, or foraminal—the procedure utilizes the biportal endoscopic technique to perform laminectomy, ligamentum flavum resection, and decompression of the neural elements. The approach preserves much of the posterior musculoligamentous complex compared with conventional open laminectomy. Indications, contraindications, and complications have been examined in our published systematic review (Heo DH, Park DY, Hong HJ, et al. World Neurosurgery. 2022).
UBE Lumbar Discectomy
For symptomatic lumbar disc herniation with corresponding radiculopathy refractory to conservative care, the biportal endoscopic approach provides direct visualization of the disc fragment and traversing and exiting nerve roots through a posterior corridor. The technique allows targeted fragment removal with limited disruption of paraspinal muscles.
UBE-TLIF (Biportal Endoscopic Transforaminal Lumbar Interbody Fusion)
Biportal endoscopic transforaminal lumbar interbody fusion is applied in select cases of lumbar degenerative disease requiring interbody fusion, including degenerative spondylolisthesis and recurrent stenosis with instability. The approach combines biportal endoscopic decompression with cage placement and percutaneous pedicle screw fixation. Technical considerations and early-learning-curve outcomes were examined in our comparative study (Kim JY, Hong HJ, et al. JMISST. January 2024).
UBE Cervical Posterior Foraminotomy
For unilateral cervical radiculopathy secondary to foraminal stenosis, biportal endoscopic posterior cervical foraminotomy provides motion-preserving decompression as an alternative to anterior cervical fusion. Radiologic and midterm clinical outcomes comparing biportal endoscopic, uniportal endoscopic, and microscopic foraminotomy were reported in our published study (Kim JY, Hong HJ, et al. Neurospine. 2022;19(1):212–223).
UBE Thoracic Decompression
In select cases of thoracic spinal stenosis—particularly that secondary to ossification of the ligamentum flavum (OLF) with associated myelopathy—the biportal endoscopic posterior approach permits decompression with limited bony resection. Technical developments and outcomes were reported in our published case series (Kim JY, Ha JS, Lee CK, Lee DC, Hong HJ, et al. Neurospine. 2023;20(1):129–140).
Microscopic Spine Surgery
Microscopic and tubular minimally invasive techniques remain core components of contemporary spine surgical practice. These approaches are utilized when microscopic visualization, multilevel pathology, or specific anatomic considerations favor their use, or when anterior cervical approaches are indicated.
Lumbar Microdiscectomy
Microscope-assisted lumbar microdiscectomy is a well-established treatment for symptomatic lumbar disc herniation. The procedure uses a small paramedian incision with microscopic visualization to remove the symptomatic disc fragment while preserving the surrounding neural elements.
MIS-TLIF (Minimally Invasive Transforaminal Lumbar Interbody Fusion)
Minimally invasive transforaminal lumbar interbody fusion uses a tubular retractor system with microscopic visualization to perform unilateral decompression, discectomy, and interbody cage placement, combined with percutaneous pedicle screw fixation. The approach is applied in degenerative disc disease, recurrent disc herniation requiring fusion, and degenerative spondylolisthesis.
ACDF (Anterior Cervical Discectomy and Fusion)
Anterior cervical discectomy and fusion is a standard surgical approach for cervical disc herniation, cervical spondylotic radiculopathy, and select cases of myelopathy. The anterior corridor provides direct access to the disc space and ventral pathology, with interbody fusion achieved using cage with or without anterior plating.
Cervical Artificial Disc Replacement
In appropriately selected patients with single- or two-level cervical disc disease and preserved facet integrity, cervical disc arthroplasty provides motion-preserving treatment as an alternative to anterior fusion. The approach aims to maintain segmental motion at the operated level.
Vertebral Augmentation
Percutaneous Vertebroplasty
In symptomatic osteoporotic vertebral compression fractures producing persistent pain unresponsive to non-operative management, percutaneous vertebroplasty involves fluoroscopically guided cement injection into the affected vertebral body via a transpedicular or extrapedicular approach. Patient selection considers fracture acuity, magnetic resonance signal characteristics, fracture morphology, and standard contraindications.
Image-Guided Spinal Pain Procedures
Image-guided spinal pain interventions are utilized for diagnostic clarification and therapeutic management of degenerative spinal pathology. These procedures are typically performed under fluoroscopic guidance and form an integral component of multimodal spinal care.
Percutaneous Epidural Neuroplasty
Catheter-based percutaneous epidural neuroplasty (also termed percutaneous epidural adhesiolysis) involves the targeted delivery of medications via a navigable catheter placed in the epidural space. Indications include persistent radiculopathy associated with epidural fibrosis, particularly in the setting of postoperative radicular pain.
Epidural Steroid Injection
Fluoroscopically guided epidural steroid injection delivers anti-inflammatory medication into the epidural space at the affected level via interlaminar or transforaminal approach. Indications include radicular pain associated with lumbar or cervical disc herniation, spinal stenosis, or postoperative radiculopathy.
Selective Nerve Root Block
Selective nerve root block delivers local anesthetic, with or without corticosteroid, around a specific nerve root under fluoroscopic guidance. The procedure serves both diagnostic and therapeutic purposes, particularly in clarifying the symptomatic level when imaging shows multilevel pathology.
Facet Joint Injection
Fluoroscopically guided intra-articular facet joint injection of local anesthetic and corticosteroid is utilized for the diagnosis and treatment of facet-mediated axial spinal pain.
Medial Branch Block
Medial branch block targets the sensory innervation of the facet joint with fluoroscopically guided local anesthetic injection. The block serves primarily as a diagnostic test to confirm facet-mediated pain prior to consideration of more definitive interventions.
Intradiscal Procedures
Intradiscal Electrothermal Therapy (IDET)
Intradiscal electrothermal therapy involves the percutaneous delivery of a thermal catheter into the symptomatic intervertebral disc. The procedure applies controlled heat to the posterior annulus fibrosus for selected cases of chronic discogenic low back pain. Patient selection depends on imaging features, provocative testing, and the absence of significant disc herniation or stenosis.