Standing and walking become harder
Pain, heaviness or weakness in the legs may increase with walking or prolonged standing.
PROF. IAKIV FISHCHENKO · KYIV
Lumbar spinal stenosis surgery in Kyiv
Biportal endoscopic decompression, BESS/UBE — Professor Yakiv Fishchenko.
Biportal endoscopic decompression, BESS/UBE, is surgery to relieve pressure on nerve structures in the lumbar spine.
The decision to operate depends on your symptoms, examination and complete MRI study. Not every case of stenosis needs surgery.
Send your MRI for a preliminary assessmentThe preliminary review is free. A response is provided on the day your scans are received.
A leading centre in Ukraine for endoscopic spine surgery
UNDERSTANDING YOUR DIAGNOSIS
Does leg pain limit your walking?
Lumbar spinal stenosis is narrowing of the spinal canal or the spaces through which nerve roots pass. Joint changes, thickened ligaments and a bulging disc can contribute to this narrowing.
Sitting or bending forward brings relief
Symptoms that ease when you sit down or lean forward are characteristic of neurogenic claudication.
Numbness and altered sensation
Symptoms may affect one or both legs. Other conditions can cause similar symptoms.
MRI shows the anatomy. Examination helps explain the symptoms.
Choosing treatment means matching the location and type of narrowing with your symptoms and neurological examination. If needed, the doctor may request CT or X-rays, including studies to assess spinal stability.
FROM DIAGNOSIS TO A DECISION
Treating the person, not just the scan
Nonsurgical treatment
When your condition allows, treatment starts with tailored pain management, physical activity and rehabilitation. The approach depends on symptom severity.
Decompression
Surgery is considered when symptoms substantially restrict daily life, treatment has not helped enough or neurological function is deteriorating.
Additional stabilisation
Not everyone needs fixation. It is considered when there is instability, deformity or another individual indication.
COMPARING APPROACHES
Compare treatment approaches
Decompression aims to relieve pressure on nerve structures. The surgical approach and any need for fixation are chosen individually.
On a phone, swipe the table horizontally.
| What we compare | BESS / UBE | Microsurgical decompression | Decompression with stabilisation |
|---|---|---|---|
| How the surgeon works | The endoscope and instruments are introduced through two separate access points. | The surgical field is viewed through a microscope via a surgical approach, which may be a minimally invasive tubular approach. | Nerve decompression is combined with fixation and, when indicated, spinal fusion. |
| Main purpose | Remove tissue that compresses the nerves while taking the segment's stability into account. | Relieve pressure on the nerves under microscopic guidance. | Relieve nerve compression and address instability or deformity. |
| When it is considered | When the anatomy of the stenosis, symptoms and surgical plan allow endoscopic decompression. | When this approach suits the anatomy and the aims of decompression. | For specific indications; a diagnosis of stenosis alone does not mean implants are needed. |
| Implants | Usually not used for decompression alone. | Usually not used for decompression alone. | Fixation devices are used according to the surgical plan. |
| Recovery | Depends on the extent of surgery, your condition before treatment and your individual rehabilitation plan. | Depends on the extent of surgery, your condition before treatment and your individual rehabilitation plan. | Fixation and the process of bone fusion also need to be taken into account. |
| What to bear in mind | Endoscopy does not remove every risk or guarantee that an already damaged nerve will recover. | Microsurgery remains one of the options for decompression. | Fixation increases the extent of surgery and needs a clear indication. |
BESS/UBE offers small, separate access points, magnified imaging and targeted instrument control to help preserve surrounding tissue. Some studies have reported lower pain medication requirements and shorter hospital stays. Clinical outcomes can nevertheless be comparable to microsurgery; the benefits and pace of recovery depend on the individual case. When indicated, endoscopic decompression can be combined with stabilisation.
BESS / UBE IN ACTION
Identify the compression. Release the nerve.
BESS and UBE refer to a biportal endoscopic technique. A camera is introduced through one access point, while instruments are used through the other under visual guidance.
01
Two access points
The camera and instruments work through separate small access points.
02
Decompression
The surgeon removes parts of the altered tissues causing compression.
03
Assessment
The extent of nerve decompression is checked under endoscopic visual guidance.
A CONVERSATION WITH THE PROFESSOR
A clear discussion of lumbar stenosis
A video interview with Professor Iakiv Fishchenko about lumbar spinal stenosis. Watch the explanation and prepare your questions for a consultation.
When is surgery needed for lumbar spinal stenosis?
Surgery for lumbar spinal stenosis may be considered when pain, weakness or walking limitations significantly affect daily life and nonsurgical treatment provides insufficient relief. Decisions are based on symptoms, examination and MRI, not the description of narrowing alone.
Biportal endoscopy, BESS/UBE, enables decompression through two separate surgical portals; the approach depends on anatomy and the required extent of surgery. Additional stabilization may be needed when indicated.
Possible risks include infection, bleeding, nerve injury, a dural tear and persistent symptoms. Activity, rehabilitation and return to work are planned individually.
New bladder or bowel dysfunction, perineal numbness or rapidly worsening weakness require urgent medical assessment. This information does not replace a surgical consultation.
Clinical cases
Three-level lumbar stenosis: is fusion needed
Preoperative review of a 62-year-old woman who can walk about 200 metres, with stenosis at L2–L3, L3–L4 and L4–L5. Preliminary plan: endoscopic decompression without fusion.
Read review in Ukrainian
Three-level L2–L5 stenosis: one-month outcome
Endoscopic decompression at three levels. At one month, pain had decreased and walking distance was 150 metres.
Read case in Ukrainian
L3–L4 stenosis: biportal endoscopic decompression
Before surgery, the patient could walk up to 200 metres. On the first postoperative day he walked and exercised; pain and neurological symptoms decreased by discharge on day two.
Read case in UkrainianPREPARATION AND RECOVERY
A plan before surgery. Support afterwards.
Before surgery
Provide your complete MRI/CT study and medical records. Tell the team about your regular medicines and other health conditions. Agree the required tests, food, drink and medication instructions with the anaesthetist.
Getting up for the first time
The patient gets up after recovering from anaesthesia and having their condition assessed. The first time is supervised by a rehabilitation specialist. Discharge depends on the patient's condition and the extent of surgery.
Returning to activity
Walking, exercises, any need for a brace, and returning to work and sport are agreed with the rehabilitation specialist. There is no single recovery timetable for every patient.
YOUR SURGEON
Personal experience. An individual decision.
Doctor of Medical Sciences, professor and physician of the highest qualification category. Specialties: orthopaedics and traumatology, and neurosurgery. Practising in the specialty since 2004.
Author of an atlas of endoscopic spine surgery.
President of the Ukrainian Association of Endoscopic Spine Surgery. Full member of the Scoliosis Research Society, AO Spine and the American Academy of Orthopaedic Surgeons.
Honoured Doctor of Ukraine. Recipient of the President of Ukraine Prize (2008), a diploma from the Presidium of the National Academy of Medical Sciences of Ukraine (2013) and the Vesalius Award of the American Association of Neurological Surgeons (2013).
Professional profileDecompression or stabilization for lumbar spinal stenosis
Professor Iakiv Fishchenko explains when relieving nerve compression may be enough and when a cage and fixation may be considered
Read the articleProfessor Iakiv Fishchenko’s publications on lumbar spinal stenosis
Professor Iakiv Fishchenko has co-authored research on endoscopic decompression and fusion procedures for lumbar spinal stenosis.
Biportal endoscopic decompression
This retrospective study analysed outcomes in 62 patients with lumbar spinal stenosis, assessed up to six months after surgery. It reports clinical outcomes and complications. Without a comparison group, it cannot establish superiority over other surgical procedures.
Georgian Medical News, 2020;(303):21–27.
Decompression with fusion: UBLIF and PLIF
This study compared unilateral biportal endoscopic lumbar interbody fusion in 25 patients with posterior lumbar interbody fusion in 31 patients over one year. It concerns fusion procedures, not decompression alone. Randomisation was not reported, which limits the interpretation of comparative findings.
Pathologia, 2020;17(3):356–362.
Professor’s research profile — ORCID
Published study results are not an individual prognosis. Surgical indications and the extent of the procedure are determined through clinical assessment.
Endoscopic treatment of lumbar spinal stenosis: results in 860 patients
These data describe our clinical series, reported in Professor Iakiv Fishchenko’s presentation for World Spine 11.
The retrospective analysis included 860 patients who underwent unilateral biportal endoscopic decompression (BESS/UBE) for degenerative lumbar spinal stenosis in 2020–2025. The mean age was 67 years, with a range of 57–89 years. Mean clinical follow-up was 15 months.
The cohort included patients with stenosis associated with hypertrophy of the ligamentum flavum and facet joints. Patients with disc herniation as the primary pathology, isolated foraminal stenosis, degenerative scoliosis, spondylolisthesis or segmental instability were excluded.
Complications and revision surgery
| Outcome | Number | Percentage of 860 patients | Course or management |
|---|---|---|---|
| Dural tear | 27 | 3.1% | Conservative management |
| Transient dysesthesia — abnormal unpleasant sensations | 14 | 1.6% | Resolved within 2–4 weeks |
| Epidural hematoma | 58 | 6.7% | Detected on imaging; no revision surgery |
| Motor deficit | 7 | 0.8% | Partial recovery in 3 patients; no recovery in 4 patients by final follow-up |
| Infection | 0 | 0% | No cases observed in this cohort |
| Revision surgery | 2 | 0.2% | Performed in 2 patients |
How to interpret these results
The percentages for separate events must not be added together: the presentation does not specify whether different complications occurred in the same patients. The 0.2% revision surgery rate is neither the overall complication rate nor the recurrence rate. No observed infections in this cohort does not mean that every patient has zero infection risk.
This was a retrospective clinical series without a comparison group. Its findings do not establish superiority over other techniques or guarantee an individual patient’s outcome. These figures apply to the selected lumbar stenosis cohort described here, not to surgery for disc herniation.
Source: Professor Iakiv Fishchenko’s presentation, “Unilateral Biportal Endoscopic Decompression for Lumbar Spinal Stenosis. Clinical outcomes in 860 patients”, World Spine 11; slides 3–4 and 9–11.
PATIENT LIBRARY
More information in the format that suits you
Lumbar stenosis on Telegram
The professor's explanations, BESS materials and answers to questions.
Open the resourcePatient guide on Telegraph
General information, treatment, preparation, rehabilitation and contacts.
Open the resourceHow to send an MRI or CT study
Illustrated instructions: a folder named with the patient's full name in Ukrainian, a ZIP archive, Google Drive and WeTransfer.
Open the resource →COST
First, a treatment plan. Then, a cost estimate.
The cost of endoscopic decompression depends on the extent of surgery and whether additional stabilisation is needed. Ask the administrator what the treatment includes: consumables, anaesthesia, hospital stay and follow-up appointments.
Administrator: +38 094 821 08 30 ↗Answers before your consultation
Does every case of lumbar stenosis need surgery?
No. MRI findings are assessed alongside symptoms and an examination. Nonsurgical treatment may be appropriate if there are no urgent indications. Surgery is considered when daily life is substantially restricted, treatment has not helped enough or neurological function is worsening.
How is stenosis different from a herniated disc?
Stenosis means narrowing of the space for nerve structures. A herniated disc can be one cause; changes in joints and ligaments often also contribute. The decompression plan therefore depends on all the causes of compression.
Can lumbar stenosis be treated with BESS/UBE?
Biportal endoscopic decompression is one surgical option for lumbar stenosis. Its suitability is determined after assessing the anatomy, affected levels, stability and the patient's condition.
Will I need screws or implants?
Not always. If decompression without stabilisation is sufficient, fixation implants are usually unnecessary. Instability, deformity and other factors may change the surgical plan. When indicated, endoscopy-assisted fusion is possible: an interbody implant (cage) is placed under endoscopic guidance, while screw fixation is performed percutaneously. The suitability of this approach and the type of implants are determined individually.
Will numbness and weakness disappear immediately?
Not necessarily. Recovery of nerve function depends on the severity and duration of the damage. Some symptoms can persist even after adequate decompression.
When can I walk and return to work?
You first get up after recovering from anaesthesia and having your condition assessed, under the supervision of a rehabilitation specialist. Further activity and return to work are planned individually.
What should I send for a preliminary assessment?
Your complete MRI/CT study in DICOM format: all the contents of the disc in one ZIP archive, or a download link. Name both the folder and the archive using the patient's surname, first name and patronymic in Ukrainian. Include the radiology report, a description of symptoms and the patient's full name in the message.
Let's start with your scans
The preliminary review is free. A response is provided on the day your scans are received.
Send your complete MRI/CT study, briefly describe your symptoms and provide the patient's surname, first name and patronymic. If the archive is large, send a link to it.
Sources and resources
This information helps you prepare for a consultation. An individual treatment plan is developed after an examination and review of your scans.
- AAOS · Lumbar spinal stenosis
- WFNS · Decompression & fusion
- BESS / microscopy · Randomized clinical trial
- NHS · Lumbar decompression surgery
- Guy’s and St Thomas’ · Recovery
- BESS / microscopy · Randomized clinical trial (2019)
- Biportal endoscopic lumbar interbody fusion · Surgical technique
- Telegraph · Prof. Iakiv Fishchenko