Establishing navigated UBE in Europe - technical note.

Introduction: Unilateral biportal endoscopic (UBE) lumbar decompression has emerged as a minimally invasive technique for the treatment of degenerative lumbar pathologies, including disc herniation and spinal canal stenosis.The reproducibility of this technique depends on standardized positioning, imaging, portal placement and stepwise decompression under continuous endoscopic visualization. We present a navigation-assisted workflow that integrates intraoperative three-dimensional imaging (Loop-X, Brainlab AG, Munich, Germany). Technique: Patients are positioned prone on a radiolucent table. A pelvic reference array is secured prior to skin incision, followed by intraoperative 3D fluoroscopy. Based on navigational planning, two paramedian skin incisions are created to establish a dedicated viewing portal and a separate working portal. Navigation-guided trajectory planning enables controlled access to the interlaminar window and targeted osseous decompression while preserving surrounding anatomical structures. Stepwise decompression of neural elements is performed under continuous irrigation and endoscopic visualization, with intraoperative confirmation of adequate decompression. Conclusion: Navigation-assisted UBE for lumbar decompression with intraoperative 3D imaging allows precise trajectory planning and controlled portal placement, potentially enhancing reproducibility while maintaining the benefits of minimally invasive surgery.