Dual Portal Endoscopic Spine Surgery – New State-of-the-Art Treatment Option for Back Pain Due to Spinal Stenosis

July 12, 2023


By Nima Salari, M.D. FAAOS
Dr. Salari is a Board-Certified, Fellowship-Trained Orthopedic Spine Surgeon with specialized training in the operative and non-operative treatment of pathologic conditions affecting the spine. He specializes in ultra-minimally invasive endoscopic spine surgery and cervical artificial disc replacement.


Desert Institute for Spine Care is now offering an ultra-minimally invasive treatment option called Dual Portal® Endoscopic Surgery for patients with low back pain.

“The technique stays true to our commitment to providing least invasive/ultra-minimally invasive options. It’s an additional tool that allows us to treat an even broader set of conditions.” Says Dr. Salari

What is Spinal Stenosis, and What Causes it?

The condition of spinal stenosis is common, affecting 11% of adults over the age of 60. Recent US studies have found that approximately 20% of older adults have evidence of spinal stenosis witnessed on imaging scans; however, more than 80% of adults have no symptoms or require treatment.

Lumbar spinal stenosis, or spinal canal narrowing, is a common cause of low back pain.
Your low back (lumbar spine) consists of five vertebrae between your ribs and pelvis. Lumbar spinal stenosis is a narrowing of the spinal canal, which compresses the spinal cord and exiting nerves that travel from your back into your legs. 


The condition is caused by spinal degeneration by which the vertebrae and facet joints become arthritic and overgrow, resulting in spinal canal narrowing. The narrowing of the spinal canal occurs gradually over many decades. Your spinal disc, which sits between the vertebral bodies, becomes hardened and less spongy resulting in loss of disc height. Bone spurs can develop, and ligaments that hold the spine together may thicken. These conditions can contribute to the narrowing of the central spinal canal, resulting in inflammation and compression of the spinal nerves. When these nerves are compressed, they can produce symptoms.

What are the Most Common Symptoms of Low Back Pain?

The most common symptoms of spinal stenosis are low back pain extending into your buttocks and often down one or both legs. The pain can also be associated with numbness or tingling in the leg or feet. The pain associated with spinal stenosis is usually worse while standing or walking and relieved when sitting or leaning forward. Some patients, over time, can gradually worsen and develop severe limitations in physical activities.

How is Spinal Stenosis Diagnosed?

A spine surgeon diagnoses spinal stenosis based on patient symptoms and physical examination. The doctor confirms the diagnosis with an x-ray and magnetic resonance imaging (MRI) to visualize and compression of the spinal cord, spinal nerve roots, and signs of degeneration in the discs, ligaments, and facet joints.

How is Spinal Stenosis Treated?

Once diagnosed with spinal stenosis, a doctor will recommend conservative measures such as:

  • Activity modification
  • Decreased periods of walking or standing
  • Over-the-counter pain medications or prescription medications
  • Physical therapy

Some patients suffering from chronic pain and symptoms who have exhausted conservative efforts may benefit from the following:

  • Epidural steroid injections
  • Interventional pain management procedures such as radiofrequency ablation (back pain only)
  • Traditional surgical interventions to decompress the nerves, such as laminectomy or laminotomy. (back pain and leg pain)

Surgical Treatment Concerns

Most often, patients are treated with a laminectomy or lumbar spinal fusion. Because of the invasive nature of these surgeries, there are potential complications and risks associated with elderly patients with heart disease, lung disease, or other chronic conditions. In addition, each of these surgeries does require extensive recovery time because of the incision size of 1-2 inches and the nature of muscle and ligament disruption during surgery.

What is the Dual Portal® Endoscopic Spine Surgery?

Dual Portal ® is A NEW and innovative ultra-minimally invasive endoscopic surgical option to relieve spinal stenosis. This new technique treats spinal stenosis by targeting and decompressing the nerves in the spinal canal through two microscopic incisions instead of a traditional 1-to-2-inch incision. At Desert Institute for Spine Care, our expert team of spine specialists offers the most advanced pain relief solutions for your back and leg pain.

What is the Advantage of Having Dual Portal Surgery versus a traditional Laminectomy/Discectomy? 

Most common questions asked by patients about Dual Portal Technique

This technique is the least invasive option available for pathologies typically addressed via MIS laminectomy. Carefully selected patients will benefit from the smallest incisions that still offer reliable and reproducible outcomes.

Often times a fusion is necessary because much of the native tissue has to be disturbed. Less invasive techniques can limit the level of exposure necessary to address pathology deep in the spine. This in turn can preserve much of the native tissue and help reduce the need for fusion surgery.

The Dual Portal technique offers excellent visualization of the surgical field. The arthroscope can visualize down to the smallest details. In trained hands, the technique offers excellent outcomes.

The Dual Portal technique is safe and effective in either setting, be it in the hospital, or an outpatient surgical center. The patient can find benefit and be released the same day.

The benefits of less invasive surgery include less pain and faster recovery times. After Dual Portal surgery, patients spend up to 2 hours in the post-operative recovery time. During this period their vitals are monitored and any pain symptoms are addressed. When deemed safe for release by the nursing team and anesthesia, patients are often discharged home.

This will depend on the type of vocation and work activity. Make sure to ask about this when discussing surgery with your surgeon.

Previous ArticleWhy Get a Virtual Second Opinion and What to Expect Next ArticleWhat Is Conus Medullaris? Everything You Need to Know