Dr. Charla R. Fischer learned the ultra–minimally invasive technique known as unilateral biportal endoscopy, or UBE, from her colleague Dr. Yong H. Kim, to her left, who traveled to South Korea in 2022 to observe the procedure being performed.
Credit: Haley Ricciardi
Daniel Yahraes’s struggle with chronic back pain began in 2014. An actor and event manager, Yahraes, then 40, rolled over in bed one morning and was struck by a jolt of agony so intense he could barely move. He’d felt twinges in his lower back before, but this was more like an explosion. After calling an ambulance, he spent several days in a hospital near his home in Astoria, Queens.
Yahraes was diagnosed with a herniated disc, a rupture in one of the rubbery cushions that sit between the vertebrae. Such an injury occurs when some of the disc’s jellylike center, or nucleus, pushes out through a tear in the casing, called the annulus.
In Yahraes’s case, the rupture was in the L5-S1 region, where the bottom of the spine, the lumbar region, meets the sacrum—and the consequences were devastating. Although doctors prescribed an array of painkillers, none brought full relief. The side effects, meanwhile, caused grogginess and gastrointestinal upset. Yahraes eventually found his way to physiatrist Salvador E. Portugal, DO, MBA, medical director of sports medicine rehabilitation at NYU Langone Health’s Rusk Rehabilitation. Dr. Portugal developed a comprehensive treatment plan centered on physical therapy, tailored home exercises, and carefully adjusted medications, enabling Yahraes to keep working. Despite these efforts, periodic relapses led to further hospitalizations. His condition made it challenging to pursue career opportunities, enjoy a social life, or engage in romantic relationships. “As the years go by,” he says, “you feel like you’re becoming a smaller and smaller person.”
By 2024, Yahraes had also developed radiating nerve pain, or sciatica, in his right leg, a common complication of a degenerating lumbar disc. That September, when the pain grew so severe that he needed a walker, he decided to consider surgery. Dr. Portugal referred him to Charla R. Fischer, MD, codirector of the Endoscopic Spine Surgery Program, part of the Spine Center at NYU Langone Orthopedics.
At their first meeting, Dr. Fischer mostly listened to her patient. “It meant so much to speak to someone who was interested in the full spectrum of my journey,” Yahraes recalls. That attentiveness stems from Fischer’s conviction that the best course of treatment is one that fits a patient’s needs and goals. “You have to understand the person to help them move forward in a way that works for them,” she says.
One crucial issue for Yahraes, she learned, was that both of his professions were physically demanding. A surgeon he’d consulted at another hospital proposed a spinal fusion, in which two or more vertebrae are joined together to improve structural stability and reduce pain. But for someone who needed to be on his feet all day, whether filming scenes or overseeing receptions, a recovery that might last up to a year before he could safely return to work simply wasn’t practical.
To shorten the downtime, Dr. Fischer suggested another option: microdiscectomy, a procedure that involves removing only the portion of a herniated disc that is compressing a nerve. Several approaches are available, but the one she recommended was a new, ultra–minimally invasive technique known as a unilateral biportal endoscopy, or UBE. The method, she explained, combines excellent efficacy with easier recovery.
“Although minimally invasive approaches to microdiscectomy are easier on the body than open surgery, they can still leave patients with considerable postoperative pain,” Dr. Fischer explains. UBE microdiscectomy lowers that risk by creating less collateral damage to surrounding tissue. Instead of operating through an inch-wide metal tube, as in a common technique called tubular microdiscectomy, surgeons make two quarter-inch-long incisions on one side of the spine, just above the targeted disc. After meticulously parting the muscle, they insert a tiny camera, or endoscope, through the first opening and deploy miniaturized surgical tools through the second. The camera and tools meet at an angle, and the procedure is guided by video.
Dr. Fischer learned the procedure from Yong H. Kim, MD, co-director of the Endoscopic Spine Surgery Program and director of degenerative spine surgery in the , who traveled to South Korea in 2022 to observe the technique being performed. A recent study led by Drs. Fischer and Kim, published in the journal World Neurosurgery, found that UBE microdiscectomy reduced the use of opioids among patients by 21 percent compared to tubular microdiscectomy, with equally low rates of complications. “Against the backdrop of a nationwide opioid epidemic,” notes Dr. Fischer, “that’s a significant advantage.”
Dr. Kim notes that NYU Langone is the only health system in the New York metropolitan region that offers a comprehensive endoscopic spine surgery program, not only for microdiscectomies but also for other procedures. “We’ve done several hundred UBE procedures, more than any other institution in the country, because we’ve seen the benefits they bring to our patients,” he says.
Yahraes was sold on the idea. On November 20, 2024, he arrived at Kimmel Pavilion, where Dr. Fischer and her surgical team performed the 90-minute procedure. Like most patients, he went home the same day and required only an occasional painkiller in the early days after the surgery. Within a month, he was walking without a cane. He returned to work after six weeks, with no restrictions save for limiting his bends, twists, and lifts until fully healed.
Today, at 51, Yahraes remains virtually pain-free. He’s back to dating, socializing, and auditioning, and he swims daily. Recently, he starred in a TV commercial—his first in years. “None of that would have happened without this surgery,” he says. “I had some of the best hands in the world working on me, and I’m forever changed by that.”
