Out-of-state? Free MRI review4.9 ★ · 619 Google reviewsBoard-certified spine surgeonSame-day spine surgeryCall (424) 217-7463
Out-of-state? Free MRI review + telehealth consult before you travel 4.9 ★ · 619 Google reviews Board-certified — American Board of Orthopaedic Surgery Minimally invasive, same-day spine surgery in Beverly Hills Call (424) 217-7463
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The differentiator

Ultra-Minimally Invasive Biportal Endoscopic Spine Surgery

Two tiny incisions, a high-definition endoscope, and no muscle cutting — most patients walk the same day and return to life in weeks, not months.

Medically reviewed byDr. Hooman Melamed, MD, FAAOS

Book a Consultation Is my case a fit? Send MRI
Dr. Hooman Melamed reviewing spinal anatomy on a model in his exam room
Every plan starts with your anatomy — reviewed personally, not by a coordinator.

The short answer

What Is Biportal Endoscopic Spine Surgery (BESS)?

Biportal endoscopic spine surgery (BESS) treats a pinched nerve, herniated disc, or stenosis through two openings under a centimeter — one for a high-definition endoscope, one for instruments. Instead of cutting muscle off the spine, the tissue is gently spread and the camera works under continuous saline irrigation, so Dr. Melamed sees and corrects the problem under magnification.

Because the muscle is preserved rather than detached, most patients walk within hours, go home the same day, and need far less narcotic pain medication than after traditional open surgery. Dr. Melamed has performed the biportal endoscopic approach in Beverly Hills, in the greater Los Angeles area, since 2019.

BESS at The Spine Pro in Beverly Hills

One portal inserts a thin fiber-optic camera for a magnified, panoramic view, while the other allows instrument passage for precise work—like removing bone spurs or herniated discs. This dual-portal system bypasses healthy tissues, preserving spinal stability and minimizing scarring.

Unlike traditional open surgery, BESS is outpatient at Cedars-Sinai Medical Center, with most patients discharged the same day. A 2025 meta-analysis confirms BESS’s superiority in reducing hospital stays compared to microscopic approaches.

Featured on Dr. Oz, The Doctors, and Fox News, and honored by Castle Connolly as a Top Doctor, Dr. Melamed delivers care to patients from Los Angeles to international locales like London and Dubai.

How it works

How BESS Is Performed: Step-by-Step

  1. 01

    Two tiny portals

    Two openings under a centimeter — one for a high-definition endoscope, one for instruments. No long open incision.

  2. 02

    Muscle is spared

    Instead of cutting muscle off the spine, the tissue is gently spread. The camera sees clearly with continuous saline irrigation.

  3. 03

    The problem is fixed

    The herniation, bone spur, or nerve compression is addressed under magnified view with millimeter precision.

  4. 04

    Home the same day

    Most patients walk within hours and go home the same day, with far less need for narcotics.

Why it matters

What muscle-sparing actually gets you

The muscles along your spine are what hold you upright and pain-free. Preserve them, and recovery changes completely.

Check if you are a candidate →
  • Incisions under 1cm — no large open wound
  • Muscle-sparing: preserved, not cut
  • Outpatient / same-day discharge for most
  • Dramatically less narcotic use
  • Faster return to work and activity

Advantages of Biportal Endoscopic Spine Surgery

BESS offers benefits, backed by 2025 research:

  • Superior Visualization and Access: Magnified views allow precise targeting, treating complex cases like multilevel stenosis.
  • Motion-Sparing and Stability-Preserving: Avoids fusions, reducing long-term instability risks.
  • Low Complication Rates
  • Rapid Recovery: drive in 2-3 days, full activity in 4 weeks.
  • Cost-Effective: Lower hospital costs than open procedures, per 2023-2025 data.

Conditions Treated with BESS

Dr. Melamed uses BESS to address:

Head to head

How is BESS different from open surgery or fusion?

Traditional openBiportal endoscopic
Incision Several inches, open exposure Two openings under 1 cm
Muscle Cut and retracted off the spine Spread and spared, not cut
Setting Often inpatient, hospital stay Typically outpatient, same-day home
Visualization Direct line of sight High-definition endoscopic magnification
Narcotics Higher post-op need is common Designed to minimize narcotic use
Recovery Weeks to months, variable Many return to light activity in weeks

Every spine is different. Candidacy and outcomes are determined case by case after Dr. Melamed reviews your imaging.

Why BESS Outperforms Uniportal Endoscopic Spine Surgery

Single-portal (uniportal) endoscopic surgery limits surgeons to a 2D view, restricting access and often requiring toxic methylene blue dye for disc identification, which can cause complications. BESS’s independent portals provide 3D flexibility, continuous irrigation to lower infection risks, and no dye is needed.

Watch Dr. Melamed compare BESS with fusion

Biportal Endoscopic Spine Surgery vs. Traditional Fusion · Dr. Hooman Melamed on YouTube

Potential Complications and Risks

Though rare, risks include spinal fluid leaks, nerve irritation, or reherniation. 2025 studies report lower rates in BESS vs. tubular surgery (10.7% vs. 15.9%). Discuss with Dr. Melamed for personalized insights.

Am I a candidate for BESS?

Patients travel from across the greater Los Angeles area to Beverly Hills for the biportal endoscopic approach. Most people with sciatica, a herniated or bulging disc, spinal or foraminal stenosis, or a pinched nerve that has not settled with conservative care are candidates. Candidacy comes down to what your imaging shows, so the honest way to know is to have Dr. Melamed read your MRI or CT himself — not every spine problem is suited to the biportal approach, and he will tell you plainly if a different technique fits your case better.

Send your MRI for a personal review →

What is recovery like?

Because the muscle is spared rather than cut, most patients are up and walking the same day and return to light activity within a few weeks rather than months. Recovery still varies by procedure and by patient, so Dr. Melamed gives you a realistic timeline for your specific case at your consultation. The muscle-sparing technique is also designed to keep narcotic use to a minimum after surgery.

Book a consultation →

Recovery Timeline for BESS

  • Day 0: Same-day discharge; Tylenol for pain.
  • Days 1-3: Light activity, driving possible.
  • Weeks 2-3: Start physical therapy.
  • Month 1: Full activities, per therapist clearance.

Common questions

Frequently Asked Questions (FAQs)

Am I a candidate for minimally invasive spine surgery?

Most patients with sciatica, a herniated or bulging disc, stenosis, or nerve compression are candidates. The fastest way to know is to upload your MRI or CT scan for a personal review by Dr. Melamed.

How is biportal endoscopic surgery different from open surgery?

It uses two incisions under a centimeter and a high-definition endoscope instead of a large open wound. Muscle is spared rather than cut, so most patients go home the same day with far less pain and narcotic use.

Will I need narcotics after surgery?

Dr. Melamed's approach is designed to minimize narcotics. Muscle-sparing technique and outpatient recovery mean most patients need far less pain medication than with traditional surgery.

What is the difference between BESS and uniportal?

BESS offers better flexibility and lower risks.

Can international patients access BESS?

Absolutely—virtual consultations available.

Sources

  1. European Review for Medical and Pharmacological Sciences (PubMed), “Unilateral biportal endoscopic spine surgery for lumbar spinal stenosis: a systematic review and meta-analysis (Zhuang et al., 2023)”
  2. European Spine Journal (PubMed), “Unilateral biportal endoscopic discectomy versus microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis (Feng et al., 2024)”

Second opinions welcome

Not sure if surgery is the answer? Neither are we — until we've seen your MRI.

Send your imaging for a personal review with Dr. Melamed. Many patients learn a smaller, muscle-sparing option is on the table.

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