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Endoscopic lumbar discectomy

Endoscopic lumbar discectomy is the most minimally invasive version of lumbar disc herniation surgery. Through a 7-8 mm incision, we introduce an endoscope with a camera that allows us to remove the herniated fragment under direct vision, preserving the paraspinal muscles and the rest of the healthy disc. Many patients come to our clinic after months of sciatica that has not improved with physiotherapy, medication or injections. They look for an effective solution, but also a fast recovery that allows them to get back to their lives soon. This guide explains how the procedure works, which herniations it is indicated for and what to expect before, during and after, so you can make an informed and calm decision.

Spine neurosurgeon in Alicante and Benidorm
More than 20 years of experience in Neurosurgery (since 2003)
Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm
Endoscopic lumbar discectomy illustration: transforaminal endoscope removing an L5-S1 disc herniation through a 7 mm incision.

What is endoscopic lumbar discectomy?

Endoscopic lumbar discectomy is a minimally invasive procedure that removes the herniated disc fragment compressing a lumbar nerve root through a 7-8 mm incision, under direct endoscopic vision. We usually perform it under local anaesthesia with sedation, which allows same-day discharge in most patients.

There are two main approaches: the transforaminal (TESSYS), which enters laterally through the foramen and is ideal for foraminal and extraforaminal herniations; and the interlaminar (Iprime), which enters through the posterior midline, particularly useful at L5-S1 when the pelvis makes lateral access difficult.

Compared with classical lumbar microdiscectomy, it offers the same efficacy on sciatic pain with less muscle injury, less bleeding and a faster recovery. If you want to know whether your herniation is a candidate, you can request an assessment with Dr. Ben Ghezala.

Symptoms and warning signs

Patients who may benefit from endoscopic lumbar discectomy typically report:

Low back pain radiating down the leg (sciatica or cruralgia) following a defined nerve path
Tingling, numbness or weakness in the leg or foot
Pain that worsens when sitting, coughing, sneezing or bending forward
Reduced ability to walk distances or stand because of radiating pain
Warning signs: sudden weakness, saddle anaesthesia, bowel or bladder changes or uncontrollable pain that require urgent assessment

When is this procedure indicated?

Paramedian, foraminal or extraforaminal lumbar disc herniation confirmed by MRI
Radicular pain (sciatica or cruralgia) persisting despite 6-8 weeks of conservative treatment
Progressive neurological symptoms: weakness, sensory changes or foot drop
Recurrent herniation at a previously operated level, when the endoscopic approach avoids the prior scar
Patients seeking a fast recovery or with comorbidities that make general anaesthesia less desirable

How is the procedure performed?

1.Preoperative preparation

We review together the MRI and the clinical examination to confirm the indication and choose the approach (transforaminal or interlaminar) according to the location of the herniation. We provide fasting instructions of 6-8 hours, adjustment of any anticoagulant medication and tailored recommendations for an outpatient procedure. We answer every question before signing the informed consent.

2.During the procedure

The patient is positioned prone. We usually use local anaesthesia with sedation, which allows some communication during surgery and adds neurological safety. We make a 7-8 mm incision and, guided by fluoroscopy, advance the endoscope with the camera to the herniation. Under direct vision, we remove the herniated fragment compressing the nerve root, preserving the paraspinal muscles and the healthy disc. Closure requires a single stitch and the procedure lasts between 45 and 90 minutes depending on the case.

3.Immediate postoperative period

After surgery, the patient spends a few hours in recovery. Most people stand up and walk the same day and are discharged within hours. We provide a clear plan of oral analgesia, wound care and activity guidance for the first days at home.

Recovery after endoscopic lumbar discectomy

Recovery is notably fast compared with open surgery. Daily activities are usually resumed within 3-7 days, office work around 1-2 weeks and physical jobs typically require 4-6 weeks depending on demands.

We recommend walking from day one in a progressive way, avoiding lifting and postponing impact sports during the first weeks. Rehabilitation, when indicated, usually begins between the second and fourth week. In case of fever, sudden increase in pain or new neurological deficits, you should contact us immediately.

Risks and possible complications

Every surgery involves general risks such as infection, bleeding or anaesthesia-related complications, although these are lower because the procedure is minimally invasive and usually performed without general anaesthesia.

Specific risks include recurrence of the herniation at the same level (around 5-7% in published series, comparable to microdiscectomy), transient nerve root injury with postoperative dysaesthesia, cerebrospinal fluid leak (uncommon) and, in selected cases, the need to convert to open surgery. Risks are assessed individually for each patient.

Frequently asked questions

Endoscopic lumbar discectomy usually lasts between 45 and 90 minutes depending on the location and type of herniation. In most cases the patient is discharged the same day, after a few hours in recovery, and goes home walking.
Both techniques remove the herniation and are effective on sciatic pain. The endoscopic approach uses a 7-8 mm incision and usually local anaesthesia with sedation, while microdiscectomy uses a slightly larger incision with a microscope and general anaesthesia. The endoscopic approach tends to involve less muscle damage, less bleeding and faster recovery, although not every herniation is a candidate.
There is a recurrence risk at the same level of around 5-7%, similar to microdiscectomy. The likelihood depends on disc quality, postoperative activity and individual factors. Looking after your back, keeping a healthy weight and strengthening core muscles helps reduce that risk.
Office work is usually resumed in 1-2 weeks. Physical jobs require 4-6 weeks depending on demands. Gentle exercise (walking, stationary bike) can be reintroduced early, while impact sports are postponed until recovery and clinical assessment allow it.
Endoscopic discectomy works very well in paramedian, foraminal and extraforaminal herniations confirmed by MRI. There are situations where another technique is preferred, for example when there is associated instability or extensive stenosis. We assess this in consultation by reviewing the imaging with you.
The surgery is not painful because we use local anaesthesia and sedation that keep the patient comfortable and calm. Being partially awake adds safety because we can check in real time that the nerve root is not being irritated. Postoperative pain is usually mild and well controlled with oral analgesics.

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Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala