Have you been advised to have a lumbar disc herniation removed? Let us explain the operation itself: how the camera and instruments work, what we agree before admission and how we plan a return to activity. For symptoms and treatment decisions, see the page on lumbar disc herniation.
What is removed during endoscopic microdiscectomy?
The surgeon removes herniated material and disc fragments compressing the nerve root. Releasing the nerve is called decompression. Discectomy aims to remove the cause of compression; it does not necessarily mean removing the entire disc.[1]
The camera sends a magnified image of the surgical area to a monitor. Endoscopic instruments allow work in the required area through small access points. Herniation position, vertebral anatomy and previous surgery are considered during planning.
More about lumbar disc herniation: symptoms, indications and comparison of methods
Advantages of endoscopic herniation removal
My specialisation is endoscopic spine surgery. For the patient, both nerve decompression and how the nerve is reached matter. Endoscopy combines targeted work with preservation of surrounding tissues.
In a 2022 BMJ randomised study, percutaneous transforaminal endoscopic discectomy (PTED) was non-inferior to open microdiscectomy for leg pain reduction at one year. Less blood loss and earlier mobilisation were also reported.[2] In a separate study of biportal discectomy for single-level lumbar herniation, functional outcomes at one year were comparable, while early surgical-site pain was lower.[3]
When we discuss surgery
We consider endoscopic herniation removal when its location matches leg pain, numbness or weakness and previous treatment is insufficient, or neurological impairment requires surgical assessment.[1] At the consultation, we compare symptoms, muscle strength, sensation and MRI findings.
Herniation size alone does not determine the need for surgery. The direction of the protrusion, compression of a specific nerve and the symptoms' effect on your life matter. Send the complete study to discuss the extent of surgery and the route to the herniation.
How we choose the endoscopic approach
We plan the approach to reach the herniated fragment and decompress the nerve as required. The disc can be approached through the intervertebral foramen or the space between the vertebral laminae, depending on the level and herniation location.[2]
In a uniportal technique, the camera and working channel share one access point. In a biportal technique, the camera and instruments pass through two separate access points. These are different ways of organising the operation; the number of access points alone does not determine the result.[4]
Herniation and stenosis present different decompression goals. For a herniation, disc material is removed. Stenosis may also require work on bone and thickened ligaments narrowing the space for nerves. We discuss that procedure's plan separately.
Endoscopic decompression for lumbar stenosis · Operations for cervical disc herniation
What to send for surgical planning
- A complete MRI study in DICOM format: all image series and the report, not just photographs of individual slices.
- A description of symptoms: where pain travels, whether there is numbness or weakness and when symptoms began.
- Treatment information: which medicines, procedures and operations you have had, and their effects.
- Previous discharge summaries and existing CT scans or X-rays, if available.
Preliminary review by the professor is free. A consultation and examination are needed for the final plan; we request further investigations as necessary.
Step-by-step instructions: how to send CT/MRI scans in DICOM format
How endoscopic herniation removal is performed
- We agree the plan. We explain the surgical level, approach and intended aim of the operation.
- We provide anaesthesia and prepare the approach. In my practice, endoscopic lumbar herniation removal is performed under general anaesthesia; preparation is agreed with the anaesthetist.
- We display the working area on the monitor. The camera provides a view of the compression site.
- We remove the herniated fragment. We decompress the nerve precisely and inspect the decompressed area.
- We complete surgery and begin recovery. We assess your condition after anaesthesia and arrange initial standing and walking.
Before surgery, we also discuss risks, including recurrent herniation, infection and nerve injury. We assess them in relation to your condition and the extent of surgery.
Preparing for endoscopic surgery
After the consultation, you receive a list of preoperative investigations and the anaesthetist's recommendations. Report other medical conditions, allergies and all medication you take. Agree food, drink and medication before anaesthesia with the team.
Plan transport home and help during the first days in advance. Before discharge, we explain wound care, permitted activity and follow-up scheduling.
Surgical arrangements and cost components
Before admission, discuss the specific extent of endoscopic herniation removal and treatment arrangements with the team. The plan and cost estimate can be clarified after reviewing investigations and a consultation.
- Place and date. Clarify the facility, admission arrangements and what to bring. Consultation address and surgical location.
- Preparation and anaesthesia. Agree the tests required, anaesthetic consultation and individual recommendations before surgery.
- What the estimate includes. Ask for an explanation of charges for the surgical stage, anaesthesia, consumables, hospital stay and follow-up visits.
- After discharge. Agree wound care, activity, the next review and how to contact the team.
Length of stay and return-to-work timing are determined according to your condition and the operation performed.
Recovery after lumbar herniation removal
The small approach helps you start moving and gradually return to your usual routine. Staff assist with initial standing; we then increase walking and everyday activity according to the agreed plan.
Guidelines from my practice after endoscopic lumbar herniation removal:
- Office work — after 7–10 days.
- Physical work — after 6–8 weeks.
- Driving should preferably be limited during the first 2 weeks.
We agree return to exertion individually, considering nerve condition, how you feel and the nature of your work. Surgery with stabilisation or a different extent of decompression requires a separate recovery plan.
Endoscopic microdiscectomy
Patient testimonial
A patient's personal account.
Questions about endoscopic microdiscectomy
Are screws or a cage needed when removing a herniation?
Endoscopic removal of a herniated fragment does not itself require fixation. We assess the need for stabilisation separately, based on segment stability and surgical goals. If my endoscopic interbody fusion is needed, the plan includes a cage, bone material and fixation.
Is endoscopic surgery possible after a previous open operation?
Yes. In our practice, we perform all revision spine operations endoscopically. For planning, send current MRI scans in DICOM format and the previous operation's discharge summary.
Does a small incision mean the operation is the same for everyone?
No. Herniation location, anatomy, nerve condition and previous procedures determine the approach and extent of work. This is why we first review the complete MRI study and perform an examination.
How much does endoscopic herniation removal cost?
The cost depends on the extent of surgery, number of levels and treatment arrangements. We clarify the plan and estimate after reviewing investigations and a consultation.
When urgent assessment is needed
Increasing leg weakness, saddle numbness, new urinary problems or loss of bowel control require urgent medical assessment. With these symptoms, seek emergency help rather than waiting for an online reply.[1]
Discuss endoscopic herniation removal with the professor
Send Professor Iakiv Fishchenko the complete MRI study in DICOM format, report and a brief treatment history. At the consultation, we will discuss the cause of symptoms, the surgical plan and return to activity.
Send your scans to Professor Fishchenko
Preliminary review is free. Consultations and surgery are in Kyiv.
How to prepare your MRI scans · Lumbar disc herniation · Contact and appointments
Book an in-person consultation is possible without an MRI already available. Start with a description of symptoms and existing records; we will determine any further investigations after assessment.