Endoscopic lumbar disc herniation removal aims to release the nerve from compression and reduce leg pain. Professor Iakiv Fishchenko consults in Kyiv and plans treatment according to your symptoms, examination and MRI.
Send MRI scans to the professor — preliminary review is free
Lumbar disc herniation: how we choose an endoscopic treatment plan
Pain radiating from the lower back into the leg, numbness or weakness require comparison of symptoms with the location of the herniation. During the consultation, we assess which nerve is compressed, how this affects movement and what previous treatment has changed.
My specialty is endoscopic spine surgery. If herniation removal is needed, we will discuss targeted nerve decompression through a small approach, the necessary extent of the procedure and the recovery plan.
This page will help you prepare for a treatment decision. The operation itself, anaesthesia, preparation and organisational matters are covered in detail on the page about endoscopic lumbar disc herniation removal.
How a lumbar disc herniation causes symptoms
A herniation occurs when some of the inner contents of an intervertebral disc protrude through its damaged outer layer. The fragment may irritate or compress a nerve root.[1]
Leg pain, numbness and weakness
Pain may spread through the buttock into the thigh, lower leg or foot. Tingling, numbness, leg weakness, difficulty walking or standing on the toes or heel may occur. Leg pain is sometimes worse than lower-back pain. These symptoms require examination: an MRI finding alone does not determine treatment.
Indications and planning for endoscopic surgery
Surgery is discussed when appropriate non-surgical treatment has not improved pain or function and imaging confirms corresponding nerve compression. Worsening neurological problems require urgent assessment. The location and migration of the fragment, anatomy and previous procedures are important when choosing a method.[2]
Examination and MRI for planning
The professor compares the images with your symptoms and assesses strength, sensation and reflexes. Additional investigations are arranged when necessary. Send the complete MRI study, and bring reports, discharge summaries and a medication list to the appointment.
When treatment without surgery is possible
In the absence of emergency indications, individually selected activity, exercises and medicines may be used. For severe acute radicular pain, the doctor may consider an epidural injection. Its indications and risks are discussed separately: spinal injections and nerve blocks.[2]
When not to wait for an online reply
Seek emergency medical care immediately, if you develop worsening leg weakness, numbness in the perineal or genital area, new urinary retention, or loss of bladder or bowel control. These may be signs of dangerous nerve compression. Do not wait for a scheduled consultation through a messaging app.[3]
From first enquiry to surgery and recovery
- First enquiry: Describe your symptoms and previous treatment. If MRI/CT has already been performed, include the complete DICOM series and report. You can start with a consultation even if you have not yet had imaging.
- Consultation: medical history and previous treatment.
- Examination: assessment of strength, sensation and reflexes.
- Diagnosis: comparison of symptoms with the scans.
- Indications: discussion of the need for surgery and alternatives.
- Planning: choosing the approach and anaesthesia, and explaining the risks.
- Surgery: releasing the nerve from compression.
- Discharge: recommendations and instructions on seeking help.
- Follow-up: assessment of your condition and adjustment of the plan.
- Rehabilitation: a gradual return to activity.
Recovery after endoscopic disc herniation removal
After endoscopic herniation removal, return gradually to your usual routine. Recovery milestones:
- Office work — after 7–10 days.
- Physical work — after 6–8 weeks.
- Driving should preferably be limited during the first 2 weeks after surgery.
We agree on the recovery plan and increases in activity individually.
Questions about lumbar endoscopy
Does the size of the herniation matter?
It matters, but is not decisive. Sometimes even large herniations do not require surgery. Conversely, a small herniation in a particular location may cause severe pain and warrant consideration of surgery. The decision depends on symptoms, examination and the results of previous treatment.
Is endoscopic surgery possible after a previous open operation?
Yes. In our practice, we perform all revision spine operations endoscopically. To plan repeat surgery, send an up-to-date MRI study in DICOM format and the discharge summary from your previous procedure.
What should I send for assessment for endoscopic surgery?
A complete MRI study in DICOM format — all image series, rather than just photographs or the written report. Include the report and a description of your symptoms and previous treatment. If you have already had spinal surgery, include the discharge summary from the procedure.
Step-by-step instructions: how to send CT/MRI scans in DICOM format
What we discuss before deciding on surgery
- The treatment goal: which symptoms are related to nerve compression and what we expect from decompressing it.
- The proposed method: how the herniation will be removed and whether an additional procedure is needed.
- The practical plan: preparation, treatment location, cost estimate and follow-up after discharge.
More about organising endoscopic surgery and the components of the estimate. We agree on the specific plan after consultation and examination.
Discuss endoscopic removal of your disc herniation
Send Professor Iakiv Fishchenko your complete MRI study in DICOM format, the report and a brief treatment history. Preliminary review is free. Discuss the endoscopic surgical plan and preparation for treatment at a consultation in Kyiv.
Send your scans to Professor Fishchenko
About the professor · Contact and appointments · How to prepare and send MRI scans
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.
Clinical case: L5–S1 herniation and recovery of foot strength
A 64-year-old woman with a central L5–S1 herniation, left-leg pain, motor deficit and urinary problems. The description after BESS/UBE includes MRI before and after surgery and progress during the first week.
Clinical case: recurrent herniation and L4–S1 stabilisation
For recurrent L4–L5 herniation and marked degeneration of two discs, revision endoscopic discectomy was combined with cages and pedicle screw fixation. The discussion covers investigations, the extent of surgery and discharge after seven days.