Full-Endoscopic Lumbar Disc Surgery (Full-Endoscopic Discectomy)

Transcript translated from Turkish (video audio remains in Turkish)

Hello everyone, I am Dr. Mehmet Levent Deniz, a specialist in brain, nerve and spine surgery. I will explain the full-endoscopic lumbar disc operation that I use in lumbar disc surgery.

Full-endoscopic lumbar disc surgery has been gaining popularity worldwide in recent years and offers patients considerable comfort. It is the latest technological development in lumbar disc surgery. This operation is performed endoscopically under local anaesthesia alone. The endoscope reaches the herniated disc tissue without cutting any muscle or disturbing bone or ligaments. The herniated tissue is removed, relieving the compressed nerve.

Compared with conventional microdiscectomy, the patient does not need to stay in hospital and can be discharged on the same day. Because there is almost no damage to anatomical tissues, the return to active life takes much less time.

I wish you all pain-free and happy days. Stay well.

What Is Full-Endoscopic Lumbar Disc Surgery?

Full-endoscopic lumbar disc surgery uses a camera to reach the herniation through a single opening of approximately 0.8 cm. It is also known as endoscopic lumbar disc surgery and is a lumbar disc herniation treatment for patients who have not responded to non-surgical care.

Tissue Preservation: Less intervention in muscle and bone means less blood loss, earlier mobilisation and a shorter hospital stay [1]. Most of our patients return to work and everyday life within approximately two weeks.

How Is Full-Endoscopic Lumbar Disc Surgery Performed?

The operation is performed through a single small opening with an endoscope, under local anaesthesia and sedation.

• Anaesthesia: Local anaesthesia and sedation are used; general anaesthesia is not needed.
• Surgical Access: The area is reached through a single opening of approximately 0.8 cm.
• Steps: The endoscope reaches the herniation without cutting muscles and with minimal disturbance of bone and ligaments. The surgeon approaches from the side (transforaminal), removes the herniated tissue and relieves the compressed nerve.
• Operation Time: Approximately 40–60 minutes.
• Hospital Stay: Patients are generally discharged the same day or within 24 hours.
• Walking: Walking begins 2–3 hours after surgery.

Which Herniations and Patients Are Suitable for Full-Endoscopic Surgery?

Not every patient with lumbar disc herniation is suitable for endoscopic surgery. Its use is more limited than microdiscectomy. Suitability for full-endoscopic lumbar disc surgery depends on the anatomical features of the herniation. How far the herniated fragment has moved away from the disc space (degree of migration) directly affects feasibility. Calcified disc herniations, associated severe canal narrowing or spinal instability limit the use of an endoscopic approach.

What Is the Success Rate of Full-Endoscopic Lumbar Disc Surgery?

In appropriately selected patients, full-endoscopic surgery is a modern minimally invasive method as successful as microdiscectomy: at 12 months, leg pain out of 100 was 7 in the endoscopic group and 16 with microdiscectomy; repeat surgery within one year was 5% versus 6%. The endoscopic group had less blood loss, a shorter hospital stay and earlier mobilisation, but the differences were small [1]. An analysis combining studies found no difference in leg pain or daily functioning at 3–12 months [2]. Compared with another minimally invasive method (microendoscopic discectomy), outcomes and recurrence counts were the same at five years [3].

What Are the Risks and Side Effects of Full-Endoscopic Lumbar Disc Surgery?

Complication rates are low. Reported rates with the endoscopic method are 1.1% for tearing of the membrane around the nerves (dural tear), 2% for wound problems, 3.5% for recurrent herniation and 4% for repeat surgery; these rates are lower than with microdiscectomy. In the same review, nerve root injury (1.2%) and neurological events involving changes in sensation or strength (4.9%) were slightly higher than with microdiscectomy [4].

🩺 Physician’s Insight & Clinical Experience

“When considering full-endoscopic surgery, the most important issue for me is not its smaller incision but whether the patient’s anatomy is genuinely suitable. MRI assessment considers the level of the herniation, its position in the canal, migration, foraminal anatomy and associated canal narrowing together. Choosing endoscopy solely for a smaller incision when the anatomy is unsuitable is not appropriate. For this reason, a microsurgical approach may be a safer and more predictable option in some patients.”

Frequently Asked Questions

What Is Full-Endoscopic Lumbar Disc Surgery, and How Is It Performed?

It is surgery for lumbar disc herniation in which a camera (endoscope) reaches the herniation through a single opening of approximately 0.8 cm.

What Is the Success Rate of Full-Endoscopic Lumbar Disc Surgery?

In suitable patients, it is as successful as microdiscectomy: at 12 months, leg pain out of 100 was 7 with the endoscopic method and 16 with microdiscectomy [1]. Long-term outcomes are also good [3].

Does Full-Endoscopic Lumbar Disc Surgery Have Risks or Side Effects?

Yes, but they are low: reported rates are 1.1% for dural tear, 1.2% for nerve root injury and 3.5% for recurrent herniation [4].

How Does Full-Endoscopic Lumbar Disc Surgery Differ from Microsurgery?

Microsurgery uses an incision of approximately 2–3 cm, whereas the endoscopic incision is less than 1 cm. Although tissue detachment is minimal in microsurgery, intervention in these tissues is even more limited with endoscopy.

Are Stitches Needed in Full-Endoscopic Lumbar Disc Surgery?

Usually one stitch is placed, or the opening is closed with adhesive strips alone; no prominent scar remains.

Can Ruptured Herniations or Fragments That Have Entered the Spinal Canal Be Removed Endoscopically?

Many can: if a ruptured (extruded) or detached (sequestered) fragment has not migrated too far within the spinal canal, it can be removed through a transforaminal (side) approach. The decision depends on the direction and distance of migration and the level of the fragment.

How Long Does Full-Endoscopic Lumbar Disc Surgery Take?

The operation takes approximately 40–60 minutes.

How Many Days Must I Stay in Hospital After Full-Endoscopic Lumbar Disc Surgery?

After endoscopic surgery, patients are usually discharged the same day or within 24 hours.

Is Endoscopic Lumbar Disc Surgery Possible Without General Anaesthesia?

Yes. This operation is performed under local anaesthesia and sedation; general anaesthesia is not needed.

When Can I Start Walking and Bathe After Full-Endoscopic Lumbar Disc Surgery?

Walking begins 2–3 hours after surgery. Special waterproof dressings allow our patients to bathe from day 2.

When Can I Return to Work After Full-Endoscopic Lumbar Disc Surgery?

Most patients return to work and daily life within approximately two weeks.

When Can I Return to Sports After Endoscopic Lumbar Disc Surgery?

Light sports are generally resumed within 2–4 weeks and intensive sports after month 2.

Which Specialist Performs Full-Endoscopic Lumbar Disc Surgery in Istanbul?

One of the physicians performing full-endoscopic lumbar disc surgery in Istanbul is M. Levent Deniz, MD, a specialist in neurosurgery.

How Much Does Full-Endoscopic Lumbar Disc Surgery Cost?

As treatment costs vary according to the patient and hospital conditions, a definite fee can only be determined after examination and review of imaging.

References

1. Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022;376:e065846. PMID: 35190388. PubMed
2. Gadjradj PS, Harhangi BS, Amelink J, et al. Percutaneous Transforaminal Endoscopic Discectomy Versus Open Microdiscectomy for Lumbar Disc Herniation: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976). 2021;46(8):538-549. PMID: 33290374. PubMed
3. Chen Z, Zhang L, Dong J, et al. Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disk Herniation: Five-year Results of a Randomized Controlled Trial. Spine (Phila Pa 1976). 2023;48(2):79-88. PMID: 36083850. PubMed
4. Bombieri FF, Shafafy R, Elsayed S. Complications associated with lumbar discectomy surgical techniques: a systematic review. J Spine Surg. 2022;8(3):377-389. PMID: 36285095. PubMed

• 👨‍⚕️ Author and medical reviewer of this content: M. Levent Deniz, MD – Neurosurgery Specialist
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.