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

Full-endoscopic lumbar disc surgery uses a camera to reach the herniation through a single opening of approximately 0.8 cm. In appropriately selected patients, it is as successful as microdiscectomy, with less blood loss, a shorter hospital stay and earlier mobilisation. Not every lumbar disc herniation is suitable for this method.

What Is the Full-Endoscopic Method?

This is a method of treating lumbar disc herniation performed entirely with endoscopic cameras in patients who have not responded to non-surgical treatment.

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.

Which Herniations Are Suitable for Full-Endoscopic Surgery? (Patient Selection)

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. Percutaneous transforaminal endoscopic discectomy (PTED) is not inferior to open microdiscectomy for reducing leg pain: at 12 months, leg pain out of 100 was 7 in the PTED group and 16 with microdiscectomy; repeat surgery within one year was 5% versus 6%. The PTED group had less blood loss, a shorter hospital stay and earlier mobilisation, but the differences were small [1]. An analysis combining studies also found no difference in leg pain or daily functioning between the methods at 3–12 months [2]. Compared with another minimally invasive method (microendoscopic discectomy), outcomes and the number of recurrent herniations were the same in both groups at five years [3].

Is Full-Endoscopic Lumbar Disc Surgery Safe, and What Are the Risks?

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 Its Success Rate?

In suitable patients, it is as successful as microdiscectomy: at 12 months, leg pain was no greater with the endoscopic method and was even slightly lower [1]. Long-term outcomes are also good [3].

Does It 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 It 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?

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) or interlaminar (back) approach. The decision depends on the direction and distance of migration and the level of the fragment.

How Many Days Must I Stay in Hospital?

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

Is Endoscopic Lumbar Disc Surgery Possible Without General Anaesthesia?

Yes, in some suitable cases, surgery can be performed under spinal or local anaesthesia while talking with the patient.

When Can I Start Walking and Bathe?

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

When Can I Return to Sports?

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 brain, nerve and spine surgery.

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 – Brain, Nerve and Spine Surgeon
• ⚠️ Medical Disclaimer: This page is for information only; consult your doctor for diagnosis and treatment.