Through a single 7–8 mm skin incision, a tubular endoscope is inserted to the spine under X-ray guidance. Two approaches are used. Transforaminal: the endoscope enters through the neural foramen (the nerve exit hole) from the side, accessing the disc and nerve root without removing any bone. Interlaminar: the endoscope enters between the laminae from the back, similar to a micro-decompression but through a smaller corridor. The herniated disc or stenotic tissue is removed under direct endoscopic visualisation with magnification. The operation takes 45–90 minutes.
Endoscopic surgery is suitable for contained and extruded lumbar disc herniations, foraminal stenosis, lateral recess stenosis, and selected cases of central stenosis. It offers faster recovery and less tissue damage than open microdiscectomy or laminectomy.
Physiotherapy, epidural injection, pain medication, and time — the same non-operative options as for standard disc surgery. Open microdiscectomy and standard laminectomy are more established surgical alternatives.
MRI confirming the pathology. Assessment of suitability for endoscopic approach — not all disc herniations or stenosis patterns are amenable. Day-case procedure.
Outcomes comparable to open microdiscectomy for appropriate indications. Advantages include smaller incision, less muscle damage, less post-operative pain, faster recovery, and same-day discharge in most cases.
Conversion to openUncommon
If the pathology cannot be adequately addressed endoscopically, conversion to open microdiscectomy may be needed. Risk approximately 2–5%.
Recurrent herniationCommon
Similar recurrence rate to open surgery (approximately 5–10%).
Leg dysaesthesiaCommon
Temporary irritation of the nerve root. More common with the transforaminal approach.
Nerve root injuryRare
Risk approximately 1%, similar to open surgery.
Dural tearUncommon
Risk approximately 1–3%.
InfectionRare
Discitis or wound infection.
Incomplete decompressionUncommon
The limited visualisation field may miss additional pathology.
Vascular injuryRare
Very rare with transforaminal approach — the iliac vessels are nearby.
General anaesthesia or local anaesthesia with sedation (awake endoscopic surgery is possible, allowing real-time patient feedback).
Most patients go home the same day. Walking immediately. Return to desk work within one to two weeks. Driving at one to two weeks. Return to sport at four to six weeks. Core strengthening from two to four weeks. Full recovery four to eight weeks — generally faster than open surgery.
Review at two to six weeks. Further follow-up only if needed.
Is endoscopic surgery as good as open surgery?
For appropriate indications, published outcomes are comparable to open microdiscectomy. The advantages are in the recovery — less pain, less tissue damage, and faster return to activity. However, it requires specialist training and equipment, and is not suitable for all spinal conditions.
Can I have this done awake?
Yes — transforaminal endoscopic discectomy can be performed under local anaesthesia with sedation. The patient provides real-time feedback about nerve irritation during the procedure. This is not suitable for all patients or all approaches.
Why can't all spinal surgery be done endoscopically?
Endoscopic surgery works through a narrow corridor with a limited field of view. Complex conditions (severe stenosis at multiple levels, large central disc herniations, instability requiring fusion, tumours) require wider access than an endoscope can provide.