Lumbar Spine

Endoscopic Surgery for Lumbar Disc Herniation and Sciatica

If you have a lumbar disc herniation causing sciatica—leg pain, numbness, or weakness—the question is not simply whether surgery is needed, but how it should be performed.

The goal of surgery is straightforward:
to remove the portion of disc compressing the nerve while preserving as much normal anatomy as possible.

Why Endoscopic Techniques Matter

Multiple studies have shown that endoscopic lumbar discectomy is as effective as traditional open or microscopic techniques for relieving leg pain caused by disc herniation, while offering important advantages, including:

• Smaller incisions

• Less blood loss

• Reduced disruption of muscles and supporting tissues

In many other surgical fields—such as sports medicine—video-assisted endoscopic and arthroscopic techniques are the standard of care, precisely because they allow surgeons to treat pathology while minimizing collateral tissue damage.

When applied thoughtfully and for the right patient, endoscopic spine surgery offers similar benefits.

Preserving the Structures That Protect the Spine

In my experience, the long-term success of lumbar surgery depends not only on nerve decompression, but on preserving the muscles, ligaments, and tendons that stabilize the spine over a lifetime.

Endoscopic techniques allow decompression to be performed with:

• Minimal muscle disruption

• Reduced scarring

• Better preservation of normal spinal mechanics

This often translates into a faster return to normal activity and less postoperative stiffness, particularly in active patients.

Surgical Technique and Visualization

The technical details of a successful full endoscopic lumbar discectomy are critical.

In the accompanying video, I narrate the steps of a posterior endoscopic discectomy using an example of a left-sided L4–5 disc herniation in a young patient who works in the construction industry.

The operation is performed through a very small incision—approximately 1 centimeter in length—using a working tube (cannula) that is only slightly larger than a standard #2 pencil.

Despite the small incision and tubular access, endoscopic visualization allows for:

• Excellent illumination and magnification

• Precise identification of nerve structures

• Effective bleeding control

• Targeted removal of the herniated disc

All while minimally disturbing healthy muscles and supporting tissues.

A Measured Approach

Endoscopic lumbar surgery is not appropriate for every patient or every spinal condition. Proper patient selection, careful imaging review, and surgical experience are essential.

When those elements align, endoscopic discectomy can provide reliable relief of leg pain while respecting the normal anatomy that supports long-term spinal health.If you have a lumbar disc hernation, sciatica, pain, and numbness in your leg, the decision on how to remove the herniated disc is an important one. Studies have shown that endoscopic techniques are as effective as traditional open techniques but with smaller incisions, less blood loss, and less tissue damage. In other fields of surgery, such as sports medicine surgery, video assisted endoscopic or arthroscopic surgery is the standard of care. In our experience, endoscopic surgery of the spine, for the right indications and on the right patient, has all of the same advantages: faster return to normal activities with less tissue damage and better preservation of the muscles that protect the spine and provide lifelong stability and strength. The technical details of a successful all endoscopic discectomy done via a posterior approach are important. In this video I narrate the steps involved, using an example of a left sided L4-5 disc herniation in a young male who works in the construction industry. This operation is done via a very small incision — approximately 1 cm in length — using a tube that is just larger than a standard #2 pencil. In spite of the small incision and operating through a tube called a cannula, I believe that I am able to better see fine anatomic details inside the spinal canal. control bleeding, and removed the herniated disc with barely disturbing the healthy muscles, ligaments, tendons, and other structures that support the spine.