Endoscopic removal of herniated disc in the lumbar spine

If severe pain and neurological symptoms cannot be controlled by conservative care a surgical intervention will be necessary. Aim of the discectomy is to remove the extruded disk tissue and to decompress or to completely set free the pinched nerve.

We carry out all disk surgeries endoscopically! With more than 4.500 endoscopic discectomies Dr. Schubert is internationally one of the leading and most experienced spine surgeons.
Refer also to NEWS.

No big incision or opening of the spinal canal is necessary with this procedure. It is hence a tissue-preserving alternative to the conventional “open” surgery. As there is almost no tissue destruction, risk of scarring is very low. Additionally the intervention is much less cumbersome. Altogether the healing process is accelerated and recovery times are much shorter.

Minimally invasive – tissue-preserving, safe and efficient

The new endoscopic discectomy technique allows us to treat a herniated disk more safely and in a more tissue-preserving way than ever. The most important difference to a conventional endoscopic procedure (TESSYS procedure) is the lateral access through the foramen compared to the traditional dorsal access. By this means the nerves that run through the spinal canal remain completely untouched and injuries, adhesions and other complications are hence avoided. Also the intervertebral ligaments that stabilize the spinal column stay intact.

As the lateral access allows for a tissue-preserving procedure which is associated with relatively little pain, no general anesthesia is required.

How is surgery carried out?

Under local anesthesia an optical endoscope is inserted through a small incision in the skin. It is equipped with tiny working cannulas and is carefully pushed forward to the site of the disk prolapse. The extruded disk tissue can be removed under sight control. Protruding remainders are eliminated by means of a special laser nucleolyser. In certain cases, the gel-like nucleus of the invertebral disk is shrinked with the aid of chymopapain – a special protein-cleaving enzyme. This helps to disencumber the fibrous ring to support the subsequent healing process. For the revitalization of the spinal disk, abrasion of the calcified vertebral bone by means of minute instruments is done. This leads to a better blood supply in the disk tissue and a firm and stable fibrous ring can develop.

The intervention takes 30 to 45 minutes. The entrance point is aseptically covered with a small plaster.
Patients are subsequently monitored for 2 hours in the recovery room. With good general condition out-patient surgery is possible.

The next day and then again after three months there will be follow-up examinations.

Not all endoscopic surgeries are the same!

The big difference between our surgery technique and other endoscopic surgeries – which is also its main advantage - is the point of entrance. Whereas in our clinic the herniated disk is accessed laterally other techniques enter from the back. The lateral transforaminal access is much more tissue-preserving than the dorsal access as it leaves the nerves and ligaments unhurt and can be done under local anesthesia. With the dorsal entrance point always the ligamentum flavum must be “sacrificed” and the nerves must be retracted to one side. This is associated with a considerable risk of injury. Furthermore the intervention has to be carried out under general anesthesia – otherwise patients could not tolerate the pain.

Refer also to Study results

What postoperative care is necessary?

There will be a follow-up examination the day after the intervention. Additionally a physiotherapist will explain to you an individually targeted rehabilitation program. During the first two weeks you will have to put on a specially fitted plastic corset, which sustains your back and will soon allow for resuming daily activities. It is recommended to start a professionally supervised physiotherapy after one week. After 6 weeks, strengthening exercises for your back and abdominal muscles should be started. Simultaneously you might gradually resume your sports activities.

For further reading on the postoperative care after a discectomy you may want to download our brochure “postoperative care”.

When may I resume my sports activities?

After about three weeks you should be able to go swimming or to ride your bicycle. Your may resume your usual sports activities after 6 weeks.

When can I go back to work?

After one to two weeks you can resume simple office work and slight physical work. You shouldn’t do any hard physical work during the first 6 weeks and then only gradually increase.

What is the success rate?

In the international scientific literature success rates of about 90% are quoted. In our own study we found a success rate of 95%.

For more detailed information please refer to Study results