Spine at the era of endoscopy.

Picture Resource: https://www.nuerahospital.com/endoscopic-spine-fusion/ (accessed 17.03.2026)

Imagine the spine as a chain of bones that protects the spinal cord and nerve roots and supports our body. The endoscopic spine surgery is a minimally invasive technique that is performed through a very small incision, usually less than 1 centimetre. The surgeon inserts a thin tube through the incision to reach the target area and then passes through it a special spinal endoscope – a tiny camera with a light – which provides a clear view of the area on a screen. The endoscope contains a working channel for the surgical instruments, so there is no need for a second incision. In this way, the doctor reaches precisely the problematic areas of the spine without pushing aside or cutting muscles, ligaments, or other tissues.

How does endoscopic surgery compare with traditional surgery?

Traditional open spine surgery requires a larger incision, which means the surgeon has to separate and often injure the paraspinal muscles – the muscles that allow us to bend sideways, flex, or rotate our trunk. In addition, removal of bone is often necessary to gain access to the deeper structures.

In contrast, the endoscopic approach uses specialised instruments and a micro-incision, allowing the doctor to visualise and operate without damaging muscles, ligaments, or bone. This drastically reduces postoperative pain, complications, and recovery time, making it an ideal option for disc herniations or spinal stenosis.

However, it is extremely important to emphasise that it is wrong to consider endoscopic spine surgery as the only suitable method. The decision to perform an endoscopic procedure depends on the correct indication, the surgeon’s experience, and other patient-related factors. It is therefore crucial that there is an open discussion between the treating doctor and the patient in order to select the most appropriate, individualised surgical treatment option.

Brief description of the technical procedure

The operation is carried out in 4 phases:

1. Diagnosis and preparation: Use of MRI, CT, or fluoroscopy to identify the target. The patient is positioned prone (face down).

2. Access: Micro-incision <1 cm, guided by fluoroscopy (real-time X-ray).

3. Endoscopic exploration: Introduction of the endoscope through the working channel (transforaminal or interlaminar). Removal of disc material, osteophytes, or hypertrophied ligament.

4. Closure: Haemostasis and 1 stitch.Duration: 45–120 minutes. Mean blood loss <50 ml.

   
   

Clinical indications

• Lumbar disc herniation.

• Spinal stenosis.

• Cervical foraminotomy.

• Revision surgery: In cases where we wish to avoid scar tissue from previous operations.

  
  

Advantages

The endoscopic method reduces postoperative inflammation by preserving the integrity of the myoligamentous structures. Mobilisation can be achieved within hours of the operation and physiotherapy can start on the first postoperative day. The patient is re-evaluated at 1–3 months with MRI.

Long-term outcomes

According to a meta-analysis published in World Neurosurgery in 2024, outcomes are durable, with 85–95% of patients reporting satisfaction with their condition at 5 years postoperatively.

Prevention of recurrence is achieved through core strengthening and weight control.

For further information, please contact 00306975400064 or info@MazarakisNeurosurgeon.com.