Vice Chairman and HOD, Neuro Surgery and Neuro Spine, BLK-Max Super Speciality Hospital, New Delhi, India
Part 13 of 17 in Recent Advances in Neurosurgery
Minimally Invasive and Endoscopic Surgery for Lumbar Disc Herniation
August 6, 2026
Minimally invasive and endoscopic surgery for lumbar disc herniation removes the compressing disc material through a small incision, relieving nerve compression while avoiding the larger exposure of open spine surgery.
Percutaneous discectomy for a contained disc
For a contained disc, where the disc material has not broken through its outer covering, a percutaneous injection and discectomy technique can be used. The patient lies on their side, and the surgeon works under imaging guidance to go inside the disc and remove the disc fragment, freeing the compressed nerve. This approach is only suitable when the disc remains contained within the disc material.
Endoscopic discectomy for extruded disc fragments
When the disc fragment has extruded, or moved beyond the disc space to compress the nerve root, an endoscopic, minimally invasive approach is used instead. A small incision is made, and dilators are used to create a working channel down to the spine. Under microscope guidance, the ligament covering the nerve, called the flavum, is cut, the nerve root is gently retracted, and the disc material compressing it, including any extruded fragment that has moved below the nerve root, is removed.
What happens after surgery
Once the compressing disc material is removed, patients with lumbar disc herniation usually do well, with the nerve compression relieved and pain improving. Choosing between the percutaneous and endoscopic approach depends on whether the disc is contained or has extruded, and this distinction is central to planning minimally invasive spine surgery.
← Diagnosing Disc Herniation: Symptoms and When to Get an MRI | Series index | When Does Disc Herniation Need Surgery? Red Flags and Treatment Decisions →
This article is based on a Jivo Masterclass session conducted by Dr. Anil Kumar Kansal, Vice Chairman and HOD, Neurosurgery and Neuro Spine Department, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Anil Kumar Kansal taught doctors across Africa on July 13, 2025.
FROM THE LIVE Q&A
Dr. Brian (Lusaka, Zambia)
What complications are expected from trigeminal neuralgia surgery (microvascular decompression)?
Dr. Anil Kumar Kansal
There can be anaesthesia-related complications. On the surgical side, we can get a haematoma in the cerebellum, sometimes bleeding, sometimes infection, or damage to the nerves — though our infection rate is very low. One patient developed chemical meningitis leading to hydrocephalus and needed a shunt, but the rest did very well. Initially some patients complained of partial hearing loss from traction on the eighth nerve; now we use minimal traction, so results are good and complications are minimal.
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Frequently Asked Questions
What is the recurrence rate of the tumours (in cases treated with microvascular decompression / related skull-base surgery)?▼
Only about 5%, not more than that. In our setup we have done more than 100 surgeries and have not had to redo any; some patients may have mild symptoms that can be managed with medicine or reassurance, but otherwise the results are good.
Are there any recent advances in the management of paediatric congenital hydrocephalus?▼
We do endoscopic third ventriculostomy in paediatric congenital hydrocephalus, but success is slightly lower at a young age — around 70-80%. A programmable shunt has a 95% success rate, but shunt revision and infection are other factors to weigh; endoscopic third ventriculostomy is a better choice when it succeeds, since the chances of recurrence problems afterward are very low.
What is the time needed for full recovery, and what are the complications, for trigeminal neuralgia treatment (microvascular decompression)?▼
We keep the patient for three or four days; the pain is usually gone right after surgery. We continue medication for one month afterward and then stop it. We mobilise the patient to walk from the next day, and they generally do very well. We do a post-operative CT scan to check for any bleeding or collection, but results are close to perfect.
What is the success rate of the surgery, what are the financial implications, and are the screws inserted in robotic spine surgery absorbable or will they need to be removed post-op?▼
The screws used in spine surgery are not absorbable — they remain in place lifelong. Financially, robotic-assisted spine surgery costs about $1,000 to $2,000 extra on top of a normal spine surgery of around $7,000, but the advantage is that screw misplacement drops to less than 1%, which is significant because a single misplaced screw can undermine the whole surgery — so while it adds cost, it also adds real value to the outcome.
What are the success rates of these surgical procedures generally, and what are the absolute contraindications to surgery?▼
Absolute contraindications include cardiac problems, any bleeding or coagulation disorders, or severe infection in the body. If a patient — for example with trigeminal neuralgia — is responding well to medication at a controllable dose, we will not operate; surgery is offered when the patient's pain is not relieved despite medical management.
What is percutaneous discectomy and when is it used?▼
It is used for a contained disc, where the material has not broken through its outer covering; the patient lies on their side while the surgeon works under imaging guidance to remove the disc fragment and free the compressed nerve.
How does endoscopic discectomy differ from percutaneous discectomy?▼
Endoscopic discectomy is used when the disc fragment has extruded beyond the disc space; a small incision and dilators create a working channel, and under microscope guidance the ligament covering the nerve is cut, the nerve root retracted, and the compressing material removed.
How do surgeons choose between these two approaches for lumbar disc herniation?▼
The choice depends on whether the disc is contained or has extruded, a distinction that is central to planning minimally invasive spine surgery.
In This Series: Recent Advances in Neurosurgery
- 1.Recent Advances in Neurosurgery
- 2.Cervical Disc Replacement for Neck Pain and Arm Weakness
- 3.Cost of Neurosurgery Procedures in India
- 4.Deep Brain Stimulation for Parkinson's Disease
- 5.Diagnosing Disc Herniation: Symptoms and When to Get an MRI
- 6.When Does Disc Herniation Need Surgery? Red Flags and Treatment Decisions
- 7.Endoscopic Removal of Colloid Cysts
- 8.Endoscopic Third Ventriculostomy for Hydrocephalus
- 9.Gamma Knife Radiosurgery for Brain Tumours
- 10.Gliadel Wafer Chemotherapy for Recurrent Glioblastoma
- 11.Kyphoplasty for Osteoporotic Spinal Compression Fractures
- 12.Microvascular Decompression Surgery for Trigeminal Neuralgia
- 13.Minimally Invasive and Endoscopic Surgery for Lumbar Disc Herniation
- 14.Neuronavigation and Fluorescence-Guided Brain Tumour Surgery
- 15.Robotic Spine Surgery: Precision Screw Placement and Reduced Radiation
- 16.Stereotactic Brain Surgery for Deep-Seated Lesions
- 17.Trigeminal Neuralgia: Causes, Diagnosis and Treatment Options