Lumbar Spinal Endoscopy

There are two main ways to perform spinal endoscopy: Full Endoscopic and Biportal Endoscopic surgery.

In Full Endoscopic Surgery, the camera and surgical instruments go through the same small channel. It is the most minimally invasive option and often used for removing disc material or relieving pressure on nerves.

In Biportal Endoscopic Surgery, two small incisions are made - one for the camera and one for the instruments. This gives the surgeon more flexibility and space to operate. It is commonly used for similar
conditions and allows more freedom of movement for the instruments.

Both methods are minimally invasive and allow for quicker recovery, less post-operative pain, and less disruption to surrounding tissue. Most procedures can be done using either technique, depending on the surgeon's recommendation and the specific anatomy.

This approach is used when the problem is located more centrally or at the back of the spine. The surgeon enters through a small space between the bones at the back of the spine, known as the lamina.

This technique can be used to perform a discectomy, which means removing part of a slipped or herniated disc that is pressing on a nerve. It can also be used to relieve pressure from spinal stenosis, which is when the space around the nerves becomes too narrow - either in the centre of the canal or the sides (known as
the lateral recesses).

In some cases, this method is also used to remove facet joint cysts, which are small fluid-filled sacs that candevelop near the joints in the spine and press on nerves. These can cause pain, weakness, or tingling in the legs. Because this approach avoids large cuts or muscle damage, recovery is usually quicker and there is less post-operative discomfort compared to traditional surgery.

This technique allows the surgeon to reach the spine from the side, through a natural opening where the nerves exit. It is often used for treating disc bulges that press on the nerve roots. Since this approach avoids the central muscles of the back, it causes very little disruption to surrounding tissue, and recovery is typically faster.

When the nerve passage (called the foramen) becomes too tight due to bony overgrowth or disc collapse, the nerves can become irritated or compressed. A foraminotomy gently opens up this space to relieve pressure. TELF, which stands for Transforaminal Endoscopic Lumbar Foraminotomy, accesses the foramen from the side. ICLEF, or Interlaminar Contralateral Endoscopic Lumbar Foraminotomy, reaches it from the back, but angles across to the opposite side. The difference is simply the path used to reach the area, depending on the anatomy and where the nerve is being pinched.

Both techniques are designed to free up space for the nerves without removing large amounts of bone or muscle. They can be highly effective in relieving leg pain and improving mobility.

In some patients, the spine becomes unstable or severely worn out, leading to persistent back pain or reduced function. When this happens, fusion surgery may be necessary. Endoscopic fusion is a newer approach where the procedure is done through small incisions using a camera and specialised tools, rather than a large open cut. This technique is considered in cases where other treatments have not worked or where the spine needs long-term stabilisation. In selected patients, endoscopic fusion can also be an alternative to open fusion surgery, offering similar results with less pain and a faster recovery.

Spinal endoscopy can also be used in patients who have had previous spinal operations that did not fully relieve their symptoms or where pain has returned. These are often referred to as cases of 'failed back surgery syndrome'. In these situations, the endoscope allows the surgeon to directly view and treat areas with ongoing nerve compression, without the need to reopen previous surgical sites. It is a less invasive option for patients who may need further treatment after earlier surgery.

Lumbar spinal endoscopy may be suitable for people who are experiencing leg pain, numbness, or weakness caused by a trapped nerve in the lower back. It is commonly used to treat conditions such as a slipped disc or spinal stenosis. It may also help people who have not improved with physiotherapy or injections. It is particularly useful for those looking for a less invasive alternative to traditional surgery, or for those who have already had spinal surgery in the past.

We accept referrals from healthcare professionals across the Local, Regional, and National NHS services, as well as private providers. If you are a GP, MSK clinician, or hospital doctor, you can refer your patient to the SEERAS (Spinal Endoscopy Enhanced Recovery and Access Service) for assessment. Patients cannot self-refer directly, but they can speak to their GP about a referral to the service.