First, I want to understand what has changed.
Where are your symptoms? What brings them on? What have you stopped doing because of them? I consider those answers alongside the examination and imaging, looking for an explanation that fits.
For a herniated disc, an MRI can show the disc and nearby nerves. The examination helps connect that picture with symptoms such as leg pain, numbness or weakness.
My MRI shows a herniated disc. Do I need surgery? ↗Why this approach interested me.
My patients’ wish to return to active lives helped draw me to endoscopic surgery. I began performing it in 2014, then travelled to learn from surgeons in Europe and South Korea.
I wanted to understand how to reach the problem while limiting disruption to the surrounding tissues. That remains an important consideration when choosing an approach for an individual patient.
The learning behind my approach ↗A close-up view through a small opening.
An endoscope combines a camera and light. It gives the surgeon a magnified view, while specialized instruments reach the area through a small incision. In lumbar endoscopic discectomy, the surgeon removes disc material pressing on a nerve.
The route depends on where the disc material is and the person’s anatomy. A transforaminal approach reaches it from the side of the lower back; an interlaminar approach reaches it from the back.
What would the operation accomplish?
For a herniated disc pressing on a nerve, the goal is to relieve that pressure. Other problems can call for different treatments. Medial branch transection, for example, targets nerve branches carrying pain signals from facet joints.
Fusion has a different purpose, such as addressing instability. The discussion should make clear what needs treating and whether an endoscopic approach can accomplish it.
When is it worth discussing surgery?
Nonsurgical treatment remains part of the discussion. If symptoms continue to interfere with daily life, or the examination shows a concerning loss of function, we should review the treatment choices and their timing.
I want you to understand what an operation is intended to improve, what it may leave unchanged, and the alternatives. Endoscopy is one option for selected patients.
Planning for recovery.
Some endoscopic procedures allow a return home the same day. Returning to work, walking farther or playing a round of golf are separate milestones. Your procedure, health and activity goals help shape that plan.
We also discuss risks, including infection, bleeding, nerve injury, a tear in the tissue covering the nerves, and symptoms that persist or return.
The work of returning to activity ↗Sources and further reading
Reviewed November 5, 2026. Technique explanations draw on Arthrex Spine education; AAOS provides diagnostic and treatment context. The personal perspective draws on Dr. Houle’s interview.
Arthrex Spine: endoscopic surgery explained ↗Arthrex Spine: lumbar discectomy and approaches ↗Arthrex Spine: safety information ↗AAOS OrthoInfo: herniated disc diagnosis and treatment ↗AAOS OrthoInfo: the purpose of spinal fusion ↗Already scheduled for surgery?
Watch my preparation and procedure videos for scheduled patients.
Go to your surgery preparation videos ↗