Neurosurgery Dr. Stoforou


What is Endoscopic Microdiscectomy MIS?

Endoscopic Microdiscectomy MIS procedure is a minimally invasive technique for treating the lumbar or cervical disc that causes back pain (lumbago, sciatica, lumbar stenosis) or neck pain (cervical stenosis). Endoscopic Microdiscectomy MIS is a modern technique that does not require bone removal, muscle mass destruction or large skin incisions. Instead, the endoscope is used with the help of X-ray to drive accurately into the intervertebral space that suffers.

Endoscopic Microdiscectomy MIS is one of the therapeutic options when methods (eg medication, physiotherapy) of conservative treatment do not work and the symptoms get worse.

There are various types of Endoscopic Microdiscectomy MIS depending on the type and location of the intervertebral disc herniation.

These are:

  • Endoscopic lateral microdiscectomy MIS / MISS.
  • Endoscopic posterior microdiscectomy MIS / MISS.
  • Hernia hunting endoscopic microdiscectomy MIS / MISS.
  • Microendoscopic discectomy MIS / MISS.

What are the advantages of Endoscopic Microdiscectomy MIS?

  • Minimally Invasive MIS / MISS.
  • Minor hospitalization duration.
  • Maintaining the Mobility of the Spinal Column.
  • Minimal blood loss.
  • Small surgical incision size (1.5cm).

Which diseases can be treated by the method of Endoscopic Microdiscectomy MIS?

  • Far lateral lumbar intervertebral disc herniation.
  • Broken intervertebral disc.
  • Stenosis of the intervertebral vertebrae.
  • Rizitis.
  • Rizopathy.

With this intervention, it is ensured that the suffering nerve is decompressed and that the pain is relieved, as well as the reduction of symptoms such as numbness of the limbs or their weakness or paralysis.

Although endoscopic methods have now become routine in adults, they have some limitations and disadvantages to be taken into account. Despite the advantages, these techniques have limitations in practice as well as in their indications of their application.

The drawbacks of Endoscopic Microdiscectomy MIS are:

  •  Long learning period for the surgeon.
  • Large intraoperative radiation during X Rays.
  • Technical difficulties due to endoscopic equipment.
  • Creation of scars in the vertebral muscles due to the insertion of the tools.

Contraindications for hernia hunting endoscopic microdiscectomy MIS are:

  • Broken disc segment away from the intervertebral segment.
  • Large central disc.
  • L5-S1 segment, especially in male patients with high iliac bones.
  • More than one level.
  • Lumbar stenosis and stenosis of the vertebral segment.
  • Vertebral slip.
  • Relapse of intervertebral disc herniation (reoperation).
  • Anatomical abnormalities of nerve roots.

How is an Endoscopic Microdiscectomy MIS surgery done?

The Endoscopic Microdiscectomy MIS surgery is performed through a minimal incision (1.5 cm).

Endoscopic Microdiscectomy MIS can be done with local anesthesia and light drunkenness. Nevertheless, general anesthesia or epidural anesthesia is sometimes recommended for patient comfort because some stages of the procedure are painful enough, to avoid unnecessary stress.

With an X Ray investigation, a small diameter tube is guided in the intervertebral space. This tube is used as a passage for surgical instruments and the endoscope. Then the nerve is pressed and the parts of the intervertebral disc that are responsible for the pressure are removed. For small projections of the intervertebral disc, laser can be used to help reduce and shrink the projected disc material, harden and prevent extra material from coming out and disable the nerve endings responsible for the pain. The patient remains in the hospital for up to 24 hours after an Endoscopic Microdiscectomy MIS surgery.

What are the possible complications of an Endoscopic Microdiscectomy MIS intervention?

Possible complications of Endoscopic Microdiscectomy MIS occur during surgery or shortly after operation.

Complication rates of an Endoscopic Microdiscectomy MIS range from 3-6% and consist of:

  • Nerve damage with concomitant dysaesthesia, paraesthesia and neuralgia,
  • Insufficient decompression and need for second surgery due to non-recovery of pain postoperatively.
  • Recurrence of the herniated disc.
  • Infection (diskitis, wound, etc).
  • Extensive hematoma in soft tissue – muscles.
  • Instability and spondylolisthisis (less than in the classic open discectomy).

Endoscopic Microdiscectomy MIS - Frequent questions

Most patients can go home on the same day or early next day.

Before the patient leaves the hospital, physiotherapists are instructed to mobilize the patient remove him/her from bed and encourage him/her to walk.

It is also recommended to avoid weight lifting, bending and turning movements for 2-4 weeks to avoid hernia recurrence.

It is also very beneficial to encourage the patient to gradually walk while sitting should be avoided for more than 45-60 minutes.

It is usually not necessary in this procedure. Occasionally, depending on the circumstances and the patient, it may be necessary to ensure a little better lumbar support in the immediate postoperative phase.


No special care is needed in most patients, except for the site of the trauma to remain clean with a small gauze to avoid contact and irritation from clothing.


The patient can have a shower immediately after an Endoscopic Microdiscectomy MIS surgery, provided the incision is covered with a waterproof gauze so that it does not get wet. After bathing, the gauze should be removed, the area dried well and a small sterile gauze must be positioned. Normal bathing can be done after 2 weeks following surgery and if the wound is healed completely.

The patient can safely drive provided there is no postoperative pain, usually from 3 to 10 days after the operation. The patient is forbidden to drive under the influence of opioid analgesics.

However, it is not advisable to make long trips for up to 2 months after the operation.

The patient can return to light work without being overworked in 1-2 weeks.

In sports and regular work he can return in 6-8 weeks provided that postoperative pain has fully receded and muscle strength has returned.

The patient will need a re-examination 10 days after an Endoscopic Microdiscectomy MIS surgery, for the surgeon to inspect the surgical incision and examine the patient.


The outcome of this kind of surgery is usually excellent with complete pain relief immediately postoperatively. Success rate of an Endoscopic Microdiscectomy MIS is over 95%.

Most patients improve immediately and return to work and everyday life without any problems.

Microdiscectomy MIS surgery is the surgery indicated for patients with herniated disc with concomitant non-rebounding pain and/or with neurological deficits (paralysis, hypoaesthesia, etc.) and is the type of surgery applied for the definite restoration of intervertebral disc herniation cases.