# Spine surgery: disc herniation, stenosis and sciatica > Disc herniation, spinal stenosis, sciatica, spondylolisthesis and scoliosis. Biportal endoscopy, minimally invasive surgery and Alaya robotics. International patients: remote second opinion within 24-48h before you travel. URL: https://brainandspine-bcn.com/en/spine-surgery/ Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com --- # Spine surgery endoscopic, MIS and robotic The Brain & Spine spine unit: disc herniation, spinal stenosis, sciatica, spondylolisthesis and scoliosis. Biportal endoscopic surgery, minimally invasive surgery (MIS) and robot-assisted surgery with the Alaya system. International patients welcome, with a remote second opinion within 24-48h before you travel. ## What is the Brain & Spine spine surgery unit? It is a **spine surgery unit** made up of neurosurgeons with subspecialty training in spinal surgery, treating **cervical and lumbar disc herniation**, **spinal stenosis**, **sciatica**, spondylolisthesis, adult scoliosis and vertebral tumours. It operates at Hospital El Pilar (C/ Balmes 271, Barcelona) using **biportal endoscopy**, **minimally invasive surgery (MIS)** and **Alaya robotics**. A **spine specialist** from the team reviews your MRI and clinical report and replies within 24-48 hours with a concrete plan: conservative, injection-based or surgical. If surgery offers no advantage over conservative treatment, we say so. For patients living abroad, this assessment happens remotely before any travel is booked. 3 surgical approaches depending on the condition and the patient MIS minimally invasive surgery in most cases Alaya millimetre-precision robot for pedicle screws ## Three technologies, one aim: precision and recovery ### Endoscopic surgery Percutaneous approach with an endoscopic camera for disc herniations and decompressions. Millimetric incisions, minimal muscle damage and early discharge. ### Minimally invasive surgery (MIS) Microdiscectomy, tubular decompression and percutaneous instrumentation. Muscle preservation, less bleeding and faster recovery. ### Alaya robotic surgery Preoperative planning and guided implant placement with a robotic system. Millimetric precision, greater safety and lower radiation. ## What we do with an endoscopic approach ### Endoscopic discectomy **What it involves:** removal of the disc herniation through a percutaneous approach with an endoscopic camera. - Millimetric incisions - Less muscle damage - Early discharge *Indications:* cervical and lumbar disc herniation, radicular pain. ### Endoscopic foraminotomy **What it involves:** widening of the canal through which the compressed nerve emerges. - Selective release - Structural preservation *Indications:* foraminal stenosis, nerve root compression. ### Endoscopic canal decompression **What it involves:** release of the nerve structures in cases of canal narrowing. - Minimal bone resection - Fast recovery *Indications:* lumbar or cervical spinal canal stenosis. ## MIS techniques in spine surgery ### Microdiscectomy **What it involves:** removal of a disc herniation through a small incision with the aid of a microscope. - Safe and effective technique - Less postoperative pain *Indications:* symptomatic disc herniation. ### Tubular decompression **What it involves:** access to the spinal canal using progressive dilators. - Muscle preservation - Less bleeding *Indications:* stenosis, nerve compression. ### Percutaneous instrumentation **What it involves:** placement of screws and fixation systems without large incisions. - Less surgical trauma - Faster recovery *Indications:* instability, spinal fusion surgery. ## Robot-assisted instrumentation ### Guided implant placement **What it involves:** preoperative planning and guided implant placement using the Alaya robotic system. - Millimetric precision - Greater safety - Lower intraoperative radiation *Indications:* spinal fusion, complex surgery, multilevel cases, revision surgery. ### Workflow **Step 1:** preoperative CT or intraoperative 2D/3D imaging. **Step 2:** trajectory planning on the images. **Step 3:** guided execution by the robotic arm with a bone reference clamp for real-time tracking. **Step 4:** radiological verification of position. See the ALAYA robot technical sheet ↓ ## Conditions by spinal segment ### Lumbar spine Endoscopic discectomy, microdiscectomy, MIS fusion (TLIF, PLIF, LLIF, ALIF), hybrid techniques and lumbar robotics with Alaya. ### Cervical spine ACDF, disc replacement (arthroplasty), laminoplasty, MIS laminectomy, endoscopic surgery and posterior fixation for disc herniation, stenosis and myelopathy. ### Thoracic spine Vertebroplasty, kyphoplasty, MIS laminectomy, thoracic endoscopic surgery and percutaneous fusion for fractures, tumours and adult deformity. ### Spinal cord surgery Intramedullary tumours, syringomyelia, spinal cord malformations and complex spinal cord conditions with continuous neurophysiological monitoring. ### Nerve root tumours Schwannomas, neurofibromas and conus medullaris tumours. Microsurgical resection with fascicular dissection to preserve nerve function. ## Can I have spine surgery in Barcelona if I live abroad? Yes. We treat patients from Latin America, Europe and the Middle East through a pathway designed to keep travel to a minimum: imaging review and the treatment decision are handled remotely, and you only fly once the surgical indication is confirmed and the date is fixed. 1. 1 · Remote second opinion within 24-48h You send your MRI and your specialist's report. You receive a written assessment or a video call covering the diagnosis, the realistic treatment options, and whether surgery is indicated at all. 2. 2 · Closed quote before you travel If surgery is indicated, you receive a quote covering the technique, the expected hospital stay and the follow-up included, so you can decide without surprises after arrival. 3. 3 · Stay and surgery In-person consultation and any additional tests on arrival, surgery within the following 48-72 hours, and a typical total stay of 7 to 14 days depending on the technique, including the safety margin before flying home. 4. 4 · Follow-up from your home country Video consultations at 6 weeks, 3 months and 12 months, reviewing the X-rays or MRI taken in your own city. Consultations in English, Spanish, Catalan, Italian and Portuguese. ## Where does the surgery take place? The team operates at four hospitals in Barcelona: **Hospital El Pilar** (C/ Balmes 271), **Quirónsalud Aribau**, **Barnaclínic+** (Hospital Clínic) and **Clínica Olivé Gumà**. The hospital is chosen according to the complexity of the case and the equipment the technique requires. - **Hospital El Pilar (Quirónsalud):** main base for spine consultations. Operating theatres with intraoperative navigation and Alaya robotics for spinal instrumentation. - **Quirónsalud Aribau:** endoscopic and minimally invasive surgery with an early-discharge pathway of 24-48 hours. - **Barnaclínic+ (Hospital Clínic):** highly complex cases requiring tertiary hospital infrastructure, such as spinal cord tumours or adult deformity. - **Clínica Olivé Gumà:** percutaneous procedures and selected day-case surgery. The hospital matters less than the surgeon: in every case the neurosurgeon who reviews your imaging is the one who operates and who follows you up afterwards. Barcelona is well connected by direct flights from most of Europe and Latin America. ## What happens from the first consultation onwards? The pathway has four stages: imaging assessment, a shared treatment decision, surgery where indicated, and structured follow-up. For patients travelling from abroad, the first two stages are completed remotely before any trip is scheduled. 1. 1 · Imaging assessment Review of the MRI and, where relevant, CT and dynamic flexion-extension X-rays to rule out instability. Imaging is correlated with the neurological examination: a herniation visible on MRI is only operated on if it explains the symptoms. 2. 2 · Treatment decision Conservative options (physiotherapy, medication, injections), percutaneous procedures and surgery are set out with the benefits and risks of each. Reply within 24-48 hours, by email or video call. 3. 3 · Surgery Biportal endoscopy, microsurgery, MIS decompression or instrumented fusion, with navigation and Alaya robotics where screw placement requires it. The surgeon who assessed the case performs the operation. 4. 4 · Discharge and follow-up Discharge within 24-48 hours after endoscopic or microsurgical decompression, and 3-5 days after instrumented fusion. Clinical and radiological review at 6 weeks, 3 months and 12 months, in person or by video call. ## How long does recovery take for each technique? Recovery depends on whether the operation only decompresses the nerve or also fuses vertebrae. Endoscopic and microsurgical decompressions allow discharge within 24-48 hours and a return to desk work in 3-4 weeks. Instrumented fusion needs 6 to 12 weeks before normal activity. - **Endoscopic discectomy (UBE):** discharge in 24-48h · light activity in 1-2 weeks · desk work in 2-3 weeks · sport and strenuous effort at 2-3 months. - **Lumbar microdiscectomy:** discharge in 24-48h · light activity in 1-2 weeks · desk work in 3-4 weeks · strenuous effort at 3 months. - **ACDF or cervical arthroplasty:** discharge in 24-48h · soft collar for 1-3 weeks · desk work in 3-4 weeks · contact sports at 3 months. - **Stenosis decompression without fusion:** discharge in 2-3 days · progressive walking from day one · normal activity in 4-6 weeks. - **Instrumented fusion:** discharge in 3-5 days · physiotherapy from week 4-6 · normal activity in 6-12 weeks · full bony fusion at 6-12 months. - **Vertebroplasty or kyphoplasty:** percutaneous procedure · discharge within 24h · pain relief usually within the first 48 hours. These are indicative ranges from our routine practice. Actual timings depend on age, the number of levels operated on, the prior condition of the paraspinal muscles and whether a neurological deficit was present before surgery. ## Who performs spine surgery at Brain & Spine? Spine cases are handled by **neurosurgeons with subspecialty training in spinal surgery**, not by a general surgeon. The same specialist who reviews your imaging performs the operation and carries out the follow-up. ### Dr. Pedro Roldán Ramos Neurosurgeon · Spine, functional and brain surgery View profile → ### Dr. Jorge Torales Endoscopic spine surgeon · Biportal technique (UBE) View profile → ### Dr. Jhon A. Hoyos Castro Neurosurgeon · Spine and peripheral nerve View profile → ### Dr. María Elena Filadoro Neurosurgeon · Minimally invasive spine surgery View profile → ### Dr. Giulia Guizzardi Neurosurgeon · Minimally invasive and skull base surgery View profile → ### Dr. Abel Ferrés Pijoan Neurosurgeon · Spine and neuro-oncology View profile → ## Frequently asked questions about spine surgery Which conditions does a spine surgery unit treat? A spine unit treats cervical and lumbar disc herniation, spinal stenosis, sciatica caused by nerve root compression, spondylolisthesis, adult scoliosis, vertebral fractures, and vertebral and spinal cord tumours. Treatment may be conservative, injection-based or surgical, depending on the degree of nerve compression. When does a disc herniation need surgery? Surgery is considered when radicular pain persists beyond 6 weeks despite physiotherapy and medication, when progressive motor weakness appears, or when there are signs of myelopathy or cauda equina syndrome. These last two require urgent assessment. Most disc herniations improve without surgery. What is biportal endoscopic spine surgery? Biportal endoscopy (UBE) uses two incisions under one centimetre: one for the endoscope and one for the instruments. It decompresses the nerve under magnified vision without detaching the paraspinal muscles. This reduces bleeding and postoperative pain, and usually allows discharge within 24-48 hours. How long does recovery from spine surgery take? After endoscopic or microsurgical decompression, discharge is within 24-48 hours, light activity resumes in 1-2 weeks and desk work in 3-4 weeks. Fusion surgery takes longer: 6-12 weeks before returning to normal activity and around 3 months before strenuous effort. Can I have spine surgery in Barcelona if I live abroad? Yes. Your MRI and clinical report are reviewed remotely and you receive a diagnosis, treatment options and a closed quote within 24-48 hours, before booking any travel. If surgery is indicated, the usual stay in Barcelona is 7 to 14 days, including the safety margin before flying home. What is the difference between an orthopaedic spine surgeon and a neurosurgeon? Both operate on the spine. A neurosurgeon adds specific training in managing the spinal cord and nerve roots, which matters in myelopathy, intramedullary tumours and intradural pathology. Here, every spine case is handled by neurosurgeons with subspecialty training in spinal surgery. ## Robot-assisted surgery with ALAYA We use the **ALAYA Robotic Assistant** (Cyber Surgery) for the precise placement of pedicle screws in spinal fusion surgery, both open and minimally invasive. ALAYA guides the trajectory of the surgical instruments through a **patented kinematic tracking system** that requires no optical navigation cameras: it avoids the classic line-of-sight problems and takes up less space in theatre. The patient's position is monitored in real time by a bone reference clamp attached directly to the tracking device, which improves the overall accuracy of the procedure. _ALAYA robot deployed in theatre during spinal fusion surgery._ ### What do we use it for? - **Pedicle screw placement** in the posterior thoracic and sacro-lumbar spine. - **Spinal fusion surgery**, both open and minimally invasive. - **Intraoperative 3D planning** using preoperative or intraoperative 2D/3D CT. - **Implant-brand independence**: compatible with any commercially available cannulated screw. A real benefit for the patient: a reduction in mean hospital stay from 9.4 to 6.8 days documented with robotic assistance in spinal fusion, together with lower intraoperative radiation exposure for both patient and team. _Video: ALAYA Robotic Assistant (Cyber Surgery) in the operating theatre. Click to play._ ↑ Greater accuracy Significantly more accurate pedicle screw placement than with conventional technique. ↓ Minimally invasive Less tissue damage, lower risk of infection and faster postoperative recovery. ⏱ Shorter operating time An intuitive workflow and fast set-up that shorten the length of the procedure. ☢ Lower radiation The system minimises the number of image acquisitions needed during surgery. ## Where we welcome you We operate at **Hospital El Pilar, Quironsalud Aribau, Barnaclínic+ and Clínica Olivé Gumà**, in Barcelona. The clinic is designed so that your first contact is calm, transparent and technical. You are seen by dedicated clinical staff, we review your scans (MRI, CT, reports) with you and we explain the options unhurriedly, never more than one patient in the room at a time, never any rush. - **Second opinion within 24-48h**, with a written report if you wish. - **Assessment using your MRI/CT**: we review the images with you on screen. - **Personalised treatment plan**: conservative, minimally invasive or surgical, based on your actual case, not a protocol. ## How should we look after our spine? ## Related articles Diagnosis and treatment of sciatica Read article → Foraminal stenosis: symptoms and treatment Read article → Minimally invasive surgery for sports injuries Read article → ## What our patients say 5,0 Average rating on Doctoralia · testimonials anonymised with consent "I arrived with a glioma I had been told was inoperable. Here they reviewed it at the tumour board and offered me a plan. The surgery was a success. Four years on, I am well." "For years I had a cervical disc herniation, operated on by another team with no improvement. Minimally invasive surgery gave me back my mobility and took the pain away." "I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique." _**A multidisciplinary team by your side.** Neurosurgeons, neurologists and nursing staff working together on every case. [Meet the whole team →](https://brainandspine-bcn.com/en/team/)_