Dr. Jorge Torales
Neurosurgeon · Skull base and spinal endoscopy
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Spinal pathology
Lumbar spine surgery: disc herniation and stenosis
Minimally invasive endoscopic and microsurgical techniques for lumbar disc herniation, spinal canal stenosis, spondylolisthesis and degenerative disease. Fast recovery.
What is it?
Lumbar spine surgery: disc herniation and stenosis
Lumbar spine surgery is the most common surgical treatment of the spine. Lumbar disc herniation is the leading cause of sciatica in adults (affecting 2% of the population each year); lumbar spinal canal stenosis is the leading cause of neurogenic claudication in people over 60. Current techniques are minimally invasive (microdiscectomy, endoscopy, mini-invasive TLIF) with recovery in days.
2%
annual incidence of lumbar disc herniation
90%
improve with conservative treatment within 6–12 weeks
<24h
typical hospital stay in lumbar endoscopic surgery
Symptoms
When should you see a neurosurgeon?
The most common symptoms are:
- Sciatica: pain radiating down the leg following a dermatome (L4, L5 or S1)
- Mechanical low back pain that worsens with bending or prolonged standing
- Tingling or numbness in the leg or foot
- Focal weakness (foot drop, quadriceps weakness)
- Neurogenic claudication: leg pain or paraesthesia when walking that eases on bending forward (pathognomonic of spinal canal stenosis)
- Sphincter dysfunction or saddle anaesthesia (cauda equina syndrome · EMERGENCY)
- Disabling chronic low back pain with functional limitation
Urgent care: Cauda equina syndrome (loss of sphincter control, perineal anaesthesia, acute bilateral weakness) is a surgical emergency requiring surgery within the first 24–48h.
Surgical treatments
Techniques we use in the lumbar spine
Lumbar endoscopic surgery
Lumbar endoscopic discectomy
What it involves: removal of the herniated disc through a percutaneous approach.
- Same-day discharge
- Fast recovery
Indications: disc herniation.
Endoscopic decompression
What it involves: release of compressed nerve structures.
- Minimal bone resection
Indications: stenosis.
Minimally invasive surgery (MIS)
Microdiscectomy
What it involves: removal of the herniation through a small incision.
- Effective technique
- Fast recovery
Indications: disc herniation.
Tubular decompression
What it involves: access to the canal using dilators.
- Preserves the muscles
Indications: stenosis.
MIS lumbar fusion surgery
TLIF (posterior transforaminal)
What it involves: access to the disc through the foramen for decompression and fusion.
- Less neural manipulation
- Fusion through a single approach
Indications: spondylolisthesis, stenosis with instability.
PLIF (posterior bilateral)
What it involves: posterior access to the intervertebral disc.
- High stability
- Solid fusion
Indications: advanced degeneration, instability.
LLIF / XLIF (lateral)
What it involves: lateral access to the intervertebral disc.
- Deformity correction
- Muscle preservation
Indications: scoliosis, multilevel disease.
ALIF (anterior)
What it involves: direct anterior access to the intervertebral disc.
- Restoration of lordosis
- Large implants
Indications: disc degeneration, deformity.
Hybrid anterolateral techniques + posterior fusion
What it involves: combination of anterior or lateral approaches with percutaneous posterior fixation.
- Maximum stability
- Global correction
Indications: complex cases, deformity, revision surgery.
Lumbar percutaneous instrumentation
What it involves: screw placement using minimally invasive techniques.
- Less surgical trauma
- Faster recovery
Indications: lumbar fusion.
Lumbar robotic surgery
Lumbar robotic surgery (Alaya)
What it involves: guided implant placement using a robotic system.
- Millimetre precision
- Greater safety
Indications: multilevel surgery, complex cases.
Our protocol
How we approach each case
Every lumbar condition is assessed with a lumbar MRI and, in selected cases, a CT scan for bone assessment, standing radiographs for dynamic instability or an EMG to confirm the level of radiculopathy. Conservative treatment (physiotherapy, NSAIDs, guided epidural or selective nerve root injections) is the first line for 6–8 weeks. Surgery is indicated in: progressive motor deficit, refractory radicular pain lasting >6 weeks, cauda equina syndrome (urgent), spinal canal stenosis with disabling claudication or progressive instability.
Perioperative protocol
How we organise each case
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1 · Preoperative assessment
Lumbar MRI (standard), CT if bone assessment is required, standing radiographs for dynamic instability, EMG in cases with a deficit to confirm the nerve root level. Conservative treatment for 6–8 weeks before considering non-urgent surgery.
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2 · Surgery
Minimally invasive technique whenever possible: tubular microdiscectomy, endoscopy or mini-invasive TLIF. In fusions, ALAYA robotic assistance for planning and precise placement of pedicle screws.
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3 · Immediate postoperative period
Mobilisation within a few hours. Radiographic check at one month. In endoscopy/microdiscectomy, discharge usually within <24h; in fusion, 2–4 days.
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4 · Discharge and follow-up
Progressive physiotherapy from the first week. Return to office work in 2–3 weeks, physical work in 6–8. Follow-up with radiographs at 6 weeks, 3, 6 and 12 months.
Team
Neurosurgeons who treat it
Dr. Abel Ferrés Pijoan
Neurosurgeon · Spine, neuro-oncology and skull base
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Dr. Pedro Roldán Ramos
Neurosurgeon · Spine, functional and brain surgery
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Dr. Jhon A. Hoyos Castro
Neurosurgeon · Spine, peripheral nerve and skull base
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Dra. María Elena Filadoro
Neurosurgeon · Functional, epilepsy and spine
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Dra. M. Noelia Sosa Echeverría
Neurosurgeon · Functional and stereotactic surgery
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Dra. Giulia Guizzardi
Neurosurgeon · Minimally invasive surgery and skull base
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Outcomes
Prognosis and recovery
Lumbar microdiscectomy achieves significant relief of radicular pain in 85–95% of selected patients. Endoscopic surgery achieves equivalent results with a faster recovery. In spinal canal stenosis, decompression improves walking capacity in 80% of patients at 2 years. In spondylolisthesis with instability, instrumented fusion achieves functional improvement in 75–85% of cases. The typical hospital stay ranges from 24h (endoscopy) to 3 days (fusion).
Frequently asked questions
Answers to your questions
When should a lumbar disc herniation be operated on?
Most lumbar disc herniations improve with conservative treatment within 6–12 weeks. Surgery is indicated when there is persistent radicular pain lasting >6 weeks with functional impairment, progressive motor deficit, or cauda equina syndrome (an emergency: loss of sphincter control, saddle anaesthesia). The latter requires surgery within the first 24–48h.
What is lumbar microdiscectomy?
It is the most widely used surgical technique for lumbar disc herniation. It is performed through a small incision (2–3 cm), using a microscope or high-definition loupes, and only the portion of the disc compressing the nerve root is removed. The rest of the disc remains intact so that it keeps its function.
What is endoscopic spine surgery?
It is a minimally invasive surgical technique in which the disc is reached through a 7–8 mm endoscopic tube via a transforaminal or interlaminar approach. It reduces muscle damage, speeds up recovery and even allows same-day discharge in selected cases.
When is a lumbar fusion necessary?
Spinal fusion is indicated when there is vertebral instability: spondylolisthesis, degenerative disc disease with disabling mechanical pain, scoliosis, or after extensive decompressive surgery. Modern techniques (TLIF, LLIF, ALIF) are minimally invasive in most cases.
How long does recovery after lumbar spine surgery take?
After microdiscectomy or endoscopy: return to light activity within 1 week, office work in 2–3 weeks, physical work in 6–8 weeks. After fusion: recovery is more gradual, between 3 and 6 months until complete fusion. Physiotherapy begins in the first postoperative weeks.
References
What the clinical guidelines say
"Minimally invasive lumbar surgical techniques (microdiscectomy, endoscopy) are equivalent in effectiveness to traditional techniques, with advantages in postoperative pain and recovery time."
"Cauda equina syndrome is a neurosurgical emergency requiring decompression within the first 24–48 hours in order to maximise functional recovery."
Bibliography
Scientific references consulted
Studies and clinical guidelines on which we base our approach to this condition.
- Weinstein JN. et al. Surgical versus nonoperative treatment for lumbar disc herniation (SPORT). N Engl J Med. 2006. View publication
- Lurie JD. et al. Long-term outcomes of lumbar spinal stenosis: 8-year results of the SPORT trial. Spine. 2015. View publication
- Forsth P. et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016. View publication
- Qaseem A. et al. Noninvasive treatments for acute, subacute, and chronic low back pain (ACP guideline). Ann Intern Med. 2017. View publication
- Ruetten S. et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus microsurgical technique. Spine. 2008. View publication
- North American Spine Society (NASS) Clinical Guidelines for Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy. NASS. 2020. View publication
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Related resources
Surgical technology
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.
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.
↑
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.
On video · 1 minute
Percutaneous discectomy with the Disc-FX system
Patient reviews
What our patients say
High-grade glioma
"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."
Cervical disc herniation
"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."
International patient
"I travelled from outside Spain. The team reviewed my case before I came and gave me a clear plan. Caring people and impeccable technique."
Request information
Lumbar spine consultation
Send us your lumbar MRI and your specialist's report. We will advise you on whether your case is suitable for conservative treatment, endoscopic surgery or microsurgery.