# Lumbar spine surgery in Barcelona: disc herniation and stenosis

> Minimally invasive lumbar spine surgery: disc herniation, spinal canal stenosis, spondylolisthesis. Care for national and international patients. Endoscopic and microsurgical techniques.

URL: https://brainandspine-bcn.com/en/spine-surgery/lumbar-spine/
Fuente: Brain & Spine Barcelona — https://brainandspine-bcn.com

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# 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.

Reviewed by
Dr. Pedro Roldán Ramos
, neurosurgeon · Last medical review: 16/04/2026

## 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

## 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.

## 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.

## 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.

## How we organise each case

1. 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.
2. 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.
3. 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.
4. 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.

## Neurosurgeons who treat it

### Dr. Jorge Torales

Neurosurgeon · Skull base and spinal endoscopy
View profile →

### Dr. Abel Ferrés Pijoan

Neurosurgeon · Spine, neuro-oncology and skull base
View profile →

### Dr. Pedro Roldán Ramos

Neurosurgeon · Spine, functional and brain surgery
View profile →

### Dr. Jhon A. Hoyos Castro

Neurosurgeon · Spine, peripheral nerve and skull base
View profile →

### Dra. María Elena Filadoro

Neurosurgeon · Functional, epilepsy and spine
View profile →

### Dra. M. Noelia Sosa Echeverría

Neurosurgeon · Functional and stereotactic surgery
View profile →

### Dra. Giulia Guizzardi

Neurosurgeon · Minimally invasive surgery and skull base
View profile →

## 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).

## 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.

## 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."

## Scientific references consulted

Studies and clinical guidelines on which we base our approach to this condition.

1. Weinstein JN. et al. *Surgical versus nonoperative treatment for lumbar disc herniation (SPORT)*. N Engl J Med. 2006. [View publication](https://doi.org/10.1056/NEJMoa065497)
2. Lurie JD. et al. *Long-term outcomes of lumbar spinal stenosis: 8-year results of the SPORT trial*. Spine. 2015. [View publication](https://doi.org/10.1097/BRS.0000000000000731)
3. Forsth P. et al. *A randomized, controlled trial of fusion surgery for lumbar spinal stenosis*. N Engl J Med. 2016. [View publication](https://doi.org/10.1056/NEJMoa1513721)
4. Qaseem A. et al. *Noninvasive treatments for acute, subacute, and chronic low back pain (ACP guideline)*. Ann Intern Med. 2017. [View publication](https://doi.org/10.7326/M16-2367)
5. Ruetten S. et al. *Full-endoscopic interlaminar and transforaminal lumbar discectomy versus microsurgical technique*. Spine. 2008. [View publication](https://doi.org/10.1097/BRS.0b013e31816c8af7)
6. North American Spine Society (NASS) *Clinical Guidelines for Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy*. NASS. 2020. [View publication](https://www.spine.org/)

## Related resources

→ Cervical spine
→ Thoracic spine
→ Nerve root tumors

## 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.

## Percutaneous discectomy with the Disc-FX system

## Related articles

Diagnosis and treatment of sciatica
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Foraminal stenosis: symptoms and treatment
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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/)_