Surgery may be considered when a herniated disc compresses a nerve and causes severe or persistent leg pain, numbness, muscle weakness or restricted mobility. Urgent assessment is required if urinary dysfunction, saddle numbness or progressive weakness develops. The decision is based on symptoms, clinical examination and MRI findings. Professor Iakiv Fishchenko personally assesses whether endoscopic surgery is appropriate.

In Professor Fishchenko’s practice, every disc herniation operation is performed exclusively endoscopically. The size, migration and location of the fragment are considered when planning the biportal BESS approach.

Please send the complete MRI study of the relevant spinal region in its original DICOM format, either as an archive or through a download link. The radiology report and a brief description of symptoms should also be included. Photographs of individual images or the written report alone are insufficient for reliable surgical planning.

Laser decompression vaporises a small amount of nucleus material within the disc in an attempt to reduce intradiscal pressure, but it does not directly remove the herniated fragment compressing the nerve. It is intended for selected contained herniations with an intact annulus. In extruded or sequestered herniations with annular rupture, laser treatment is not used and is contraindicated. During BESS, the professor directly visualises and removes the fragment under endoscopic control.

During microdiscectomy, the surgeon works through an operative access using an external microscope. With BESS, the optics are positioned directly beside the pathological area, while the endoscope and instruments are introduced through two separate small portals. This provides a wide view and independent instrument movement and may reduce disruption of muscles and healthy tissue. BESS is a complete surgical procedure, not a needle-based intervention.

Endoscopic disc herniation removal usually takes 15–30 minutes. The patient is normally mobilised on the same day, and the hospital stay is usually one day. The exact timing depends on the location of the herniation, fragment migration, previous surgery and the patient’s general condition.

For maximum patient comfort, all endoscopic spine procedures are performed under general anaesthesia. An anaesthesiologist continuously monitors the patient, and a preoperative assessment is completed before surgery.

Yes. BESS enables direct visualisation and removal of an extruded or sequestered fragment through the annular defect under continuous visual control. Professor Fishchenko performs all such operations exclusively using biportal endoscopy.

Yes. In many cases, a recurrent herniation can be removed endoscopically. If there is no significant instability, fixation may not be required. When instability, marked degeneration or repeated recurrence is present, Professor Fishchenko may recommend stabilisation using fixation implants.

No. Significant body weight is not an obstacle and, in selected cases, can be a practical advantage of BESS: the small working portals avoid a large incision and extensive muscle dissection even when the soft-tissue layer is thick. Anaesthetic and other individual risks are assessed before surgery.

For an isolated herniation without significant instability, fixation is generally unnecessary. When marked disc degeneration, instability, spondylolisthesis, previous spinal operations or a combination of these factors with excess body weight is present, Professor Fishchenko may recommend endoscopic surgery with fixation implants. The decision is based on MRI and, when required, additional imaging.

According to Professor Fishchenko’s own clinical materials, based on more than 3,000 personally performed endoscopic operations over eight years, the complication rate is below 1% and the recurrence rate is no more than 2%. These figures describe the surgeon’s personal experience but do not guarantee the same outcome for every patient. Individual risk is discussed before surgery.

Patients usually begin walking approximately two hours after surgery. Return to office work is often possible after 10–12 days, while return to physical work commonly takes about six weeks. Final timelines and the individual recovery programme are determined by the rehabilitation specialist.

The operation is personally performed by Professor Iakiv Fishchenko together with a specialised surgical team. Over the past eight years, he has personally completed more than 3,000 endoscopic operations and currently performs more than 400 such procedures annually.