Endoscopic Spine Surgery
Frequently Asked Questions

Endoscopic spine surgery is a full endoscopic procedure performed through a small 8–10 mm incision using fine surgical instruments fitted with an HD camera at their tip. Muscles and healthy tissues are preserved without being cut. The patient can walk on the same day and usually goes home the next day.

In open surgery a 5–8 cm incision is made, muscles are cut and retracted, blood loss is significant and recovery takes weeks. With the endoscopic method only an 8–10 mm entry is used; muscles are untouched, blood loss is minimal, and walking the same day with rapid recovery is possible.

Endoscopic technique is appropriate for many patients; however, it is evaluated according to the type and extent of the condition and the patient's overall health. A personalised plan is created after surgical examination and imaging (MRI).

General anaesthesia is usually preferred. In some cases it can also be performed with a nerve block (local anaesthesia). The type of anaesthesia is decided jointly by the surgeon and anaesthesiologist.

For desk-based work, 1–2 weeks is generally sufficient. For physically demanding work, 4–6 weeks' rest is recommended. Walking and climbing stairs is usually possible on the day of surgery.

As with any surgical procedure, risks such as infection, bleeding or nerve injury are theoretically present. However, the endoscopic method significantly reduces these risks compared with open surgery. Because surrounding tissue is not damaged, healing is easier and faster.

Full endoscopic lumbar disc herniation surgery typically takes between 45 minutes and 1.5 hours. This may vary depending on the number of herniations and the patient's anatomy.

Only an 8–10 mm skin incision is made. The herniation site is visualised directly with an HD-camera endoscope and the herniated tissue is removed with precision instruments. Muscles are not touched; no sutures are required.

The endoscopic method is far less risky than open surgery. Blood loss is minimal, infection risk is low and surrounding tissues are not damaged. Op. Dr. Tunc Koc has performed this technique in more than 3,500 cases.

With the endoscopic method, patients can generally walk 2 hours after surgery. Discharge occurs on the same day or the following morning.

No. The vast majority of disc herniations can resolve with physiotherapy, medication or non-surgical methods such as nucleoplasty. Surgery is considered when pain persisting beyond 6 weeks, muscle weakness or compression symptoms develop.

Recurrence at the operated level is uncommon. However, new herniations may develop at other levels over time. Lifestyle adjustments (exercise, correct posture) reduce this risk.

With the full endoscopic technique, no screws, cages or any foreign implant is used. The disc joint is not completely removed; neck mobility is preserved. In conventional ACDF surgery, a PEEK cage and screws are used.

Fine instruments fitted with a camera at their tip are placed in the cervical region through a millimetre-scale entry. Muscles and surrounding tissues are preserved without being cut. Only the herniated tissue is removed. An anterior or posterior approach can be used.

With the endoscopic method, patients are typically discharged within 1 day. For desk-based work, 1–2 weeks' rest is recommended; for physical work, 4–6 weeks. Because muscles are not touched, recovery is much more comfortable.

Risks are very low with the endoscopic method. In anterior approaches, brief swallowing difficulty may occur; this usually resolves within a few days. Hoarseness, bleeding and spinal cord injury are rare complications.

No. Many cervical herniations can improve with conservative treatment or camera-guided nucleoplasty. Surgery is considered when pain persisting despite prolonged treatment, arm weakness or signs of spinal cord compression are present.

With the endoscopic method, the likelihood of re-operation is low because the disc is not completely removed. In conventional fusion surgery, adjacent-level problems can develop over time due to added load on neighbouring levels.

In mild to moderate stenosis, physiotherapy, analgesics and injections can control symptoms. However, if there is significant walking difficulty, leg weakness or urinary retention, surgical treatment is necessary.

Yes. With the full endoscopic method, spinal stenosis surgery can be performed successfully without screws, plates or any implant. Op. Dr. Tunc Koc performs this technique as a pioneer in Istanbul.

With the endoscopic method, patients can get up hours after surgery. Discharge is usually within 1 day. Full walking capacity is regained within a few days to 2 weeks depending on the individual.

Re-narrowing (restenosis) is possible but uncommon. Staying active after surgery, appropriate exercise and lifestyle adjustments reduce this risk.

In disc herniation, it is soft disc tissue that presses on the nerve. In spinal stenosis, canal narrowing is generally caused by ligament thickening and facet joint arthritis. Both conditions can occur simultaneously.

With the endoscopic method, multiple levels can be operated on in a single session. The surgeon's assessment and the patient's condition are determining factors in each case.

Surgery is considered when severe low back pain, leg pain, walking difficulty or signs of nerve damage fail to respond to conservative treatments. The degree of slip and the patient's overall condition are also determining factors.

It depends on the degree of slip. In mild cases, endoscopic decompression without screws may be sufficient. In advanced cases, a minimally invasive screw system may be used for inter-vertebral stabilisation; however, Op. Dr. Tunc Koc performs this too with the least possible intervention.

With the endoscopic method, discharge is generally within 1–2 days. Return to desk work is possible after 2–4 weeks, and to heavy physical work after 6–12 weeks. Bone fusion may take 3–6 months.

Spondylolisthesis does not correct spontaneously; however, in mild cases symptoms can be managed. Because of the risk of progression, specialist follow-up is strongly recommended.

Camera-guided nucleoplasty is a non-surgical closed treatment method that enters the centre of the herniation under a 3 mm HD camera and directly reaches all pain sources. Unlike conventional nucleoplasty, camera guidance makes the procedure significantly safer and more precisely targeted.

No. Nucleoplasty is not surgery; it does not require general anaesthesia, no incision or sutures are made. Patients return home a few hours after the procedure.

Conventional nucleoplasty is performed blind (without a camera); target tissues cannot be fully visualised. With the camera-guided method, the procedure is performed under HD image guidance, providing higher safety and success rates. Op. Dr. Tunc Koc is among the first surgeons in the world to perform this technique.

It provides long-lasting relief in many patients. However, disc tissue remodelling and the patient's lifestyle are determining factors. Some patients may require additional treatment over time.

It is suitable for patients with mild to moderate disc herniation. In cases of serious muscle weakness, complete nerve compression or structural spinal abnormalities (spinal stenosis, advanced spondylolisthesis), surgery is evaluated.

The procedure usually takes 30–60 minutes. After a brief observation period, patients return home the same day.

Endoscopic RFA targets facet joint nerve branches one by one under a 3 mm HD camera and interrupts pain signals with radiofrequency energy — a non-surgical closed treatment for spinal calcification. It is far safer and more effective than conventional RFA.

Post-treatment pain relief generally lasts between 6 months and 2 years. Because nerve branches can regenerate over time, repeat application may be needed. The precision targeting of the camera-guided method extends the duration of effect.

It is usually completed in a single session. Depending on the number of affected levels and the clinical picture, the surgeon may recommend an additional session.

Conventional RFA is performed "blind" under fluoroscopy guidance; target nerve branches cannot be fully visualised and radiation exposure is a concern. With the endoscopic method the procedure is performed under HD camera imaging, providing less radiation, higher precision and better outcomes.

It is particularly suitable for patients aged 50 and over with chronic back or neck pain caused by spinal calcification who are seeking non-surgical treatment. It is also a safe option for individuals at high surgical risk, such as diabetic or cardiac patients.

Patients return home on the day of the procedure. Mild pain or sensitivity may be experienced for 1–3 days; once this period passes, full return to daily activities is possible.