Endoscopic spine surgery treats many of the most common spine problems, including disc herniations, sciatica, and spinal stenosis, through incisions of about 7 to 10 millimeters. It is not the right operation for every patient or every diagnosis. Candidacy depends on your symptoms, your anatomy, and your imaging, and it is decided together with Dr. Kazarian at an in-person consultation at NYU Langone Health in New York City. The criteria below describe general patterns, not a diagnosis.
Who is typically a good candidate
- A lumbar or cervical disc herniation causing arm or leg pain (radiculopathy or sciatica) that has not improved with 6 or more weeks of conservative care
- Spinal stenosis with leg pain, numbness, or weakness from a compressed nerve
- A bone spur or thickened ligament compressing a single nerve root
- Recurrent disc herniation after a prior discectomy, in selected cases
- Spondylolisthesis or instability that also needs fusion, where an endoscopic TLIF may be appropriate
Situations where endoscopic surgery is usually not recommended
- High-grade spinal instability or deformity (such as scoliosis) requiring multi-level correction
- Spinal tumors or active infection
- Severe multi-level stenosis where a broader decompression is safer and more durable
- Fractures requiring stabilization across several levels
How the approaches compare
| Endoscopic (BESS) | Microdiscectomy | Open Fusion | |
|---|---|---|---|
| Incision size | Two incisions of about 7 to 10 mm | One incision of roughly 1 inch | One incision of several inches |
| Muscle handling | Muscles gently dilated, not cut | Limited muscle retraction | Muscles stripped from bone to expose the spine |
| Anesthesia | General, typically shorter | General | General, typically longer |
| Hospital stay | Usually same-day discharge | Same day or overnight | Often 2 to 4 days |
| Return to desk work | Often 1 to 2 weeks | Often 2 to 4 weeks | Often 4 to 6 weeks or more |
| Best suited for | Disc herniations, stenosis, and nerve compression; fusion when combined with endoscopic TLIF | Disc herniations when endoscopic access is not ideal | Instability, deformity, and multi-level disease needing stabilization |
Typical ranges for appropriately selected patients, not guarantees. The right operation depends on your diagnosis and anatomy.
Candidacy questions, answered
How do I find out if I am a candidate for endoscopic spine surgery?
Candidacy is determined by your symptoms, physical examination, and imaging. Dr. Kazarian personally reviews every patient's MRI to decide whether an endoscopic approach can safely accomplish the goals of surgery. You can book a consultation at any of his three New York area offices, and second opinions on existing MRIs are welcome.
Do I need to have tried physical therapy first?
In most cases, yes. Unless there is progressive weakness or another urgent finding, spine surgery of any kind is usually recommended only after 6 or more weeks of conservative care such as physical therapy, activity modification, anti-inflammatory medication, or injections.
Is age a barrier to endoscopic surgery?
Age by itself is rarely disqualifying. Because endoscopic surgery involves less blood loss, less tissue disruption, and shorter anesthesia time, it is often well suited to older patients when their anatomy is appropriate.
Can endoscopic surgery treat back pain alone, without leg pain?
Endoscopic decompression works best when symptoms come from a compressed nerve, which usually causes arm or leg pain, numbness, or weakness. Pain that is purely in the back or neck has many possible causes, and surgery is not always the right answer. An evaluation clarifies what is driving your symptoms.
What if I have already had spine surgery?
Prior surgery does not automatically rule out an endoscopic approach. Recurrent disc herniations after a previous discectomy can sometimes be treated endoscopically. Each case depends on your anatomy and imaging.
What happens at the consultation?
Dr. Kazarian reviews your history, examines you, and goes through your imaging with you on screen. If surgery is appropriate, he explains which approach he recommends and why, including whether an endoscopic technique fits your situation. If surgery is not needed, he will tell you that too.
Learn more about how endoscopic spine surgery works or explore the endoscopic procedures Dr. Kazarian performs.
This page is for general education and is not medical advice. Candidacy for any procedure is determined at an in-person consultation after review of your history, examination, and imaging.