Endoscopic Spine Surgery

How Dr. Salman Falak performs the operation

The operation is planned on the MRI. Dr. Salman Falak marks the exact level on the skin under X-ray guidance, so the incision sits directly over the disc. Depending on the patient and the problem, it is done under local anaesthesia with sedation, where the patient is drowsy but breathing on their own, or under general anaesthesia. The anaesthetist settles this with the patient at the pre-operative visit, and anyone who would rather be fully asleep can say so.

A small incision is made and the tube is guided down to the disc. The camera shows the nerve root and the herniated fragment in a clear, magnified picture. The fragment is removed and the nerve is checked to see that it moves freely. The tube comes out, and the wound usually needs only a stitch or two and a small dressing. Many patients walk within hours and go home the same day or the next morning.

Benefits and what to realistically expect

The main gain is less damage on the way in. The back muscles are gently pushed aside and left intact, so wound pain after the operation is usually mild and the scar is small. Blood loss is minimal and the hospital stay is short. Most people return to desk work within a few weeks.

Leg pain from a pinched nerve often eases quickly once the pressure is off. Numbness and weakness take longer, because the nerve itself has to recover, and in some cases they do not go away completely. Pain in the back itself, from a worn disc, may not change much because the operation treats the nerve. Dr. Salman Falak explains what the operation can and cannot fix before anyone agrees to it.

Who is a candidate, and when it is not the right choice

Good candidates are people with a single-level disc herniation that matches their symptoms on the MRI, or a nerve passage narrowed at one point, who have given non-surgical treatment a fair trial. For older patients, and for those with diabetes or heart disease, the lighter anaesthesia and the smaller wound can be a real advantage.

The technique has limits. A spine that is unstable or slipping needs fixation with screws, which is a different operation. Heavy calcified discs, narrowing at several levels, tumours and some very large central herniations are usually better handled with microscopic spine surgery or an open operation. Occasionally the view through the tube is not enough, and Dr. Salman Falak converts to a larger incision during the same sitting. Patients are told about this possibility beforehand. Surgery is also not advised when the MRI finding does not explain the pain, because removing a disc that is not the cause will not help. Patients with mainly back pain and a nerve that looks free on the MRI are better served by physiotherapy and pain management than by any operation.

Before surgery: tests and preparation

A recent MRI of the lumbar spine is the key test, and patients from outside Lahore can send it on WhatsApp before they travel. Dr. Salman Falak also examines the patient, because the MRI and the symptoms must agree. Standing X-rays are sometimes added to check that the spine is stable.

Routine blood tests, a blood sugar check, an ECG and, when needed, a chest X-ray are done before the anaesthetist sees the patient. Blood thinners are stopped on the doctor's advice, and smokers are asked to stop, since smoking slows healing. Anyone taking medicines for blood pressure or the heart continues them unless told otherwise. Patients come fasting on the morning of surgery and bring all their old reports and scans with them.

Recovery and follow-up

Most patients are out of bed and walking on the day of surgery. The wound is kept dry for a few days and checked at the first follow-up. Light walking is encouraged from the start, while bending and heavy lifting are avoided for the first few weeks. Sitting is kept to short spells at first, with a cushion behind the lower back. Desk work usually restarts within a few weeks, and heavier manual work takes longer. Fever, redness, more pain or any leakage from the wound should be reported at once.

Follow-up visits are at the Lahore OPD, and patients from Gujranwala or Phool Nagar can be seen on the OPD days there. For anyone further away, the routine follow-up can be done by video consultation, and a photo of the wound can be sent on WhatsApp. A home exercise programme is started once the wound has healed.

Where the surgery is done

Endoscopic spine surgery is carried out in Lahore. Dr. Salman Falak consults at Sharif Medical City Hospital in Jati Umra on Raiwind Road. He also sees patients at Life Hospital in Bahria Town and at Doctor Care Hospital in Al Kabir Town, and the hospital for the operation is decided with the patient. He holds an OPD at Gujranwala Medical Complex on G.T. Road every Friday, and in Phool Nagar on Tuesdays, so patients from those districts can be examined close to home and travel to Lahore only for the operation itself. A video consultation is the simplest first step for anyone elsewhere in Punjab.

Risks and how they are kept low

Every spine operation carries some risk, and the keyhole route does not remove it. The known risks include infection, a tear of the thin membrane around the nerves with leakage of spinal fluid, injury to a nerve root, bleeding, and a fresh herniation of the same disc some months later. Serious harm such as paralysis is very rare in this type of surgery. A small number of patients need a second procedure.

Dr. Salman Falak keeps these risks low by operating only when the MRI and the examination agree, by marking the level under X-ray, by working under direct camera view, and by using antibiotics and careful wound closure. He discusses the risks frankly before consent is signed.

Related conditions and procedures

Keyhole surgery is one of several ways of treating a disc problem, and the right one depends on the MRI. The wider family of small-incision techniques is explained under minimally invasive spine surgery, and the full picture of an operation on a lower back disc, open and keyhole, is on the lumbar disc herniation surgery page. Patients whose main complaint is a slipped disc can read about the condition itself, with and without surgery, before deciding. Send your MRI on WhatsApp and Dr. Salman Falak will tell you whether the keyhole route is right for you.