Benefits of Microendoscopic Lumbar Discectomy?

Review written by: James Demetrious, DC, DABCO

At PostGradDC, we offer advanced post-graduate continuing education through current and critically reviewed research. It is our goal to improve and enhance the standard of healthcare delivery. We seek to alleviate suffering and promote health through education.


I recently had the opportunity to observe a remarkable neurosurgeon perform a revision ACDF and a multi-level lumbar foraminotomy. The surgeon employed careful selection criteria and redundant safety measures. To preserve and minimize tissue damage, he utilized microendoscopic laminectomy tubular retractors and serial dilators.

Chiropractic physicians, PCPs and physical therapists recognize that progressive motor deficits, bladder, bowel, sexual dysfunction and saddle dysesthesias may require neurosurgical consultation and possible intervention. It is clear that the surgical alteration of native tissue during the surgical decompression of disc herniations, synovial cysts, and degenerative sequelae has consequences. When indicated, minimally invasive, small window surgical technique has benefits.

As a chiropractic orthopedist, I am able to help many patients with profound neurologic compromise. However, there are times when surgical decompression may be necessary. As a member of a community of caregivers, it is my hope to inform and recommend therapeutic options that may benefit my patients. To best serve my patients, it is incumbent upon me to be aware of procedures and protocols of ancillary providers and direct patients to those practitioners, when necessary.

Recent Papers

In their paper, Kulkarni et al, report the advantages of microendoscopy including cosmesis, early postoperative recovery, and minimal postoperative morbidity. Utilizing tubular retractors with a microscope affords the physician the ability to minimally damage the multifidus and posterior primary ramus that is important for afferent and efferent segmental control. 

When indicated, the benefit of minimally invasive procedures offers significantly shorter operating times, less intraoperative blood loss and minimized damage to native tissues offering patients improved outcomes.

Following are some current papers regarding the subject:


Physicians who employ care that reflects the best interest of patients achieve superior outcomes. Spinal care requires careful differential diagnosis and orchestration of spinal interventions. The literature clearly defines the benefit of initial chiropractic care and its ability to decrease surgical need and reduce adverse drug events due to opiates:

However, there are times that patients require pharmacologic, pain management, physical therapeutic and surgical interventions. For those patients, it is incumbent upon all practitioners to be aware of and employ the necessary care at the necessary time.

Final Thoughts

As a chiropractic orthopedist, I have an interest in understanding the protocols provided by ancillary providers so that I may make appropriate and correct referrals to my colleagues. For this reason, even after 36 years of clinical practice, I continue to read, shadow neurosurgeons and teach postgraduate coursework to benefit our patients. For your patients, I encourage you to do so.

PostGradDC offers advanced post-graduate chiropractic continuing education. Our founder, Dr. James Demetrious, is a nationally distinguished board-certified chiropractic orthopedist, educator, author and editor. For current, evidence-based and clinically intuitive CE Coursework, attain your advanced training at