Endoscopic Laser Decompression

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Endoscopic laser decompression is a minimally invasive spine procedure. A fine endoscope and fibre laser are used to shrink a herniated disc and relieve pressure on a compressed nerve. It is performed under local anaesthesia through a needle-sized port. Recovery is generally shorter than with open surgery, though long-term outcomes are still being studied.

What is Endoscopic Laser Decompression?

Endoscopic laser decompression is a minimally invasive spine procedure that treats back pain and nerve impingement caused by a slipped, or herniated, disc. Using a fine endoscope for direct visualisation, the surgeon can decompress and shrink the herniated portion of the disc, relieving pressure on the spinal cord and nerve roots. The shift is often compared to the move from open bypass surgery to angioplasty in cardiac care: both treat the same underlying problem through a much smaller access point. Endoscopic laser decompression is one of the treatments in Singapore Paincare’s Neurospan® suite of spinal and nerve interventions.

The procedure is performed under local anaesthesia with X-ray guidance. A video-guided catheter allows the surgeon to approach the disc at a precise angle, which is generally associated with a lower risk of nerve injury compared with traditional open techniques.

Endoscopic Laser Decompression

Who Will Benefit from Endoscopic Laser Decompression?

This treatment may be suitable for patients who:

  • suffer from severe, chronic back or neck pain
  • have spinal stenosis, a narrowing of the spinal canal
  • have had previous back surgery without lasting relief and wish to avoid another open procedure

Suitability is confirmed through a Painostic® diagnostic assessment, which looks at pain patterns, imaging findings, and nerve involvement before this or any other intervention is recommended.

How Is Endoscopic Laser Decompression Done?

  1. Local anaesthesia is given and the treatment area is prepared under X-ray guidance.
  2. A small incision, typically under one centimetre, is made. A needle-sized port with a camera (endoscope) is inserted into the spinal canal for direct visualisation.
  3. A fibre laser passed through the endoscope vaporises disc tissue or frees scarred nerve tissue.
  4. Disc material pressing on the nerve in the foramen, the nerve’s exit canal, is removed under direct vision.

Is the Pain Relief Permanent?

The holmium laser vaporises and shrinks the herniated portion of the disc, and this effect is generally lasting. A randomised controlled trial found percutaneous laser disc decompression was non-inferior to microdiscectomy on disability scores at 8 and 52 weeks (Brouwer et al., Spine J, 2015). However, patients treated with laser decompression needed further surgery more often than those treated with microdiscectomy, at 38% versus 16% (Brouwer et al., Spine J, 2015).

A slipped disc can recur after any treatment, including surgery. Recurrence can result from ongoing disc degeneration, re-injury, or tears in the disc’s outer wall. Pain relief may ease immediately or build gradually over a few weeks.

What Are the Risks and Side Effects?

As with all spine procedures, endoscopic laser decompression carries some risk. Even though the procedure is done under direct endoscopic vision, heat from the laser can, in rare cases, cause thermal injury to nearby nerves, which may cause temporary weakness in the affected nerve’s distribution. A meta-analysis of percutaneous endoscopic techniques found overall complication rates and dural tear rates were lower than with traditional open disc removal (Zhao et al., Biomed Res Int, 2022). Recovery is generally shorter than with open surgery, though individual recovery varies, and some patients may need further treatment.

Frequently Asked Questions 

It is a minimally invasive spine procedure that uses a fibre laser under endoscopic vision to shrink a herniated disc and relieve pressure on a compressed nerve, performed under local anaesthesia.

Patients with severe chronic back or neck pain, spinal stenosis, or a previous back surgery who wish to avoid another open procedure may be candidates, subject to a Painostic® diagnostic assessment.

A small needle-sized port and camera are inserted into the spinal canal under X-ray guidance and local anaesthesia. A fibre laser is then used to vaporise or shrink the herniated disc tissue under direct vision.

Most patients return to light activities within one to two days, depending on the treatment.

Relief is generally lasting, though a randomised controlled trial found patients treated with laser decompression needed further surgery more often than those treated with microdiscectomy. A slipped disc can recur after any treatment.

Risks include rare thermal nerve injury, which may cause temporary weakness. Meta-analysis data suggest endoscopic techniques carry lower complication and dural tear rates than traditional open disc removal.

References

  • Brouwer PA, Brand R, van den Akker-van Marle ME, et al. Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. Spine J. 2015;15(5):857–865.
  • Brouwer PA, Brand R, van den Akker-van Marle ME, et al. Percutaneous laser disc decompression versus conventional microdiscectomy for patients with sciatica: two-year results of a randomised controlled trial. Interv Neuroradiol. 2017;23(3):313–324.
  • Zhao K, Li LD, Li TT, Xiong Y. Percutaneous Endoscopic Lumbar Discectomy for the Treatment of Recurrent Lumbar Disc Herniation: A Meta-analysis. Biomed Res Int. 2022;2022:6488674.

Updated 21 Aug 2026