Lumbar disc herniation: can endoscopic surgery still involve screws?

“Endoscopic” is not a complete procedure name

Some endoscopic procedures only remove herniated disc material pressing on a nerve; others also involve fusion and internal fixation. “Minimally invasive” or “endoscopic” does not by itself define the operation’s scope or establish that screws will not be used.[1,2]

A 2024 Beijing Administration of Traditional Chinese Medicine article from Pinggu District’s Chinese medicine hospital describes transforaminal endoscopy separately from OSE, or open spinal endoscopy. Its explanation of OSE explicitly includes decompression, fusion and internal fixation.[1] In consultations in China, two plans using the word “endoscopic” can therefore still describe different procedures.

Decompression mainly relieves pressure on nerves. Fusion aims to join adjacent vertebrae with bone and improve stability. Screws and rods can support the bones while fusion develops.[2,3] Behind the question “Will there be screws?” is another: is fusion planned, and why is it needed?

Fusion is not routine for a first herniation

The WFNS Spine Committee’s 2024 recommendations on surgery for a first lumbar disc herniation state that lumbar fusion should not be routine. It may be considered for some patients with spinal instability or chronic low back pain.[2]

Relieving nerve compression and addressing stability need separate explanations. A decision to operate does not automatically make fusion necessary. Conversely, if there is a genuine stability problem requiring treatment, wanting fewer implants does not prove that disc removal alone will be enough.

These recommendations concern first-time herniation surgery. They cannot simply be applied to recurrence after surgery, revision surgery, or other main spinal diseases. Having mainly back pain does not let a patient decide that fusion is needed; a spine specialist must interpret symptoms, examination and imaging together.[1,2]

Compare the scope of the two proposed operations

If one proposal says “endoscopic discectomy” and another says “decompression, bone graft fusion and internal fixation”, the difference extends beyond the incision or endoscope. Ask which spinal level or levels will be treated, what tissue will be addressed, and why fusion is being added. Align these details before comparing the plans.[1–3]

Fusion also carries risks worth understanding: the intended bone fusion may not develop, implants may be misplaced or fail, and adjacent spinal levels may develop problems.[3] Recovery and follow-up cannot simply follow another patient’s “endoscopic surgery” experience. The responsible team should determine activity, follow-up and fitness to travel according to the actual procedure.

When sending information to a Chinese hospital, use the medical records preparation guide to retain complete images, reports and prior treatment details. Describe changes in back pain, leg pain, numbness or weakness. Doctors need those records and an in-person assessment to explain the plan. The questions before agreeing to treatment can help you obtain a written procedure name, scope and expected improvement.[1,2]

New difficulty passing urine, altered sensation around the perineum, or rapidly worsening leg weakness requires emergency assessment nearby. Do not wait for travel to China or a platform reply.[1,2] The cause must be checked in person; this article cannot determine whether a particular operation is needed.