When Chronic Back Pain Becomes a Serious ProblemUnderstanding a New Surgical Option — Endoscopic Spine Surgery
Prepared by a team of spine specialists
Have you ever felt that your long-standing back pain is no longer just ordinary soreness from work? If you experience pain while sitting at your desk, standing up, or moving around, and the pain has started radiating to your buttocks and legs, while medication no longer provides relief, this may be a sign that a herniated disc is compressing your nerves.
In the past, spinal surgery often meant a large incision, a long recovery period, and several months away from work. However, today, endoscopic surgical technology has completely changed that perception — with an incision smaller than 1 cm, and most patients requiring only 1–2 days of hospitalization.
This article will help you understand everything from the causes of back pain and treatment procedures to important considerations before making a decision.
Why Are More Working-Age Adults Experiencing Back Pain?
Take a look around your workplace. How many people actually maintain a perfectly upright posture throughout the day? Most of us spend hours looking down at screens, rounding our shoulders, and sitting continuously for 2–3 hours without getting up. These habits gradually increase stress on the spine without us realizing it.
A systematic review of research indicates that lower back pain affects approximately 80% of people at some point during their lifetime and is one of the leading causes of work disability worldwide [1]. Interestingly, among adults aged 30–50 years, who are in their prime working years, herniated discs causing nerve compression have become one of the most common causes of spinal symptoms [2].
Common Risk Factors Around You
According to epidemiological studies, the following factors increase the likelihood of developing spinal problems prematurely:
Prolonged sitting habits — Sitting with a rounded back, looking down at a smartphone, or working continuously without breaks can increase pressure on the intervertebral discs by up to 40%.
Excess body weight — A higher body mass index (BMI) is directly associated with increased degeneration of intervertebral discs [2].
Smoking — Nicotine causes the small blood vessels supplying the discs to constrict, reducing nutrient delivery to disc cells and accelerating degeneration.
Improper heavy lifting — Especially bending forward to lift objects instead of lowering the body and using proper lifting techniques.
Genetics and age — These are uncontrollable factors, but deterioration can be slowed through appropriate lifestyle choices.
How Does a Herniated Disc Cause Nerve Compression?
Before understanding why pain occurs, let’s first look at the structure of the spine.
The spine is not one long solid structure. It consists of 33 small vertebrae stacked together, separated by intervertebral discs that function like “shock absorbers.” These discs absorb impact and allow us to bend, extend, and rotate our bodies with flexibility.
Each intervertebral disc has a structure similar to a jelly-filled donut:
The tough outer layer is called the annulus fibrosus.
The soft gel-like inner core is called the nucleus pulposus.
As we age or experience continuous pressure and stress, the outer layer may develop tears, allowing the inner gel-like material to protrude outward. If the protruding disc material compresses a nearby nerve, it can cause:
Pain
Numbness
Tingling sensations
Electric shock-like pain traveling from the buttocks down to the calf and sole of the foot
Weakness in the leg muscles
When Should You Consult a Spine Specialist?
There is an important difference between general back pain and symptoms caused by a herniated disc compressing a nerve.Ordinary back pain caused by muscle inflammation often improves within 2–6 weeks with rest, pain medication, or physical therapy. However, nerve compression usually presents with more specific warning signs.
4 Signs That It May Be “More Than Just Back Pain”
1. Radiating pain The pain is not limited to one area but travels from the lower back to the buttocks, thigh, calf, and foot. In some cases, coughing, sneezing, or straining may worsen the pain.
2. Abnormal skin sensations Numbness, tingling, pins-and-needles sensations, or a feeling like being pricked by needles, especially around the calf, sole of the foot, or certain toes.
3. Muscle weakness Difficulty getting up from a chair, inability to move certain toes, difficulty climbing stairs due to the knee giving way, or increased frequency of stumbling.
4. No improvement with medication or physical therapy Symptoms remain unchanged after 4–6 weeks of treatment or repeatedly return.
Warning Signs Requiring Immediate Medical Attention
If you experience loss of bladder or bowel control, numbness around the anus or genital area, together with sudden leg weakness, this may indicate Cauda Equina Syndrome. This condition may require emergency surgery within 24–48 hours to prevent permanent disability. Do not delay seeking medical care.
Treatment Options — From Medication to Surgery
Surgery is not always the first treatment option. Most doctors recommend starting with the least invasive approaches and gradually progressing to more intensive treatments when necessary. This approach is known as the “Treatment Ladder.”
Step 1: Conservative Treatment
Suitable for most patients during the first 6 weeks. Options include:
Allowing muscles to relax through appropriate rest (but avoiding prolonged bed rest — gentle movement is usually better)
Pain medication and anti-inflammatory drugs such as NSAIDs under medical guidance
Physical therapy focusing on stretching and strengthening core muscles
Improving posture and adjusting the workplace environment
Step 2: Targeted Injection Therapy
If the first stage of treatment is insufficient, doctors may consider an epidural steroid injection, where anti-inflammatory medication is injected near the compressed nerve area.
This treatment can provide good results for some patients, although the effects are often temporary.
Step 3: Surgery
When conservative treatments and injections do not provide sufficient improvement, or when urgent conditions occur such as severe muscle weakness, surgery may become a treatment option.
Currently, one of the minimally invasive techniques widely recognized for reducing tissue damage is Endoscopic Spine Surgery, which will be discussed in detail in the next section.
Comparison Table: Three Surgical Options
|
เกณฑ์เปรียบเทียบ |
ผ่าตัดเปิด |
Microscope (กล้องจุลทรรศน์) |
Endoscope |
|
ขนาดแผล |
5 – 15 ซม. |
2 – 3 ซม. |
0.5–1 ซม. |
|
เสียเลือดเฉลี่ย |
~250 มล. |
~100 มล. |
~10-20 มล. |
|
ระยะนอน รพ. |
3 – 7 วัน |
2–3 วัน |
1 คืน |
|
กลับทำงาน |
2 – 3 เดือน |
4 – 6 สัปดาห์ |
1 – 4 สัปดาห์ |
The comparative figures are based on systematic reviews and meta-analysis studies [3, 4].
What Is Endoscopic Spine Surgery?
Endoscopic Spine Surgery, or endoscopic spinal surgery, is a minimally invasive surgical technique that uses a small camera (endoscope) and specialized instruments inserted through a small incision to reach the area where the nerve is being compressed.The surgeon can view the spinal nerves and intervertebral discs on a high-resolution monitor, allowing the removal of the tissue causing nerve compression while minimizing damage to surrounding muscles and soft tissues compared with traditional open surgery in many cases.The goal of this approach is not simply to “make the incision as small as possible.” Instead, the focus is on performing precise surgery at the correct location, clearly visualizing important anatomical structures, reducing unnecessary tissue injury, and tailoring the procedure to each patient’s specific condition.
Advantages of Endoscopic Spine Surgery
1. Less Damage to Muscles and Surrounding Tissues (Minimally Invasive Surgery: MIS)
Endoscopic spine surgery uses minimally invasive techniques through the posterior or lateral approach, requiring only 1–2 small incisions. The incision size is typically only 4–10 mm, resulting in less postoperative pain, shorter recovery time, and faster return to daily activities.
2. High Precision
Endoscopic spine surgery uses instruments equipped with a camera and advanced optical lenses (lens optics under fluid) with high-definition, 4K-level visualization.
This provides surgeons with a clear view of the compressed nerve structures, allowing them to perform the procedure accurately and precisely.
3. Enhanced Safety
Because endoscopic spine surgery requires a very small incision of less than 1 cm, it can help reduce complications such as wound infection and spinal infection.
It also significantly reduces:
Blood loss
Muscle injury
Damage to surrounding soft tissues
Unnecessary bone removal
4. Short Hospital Stay and Faster Recovery
Patients undergoing endoscopic spine surgery typically require only one night of hospital observation and can usually return home the following day if there are no complications.
Recovery at home generally takes approximately 1–4 weeks, compared with traditional open surgery, which may require a much longer recovery period.
5. Cost Effectiveness
Endoscopic spine surgery usually requires only a short hospital stay of approximately one night for postoperative monitoring.
If no complications occur, patients can be discharged the following day, helping reduce hospitalization costs and overall treatment expenses.
Conditions That Can Be Treated with This Technique
Currently, endoscopic spine surgery can be used to treat various spinal conditions. Common conditions include:
Herniated Disc — The most common condition treated with this technique. Patients are often between 30–50 years old.
Spinal Stenosis — Narrowing of the spinal canal that can compress nerves.
Foraminal Stenosis — Narrowing of the nerve root openings where spinal nerves exit.
Spondylolisthesis with Nerve Compression — Forward slipping of one vertebra that causes nerve compression.
The goals of surgery include:
Relieving compression of spinal nerves or the spinal cord
Improving spinal stability through fusion procedures when necessary
Correcting certain spinal deformities
However, Endoscopic Spine Surgery is not suitable for every patient.
The appropriateness of this procedure depends on several factors, including:
The location and characteristics of the spinal condition
Spinal stability
Presence of vertebral slippage
Other medical conditions
The patient’s individual treatment goals
Therefore, the decision to undergo surgery should be made after evaluation by a specialist in spinal surgery.
