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Written by: dr. Schröder

Percutaneous Transforaminal Endoscopic Discectomy (PTED)

Those who know me are aware that I have been performing hernia surgeries through a small tube, the so-called Microtube (MTD), since 2004. At the time, this technique was revolutionary and offered significant advantages:

  • Less tissue damage
  • Reduced risk of complications
  • A smaller scar in the long term

Since then, work has been done behind the scenes on an even more groundbreaking innovation: the PTED technique, which stands for Percutaneous Transforaminal Endoscopic Discectomy.

Faster recovery than ever before

I will explain what it entails shortly, but first, I want to share why I have learned this method of surgery and now embrace it enthusiastically. The PTED surgery is even less invasive than the MTD surgery. This means that we can operate even more delicately and cause even less damage to the back. Patients recover faster and can resume their lives more quickly after the procedure. It almost sounds unreal when you consider that in the past, patients had to lie flat for six weeks before and after a hernia surgery. Today, those who undergo a PTED surgery are almost immediately free from leg pain and can go home a few hours after the procedure with less back pain. Recovery with this surgical technique is much faster.

How is that possible?

I will try to describe how this is possible. To give an overview, I will list the facts:

  1. This technique also uses a tube, but it is a little thinner than the MTD tube.
  2. To locate the hernia, a minuscule camera (endoscope) is attached to the tip of the surgical tube.
  3. The surgeon approaches the hernia diagonally from the side. This makes it possible to remove the hernia without touching the compressed leg nerve, significantly reducing the risk of nerve damage.
  4. Once the camera has located the hernia, it is removed bit by bit with tiny forceps (think of 'Pac-Man').
  5. This surgery results in significantly less blood loss.
  6. There is also less muscle damage.
  7. Because this surgery is even less invasive than the MTD technique, the patient does not need to be fully anesthetized. A sedative is sufficient. You will not feel any pain or anxiety, but the anesthesiologist will stay in contact with you to ensure everything is going well. As a result, you will experience fewer side effects after the surgery.
  8. This technique has been performed for at least 15 years with good results. Patients are certainly not guinea pigs. What is new is that this technique has now been scientifically approved and is therefore covered by all insurers from 2021 onward. If you are interested, you can read the research results in the prestigious British Medical Journal. I can proudly say that my esteemed colleague at the Park Medical Center, Dr. Sanjay Harhangi, led this multicenter study. He is one of the pioneers in this field, and I also learned this technique from him.
  9. After the surgery, the patient does not need to return to the clinic for a follow-up. Of course, we are available for any questions or concerns. If the patient feels safer after a physical check-up, that is always possible. Personally, I choose to call all my patients after two weeks to check on how they are doing.
  10. My three post-operative golden rules (Blog 8) also apply after a PTED surgery: a. Once you get home, you can do anything you are capable of. b. Listen carefully to your body. c. Slow down if you experience pain.

In conclusion

We can basically conclude that the PTED surgery offers the same benefits as other surgical techniques but with fewer drawbacks. Of course, it is still more intense than a visit to the dentist, but it is a significant step forward in the treatment of lumbar hernias.

Unfortunately, not every hernia is suitable for removal in this way. After your neurologist has conducted the examination, I will be able to tell you if you are eligible for a PTED surgery. It depends on the location and size of the hernia. Even if you are eligible for a PTED surgery, you are free to choose which surgical technique you prefer. If, for whatever reason, you would still prefer the MTD surgery, that is perfectly fine. It is your body, and I believe it is important that we enter the operating room with confidence after thorough consultation.

Surgery manual

Dr. Schröder is happy to inform you about the surgical treatment of your neck or back condition. He also discusses the possible complications of the procedure with you.

After you've carefully weighed up the pros and cons of the surgery, you can decide for yourself whether you consider your condition serious enough to operate.

View the surgery manual

  • Instructions for after you have left the clinic

    Once you leave the clinic:

    • Make sure that someone comes and picks you up in a car, and refrain from driving yourself
    • Make sure that you recline your car seat
    • Make sure that you are not home alone for the first few days following the operation
    • Allow the wound to heal for the first 2 to 3 weeks
    • You are allowed to shower, as the nurses will give you a waterproof plaster to cover your wound before you leave the clinic
    • You must not drive for 3 weeks, but you will be allowed to sit in the passenger seat while someone else drives you around
    • You are allowed to do whatever you feel up to, as long as you keep listening to your body and stop doing whatever it is you are doing whenever your body tells you to stop

    Your doctor, nurse and/or physiotherapist will provide you with more information on how to look after yourself following the operation.

  • How long will I have to stay at the clinic?

    Depends on the nature of the operation

    The duration of your stay with us will depend on your situation and on the type of surgery you are undergoing. If everything goes according to plan, and if you are undergoing a minor back or neck operation, you will only have to stay with us for one night. If you are undergoing major surgery, such as a spinal instability operation, you will generally have to spend a few nights at our clinics.

  • Swelling after surgery

    Swelling reduced after 2 to 3 months

    After the operation, your wound will swell, which may be painless but may also be a little uncomfortable due to your skin being pulled so taut. Generally speaking, the swelling will subside of its own accord within 2 to 3 months of the operation, and the skin will grow less thick.

  • Medication after surgery

    Following the operation, you will be given painkillers for as long as you need them. You will receive these painkillers in accordance with a set schedule. It is vital that you take your medication at the scheduled times, even when you are not experiencing any pain. In this way, your body will build up a steady level of analgesia.

    Most people will be able to stop taking painkillers a few days after undergoing back or neck surgery. If your painkillers somehow fail to provide you with a sufficient level of relief, we recommend that you notify a nurse as soon as possible. If you were on morphine-like medication prior to your operation, we advise that you gradually cut down on your medication after the operation, if your level of pain allows you to do so, in consultation with your GP. Acute withdrawal may result in adverse events.

  • Post-operative pain

    If you are experiencing an excessive amount of pain, you will receive additional painkillers

    The level of post-operative pain differs from person to person, and from operation to operation. Generally speaking, major lengthy operations will prove more painful than brief minor operations. At our clinics, all patients receive proper painkillers following surgery, as a result of which very few of our patients ever experience a great deal of pain. In consultation with yourself, we will determine your pain score, both at the ward and once you are home (we will call you to discuss this with you). If your pain score is too high, you will be given additional painkillers.

100% insurance covery

Nearly all treatments performed by Dr Schröder are covered by health insurance. This is true for the following conditions: neck hernia, spinal hernia, lumbar spinal stenosis and cervical spinal stenosis.

Read more

Dr Schröder's blog

Dr Schröder regularly publishes new articles on his blog. Read all about spinal hernia, neck hernia, spinal stenosis, neurosurgery and other related subjects.

View all blog posts

  • 18. Thank You, Bergman!

  • 17. New surgical technique for lumbar hernias approved!

  • 16. You can't always get what you want

  • 15. To the world at large

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