A Minimally Invasive Fix for a Herniated Disc

Beth Bernstein woke up one Sunday morning with crippling leg pain.

“It was the worst pain in my life. I’ve given birth to two children, and that was nothing compared to this pain in my left thigh,” says Bernstein, who is 66, retired, and lives in Northford, Conn.

Although she could hardly bear weight on her left leg, Bernstein managed to get up and see her primary care physician the following day in January 2023. After pain medications and physical therapy offered little relief, her doctor referred her to a neurologist, who ordered an MRI (magnetic resonance imaging) study, which showed a herniated disc.

Also known as a “slipped” or “ruptured” disc, a herniated disc occurs when the gel-like center of an intervertebral disc (which separates the vertebrae and acts as a cushion for the spine) protrudes through a tear in its outer covering. That gelatinous material was pressing on Bernstein’s sciatic nerve, the largest nerve in the body and one that controls the motor and sensory function of the legs—from the lower back to the feet.

Bernstein’s pain and associated symptoms were all in her left thigh. “When it wasn’t numb, I’d get shooting pain, and my leg would shake from the discomfort,” she recalls.

She tried a corticosteroid injection and various medications, but the relief was only temporary and insufficient. As a result, Bernstein’s neurologist referred her to Peter G. Whang, MD, a Yale Medicine spine surgeon, whom she saw for the first time in October 2023.

From reviewing her MRI exam and hearing about her symptoms, Dr. Whang says Bernstein fit the classic diagnosis of nerve compression caused by a herniated disc.

“The majority of disc herniations are in your lower lumbar spine. In those cases, they will cause symptoms traveling all the way to the foot, which is what is classically called sciatica,” Dr. Whang explains. “However, her herniation was between her L3 and L4 vertebrae, which is higher up in the spine and explains why her pain stopped at her knee.”

The cause of disc herniation often can’t be identified, but sudden repetitive bending and twisting can predispose individuals to this condition. Age is also a factor, as wear and tear over the years can cause the discs to break down or deteriorate.

“Herniated discs are one of the most common spinal conditions we treat. In younger people, they usually are due to some kind of injury,” Dr. Whang says. “In older people, it can be due to trauma or simply from degeneration.”

Because conservative treatment options hadn’t helped Bernstein’s pain, she and Dr. Whang began to talk about surgery.

“Dr. Whang didn’t rush me into anything, but it became clear that surgery was the way to go because my nerve was compressed and he needed to take away the pressure in order to alleviate the pain,” Bernstein says.

Dr. Whang proposed an endoscopic discectomy, which involves making a tiny incision in the lower back and using an endoscope (a tube with a light and camera attached to it) and other specialized instruments to access the area of the herniated disc and remove the portion compressing the nerve.

“We call this procedure a decompression, which is taking pressure off of the nerves, and it generally will make the leg will feel better,” Dr. Whang explains.

An endoscopic discectomy is one of three different ways herniated discs are treated surgically. A herniated disc might also be treated with traditional open discectomy and microdiscectomy. With an open discectomy, a larger incision is made and the surgeon must mobilize or remove bone, muscle, and other tissues to reach the herniated disc. With a microdiscectomy, a smaller incision is made, and there is less disruption of these surrounding tissues; a microscope is used instead of an endoscope.

Endoscopic discectomies have been performed in the United States for decades but are not performed as frequently as traditional open and microdiscectomies—but that is changing, Dr. Whang says.

“Endoscopic discectomy is the least invasive of all of these techniques. Another difference is that it allows us to enter the nerve tunnel, or foramen, which means we don’t have to remove any bone to access the herniation,” he says. “With a microdiscectomy, the incision is 2 to 3 centimeters; with endoscopic discectomy, it’s a few millimeters. When you have smaller incisions, there is less pain, minimal scar tissue, and a quicker recovery.”

Bernstein’s surgery was performed in September 2024 at Yale New Haven Hospital’s McGivney Advanced Surgery Center. It took less than an hour, and everything went smoothly for her before, during, and after her procedure.

“I walked out of there that day and immediately felt better. I didn’t need physical therapy, and I simply took it easy for a few weeks and iced my lower back for the first few days without the use of any pain medications,” Bernstein says.

She does feel some lingering numbness in her thigh, but that is normal, Dr. Whang says, and should recede over the next few months.

“What I always tell patients is that the pain gets better first but numbness and any weakness in that area takes a little longer because it takes time for the damaged nerve to regenerate,” Dr. Whang explains. “It can take up to a year for all of these symptoms to resolve. I’m very optimistic that she will continue to improve over time.”

Meanwhile, the residual numbness hasn’t stopped Bernstein from getting back to her regular walks, and she’s planning a month-long trip to tour national parks.

“I’ve had other surgeries before and I’d always be nervous before them, but I didn’t feel that way with Dr. Whang. I always thought I was in the right hands. He was so cautious and explained everything so well,” she says.