Minimally Invasive Spine Surgery · Naples & Fort Myers, FL
Endoscopic spine surgery —
through an incision smaller
than a fingertip.
The smallest footprint in spine surgery. A camera, a working channel, and surgical instruments through a single tiny portal — no significant muscle disruption, no large incision, general anesthesia, same-day discharge. Available for lumbar disc herniation and facetogenic back pain.
“Open spine surgery with a large midline incision and significant muscle stripping is archaic. The camera changed everything — and most patients still don’t know it exists.”
Dr. G. Katsevman, MD · Neurosurgeon & Minimally Invasive Spine SurgeonWhat can be treated endoscopically
Two procedures.
One small portal.
Endoscopic spine surgery is not a single operation — it is an approach. The same working channel and camera system can be applied to different lumbar pathologies depending on anatomy, diagnosis, and patient factors.
A lumbar disc herniation compresses a nerve root, producing leg pain, numbness, or weakness in a dermatomal distribution. Endoscopic discectomy removes the herniated fragment and decompresses the nerve through a portal smaller than a fingertip — under direct camera visualization, with no significant muscle disruption and no requirement for retraction of the paraspinal musculature.
Who is a candidate: Lumbar disc herniation causing radiculopathy, with appropriate anatomy for the endoscopic approach. Patient factors, pathology location (central, paracentral, foraminal, far lateral), and disc anatomy all influence whether endoscopic or tubular microdiscectomy is the right approach for a specific patient. Dr. Katsevman evaluates these factors on a case-by-case basis and selects the approach most appropriate for the individual.
The medial branch nerves are the sensory nerves that supply the facet joints. When facet arthropathy is the source of axial low back pain, interrupting the medial branch nerves eliminates the pain signal at its source. Endoscopic medial branch transection physically cuts these nerves under direct visualization — a definitive procedure compared to radiofrequency ablation, which burns the nerves and requires repetition as they regenerate.
Who is a candidate: Patients with facetogenic back pain confirmed by diagnostic medial branch blocks, without significant instability or deformity that would require surgical stabilization. MBT addresses the pain generator directly — it is not a substitute for fusion in patients who have structural instability.
The honest comparison
Open vs. tubular vs. endoscopic
Three approaches to the same lumbar pathology. The differences in incision size, muscle disruption, recovery, and long-term outcomes are meaningful — and most patients are never told all three options exist.
| Open Surgery Large incision · muscle stripping |
Tubular (METRx) 18mm tube · muscle dilated not cut |
Endoscopic Single small portal · camera-guided |
|
|---|---|---|---|
| Incision | 3–5 cm midline | ~18mm (~¾ inch) | Fingertip-sized portal |
| Muscle handling | Stripped & retracted bilaterally | Dilated, not cut | Natural tissue planes — minimal disruption |
| Visualization | Loupes or operating microscope | Operating microscope through tube | HD camera, continuous irrigation |
| Hospital stay | 1–2 nights inpatient | Same-day discharge | Same-day discharge |
| Return to activity | Weeks restricted | Walking same day; no restrictions at 6 wks | Walking same day; rapid return |
| Post-op muscle pain | Significant — stripping causes lasting pain | Minimal | Minimal — least disruption of any approach |
| Right for most cases in 2025? |
Rarely | Yes — versatile, well-evidenced | When anatomy & pathology support it |
Why open surgery is no longer the standard
Open lumbar surgery
in 2025 — archaic.
Large midline incisions with significant paraspinal muscle stripping were the only available approach for decades. They are not anymore. The persistence of open surgery for routine lumbar disc and stenosis cases in 2025 is a function of surgeon training, not patient need.
What open surgery requires
3–5 cm skin incisionMultiple tissue layers cut through to access the spine
Bilateral muscle strippingParaspinal muscles stripped off the vertebrae with retractors — a source of chronic post-operative back pain independent of the disc problem
Prolonged retractionSustained pressure on muscles and soft tissue during the case contributes to ischemic muscle injury
Hospital admissionTypically 1–2 nights inpatient — not because the procedure requires it, but because the tissue trauma does
Longer recoveryWeeks of restricted activity. Return to light work often 4–6 weeks; physical labor longer still
What endoscopic and tubular surgery replace it with
Fingertip-sized or 18mm portalAccess to the same pathology through a fraction of the incision
No muscle strippingMuscles dilated or bypassed through natural planes — the source of post-operative muscle pain is eliminated, not just reduced
Equivalent decompressionThe nerve is decompressed as completely as in open surgery — through a smaller access point, not a compromised one
Same-day dischargeHome the same day in virtually all cases. No hospital stay required
Walking the same dayNo restrictions at 6 weeks in most tubular and endoscopic cases. Rapid return to normal activity
Both are minimally invasive — the choice matters
Tubular vs. endoscopic —
how the decision is made
Dr. Katsevman performs both tubular (METRx) and endoscopic lumbar surgery. These are not competing philosophies — they are complementary tools, and the right approach depends on the patient, the pathology, and the anatomy.
Tubular microdiscectomy is a highly versatile, well-evidenced approach with decades of outcome data and the ability to address a broad range of lumbar pathology including disc herniation, stenosis, and decompression with Barricaid annular closure. Endoscopic surgery offers an even smaller footprint and is well-suited to specific anatomical situations and pathologies.
The decision is never made on the basis of surgeon preference alone. Anatomy, the location and character of the pathology, patient factors, and what gives the best outcome for that individual are the variables that determine the approach. Both are available; the right one is chosen.
Common questions
What patients ask about endoscopic spine surgery
Am I a candidate for endoscopic spine surgery? +
Candidacy depends on your specific diagnosis, the location and character of your pathology, and your anatomy. Endoscopic lumbar discectomy is well-suited to certain disc herniations causing radiculopathy; endoscopic medial branch transection is appropriate for confirmed facetogenic back pain after successful diagnostic medial branch blocks. Dr. Katsevman reviews imaging and clinical presentation to determine whether endoscopic surgery, tubular surgery, or another approach is the right fit for your situation — and will explain the reasoning clearly.
What is the difference between endoscopic and tubular (METRx) discectomy? +
Both are minimally invasive approaches that avoid the muscle stripping of open surgery. Tubular discectomy uses an 18mm working tube through which an operating microscope is used for direct visualization. Endoscopic discectomy uses an even smaller portal and a camera system with continuous irrigation for visualization. Both achieve equivalent nerve decompression; the choice between them is determined by the anatomy, pathology location, and patient factors. Dr. Katsevman performs both and selects the approach that best serves the clinical situation.
What is medial branch transection and how is it different from radiofrequency ablation? +
Both target the medial branch nerves that supply the facet joints. Radiofrequency ablation (RFA) uses heat to damage the nerve — it is effective but the nerves typically regenerate within 6–18 months, requiring the procedure to be repeated. Endoscopic medial branch transection physically cuts the nerves under direct camera visualization, which is a more definitive interruption. Candidates for MBT are patients who have had confirmed relief from diagnostic medial branch blocks and whose pain source is clearly facetogenic without structural instability.
Is endoscopic spine surgery performed under general anesthesia? +
Yes — endoscopic lumbar surgery at this practice is performed under general anesthesia. Patients go home the same day after a recovery period. The same-day discharge reflects the minimal tissue disruption of the approach, not the anesthesia type.
Why does my surgeon not offer endoscopic spine surgery? +
Endoscopic spine surgery requires specific training beyond standard neurosurgical or orthopedic spine residency. Surgeons who were not trained in endoscopic techniques — or whose practice is built primarily on open or tubular surgery — may not offer it. This is not a criticism; it is how surgical training works. A surgeon offers what they know how to do. If you have been told you need spine surgery and want to know whether a less invasive approach is available, a second opinion from a surgeon who performs the full spectrum of minimally invasive options is appropriate.
I’ve been told I need open lumbar surgery. Should I get a second opinion? +
Yes — particularly for routine lumbar disc herniation or stenosis. Open lumbar surgery with large incisions and muscle stripping is rarely the right choice when minimally invasive alternatives exist. A second opinion from a surgeon who performs both tubular and endoscopic spine surgery will give you an honest assessment of whether a less invasive approach is applicable to your specific anatomy and pathology. Bring your MRI. Dr. Katsevman offers second opinions in person in Naples and Fort Myers, and by telemedicine.
"Open surgery with a large incision and muscle stripping is not the standard of care for routine lumbar disc disease — it is what happens when a surgeon doesn’t have a better option. A better option exists."
Gennadiy (Gene) A. Katsevman, MD
Neurosurgeon & Minimally Invasive Spine Surgeon
Fellowship-trained at Barrow Neurological Institute under Dr. Juan Uribe — world pioneer in minimally invasive spine surgery
Neurosurgery residency, West Virginia University — Level 1 Trauma Center
Performs endoscopic lumbar discectomy and endoscopic medial branch transection
Also performs tubular (METRx) microdiscectomy with Barricaid annular closure + PRP (3R Discectomy)
TOPS motion-preserving surgery · Cervical and lumbar disc replacement · ACDF · SI joint fusion
30+ peer-reviewed publications in spine surgery and neurosurgery
Naples Top Doctor in Neurosurgery — 2024, 2025, and 2026
5-star Google rating · Healthgrades Choice · WebMD Preferred · U.S. News Patients’ Top Choice
Offices in Naples & Fort Myers · Telemedicine available statewide
Book a consultation
The smallest incision.
The same result.
Find out if endoscopic spine surgery is right for your situation. Dr. Katsevman evaluates each patient individually and selects the approach — endoscopic, tubular, or other — that gives the best outcome for that specific anatomy and pathology.
Or submit your imaging directly for review:
6101 Pine Ridge Road #101
Naples, FL 34119
Fort Myers, FL 33919
available statewide