Surgery is often the last resort and is advised in patients where symptoms have not settled in six weeks of conservative treatment like medication, injections and physiotherapy. The aim of the surgery is to remove the prolapsed part of the disc releasing pressure from the spinal cord. Various techniques of herniated disc surgery includes:

• Discectomy removes herniated disc material that presses on thespinal cord or a nerve root.
• Percutaneous discectomy is used for bulging discs and discs that have not ruptured into the spinal canal.
• Laminotomyand laminectomy- ‘'Laminotomy'' removes a portion of the thin part of the vertebrae that forms a protective arch over the spinal cord (lamina). ‘'Laminectomy'' removes all of the lamina on selected vertebrae and also may remove thickened tissue that is narrowing the spinal canal.
• Minimally Invasive Spinal (MIS) Fusion – This spinal surgery is performed to remove the lamina and the disc with introduction of graft to fuse the vertebrae. The surgery can be performed using both the anterior or posterior approaches.

The most common process used is the posterior approach, where the surgery is done from the back. The three main Posterior fusion techniques are:

• Postero Lateral Gutter Fusion Surgery
• Posterior Lumbar Interbody Fusion (PLIF) Surgery
• Transforaminal Lumbar Inter body Fusion (TLIF) Surgery

The anterior approach involves placing the bone directly into the section between the vertebrae where the shock-absorption disc had been situated.

• Spinal decompression – This procedure is done torelieve spinal stenosis caused by narrowing vertebral column and compressed nerves with associated symptoms.

People with back pain, numbness or weakness in upper or lower limbs who are not responding to non-surgical treatments like pain killers, nonsteroidal anti-inflammatory drugs and physiotherapy are considered for surgery. They need further investigations like X-ray/ CT scan/ MRI to confirm bulging or protruding disc which can be corrected by surgery.

Surgery for herniated disc should be considered emergency if there are symptoms of pressure on the spinal cord or on the cauda equine or cases involving serious or increasing paralysis.

Minimally invasive Spine Surgery (MISS) is performed through small incisions, with the help of endoscopic instruments and techniques that are used to have a clear view of the internal organs of the body.

One or more minor incisions, generally less than half an inch are made, through which specially designed instruments and excellent video transmitting machines are inserted.

The muscles of the back are moved from their spinal connections to make space for the surgeon to place the rods, screws, bone grafts, etc. as required by the surgery.

MISS fusions and decompression are done with surgical instruments called tubular retractors. A small incision allows access of tubular retractor into the skin and soft tissues creating a tunnel to the spine which keeps the muscles and tissues in open position throughout the surgery. Other instruments are also used through the retractor so that the fusion procedure can be completed including the incorporation of rods and screw. The procedure is guided by fluoroscopy. After the procedure, the retractors are removed.

There are various ways of MISS to minimize trauma to soft tissues. These includes

• Procedure with tubular retractor– In this method, the soft tissues are distended rather than incising them, thus reducing chances of trauma to the muscle.
• Direct lateral access – This method involves procedure approached from the side which reduces the pain and trauma to the muscles.
• Thoracoscopic access – This method is used when approach from front is necessary with help of multiple small incisions.
• Percutaneous screw and rod placements – This method is used to stabilize the spine and immobilize the spine and help fusion of the vertebrae. It is done with the help of guide-wires.

The success rates are excellent in minimally invasive spine surgery. Most patients experience dramatic and lasting improvement in their back. It relieves the symptoms of herniated or slipped disc in up to about 90% of the patients.

Recovery is different for each patient. However, it is normal to feel pain at the site of surgery for the first few days which can be controlled with medication. You would be advised to start physical therapy after a week of the surgery. You would be able to return to normal activities in about two weeks while full recovery may take few weeks to months. Your treating surgeon would advise you about the rehabilitation and when to start rigorous activities.

You would stay at the hospital for about a week after the surgery to make sure you are on the right healing path. Another week to ten days are required in town for recovery and initial rehabilitation for minimally invasive spine surgery in India before you can go back.