Herniated disk surgery

There are other treatments that are performed without opening or with minimal incisions.

Among them are percutaneous nucleotomy, laser nucleotomy (coagulation of the disc by laser) and chemonucleosis with chemo-papain (chemical dissolution of the center of the disc through an injection with this substance). 

These techniques, which can only achieve good results when the indication is correct, are recommended in a small number of cases, when the disc content has not completely come out of the wall and the nerve is compressed.

In certain circumstances, depending on the associated osteoarthritis and previous history of low back pain, in addition to root decompression, a vertebral fusion is performed (either with screws attached to bars or plates, or with boxes in the disc space) that manages to eliminate movement, an effect that improves low back pain.

This technique offers a success rate of close to 80%, although it is assumed as a disadvantage the risk of accelerated degenerative change in the adjacent disc segments which, according to studies by the University of Navarra, has not been shown to be superior to that of the evolution of arthrosis itself.

As an alternative to some vertebral fusions or in cases of disc herniation or degenerative disc affectation, arthrosplasty or complete disc replacement with an artificial prosthesis is used. It is indicated mainly for low back pain, with or without sciatica, mechanical, refractory and discogenic origin.
 
Arthroplasty can also be indicated for the treatment of the degeneration of the segment adjacent to a fusion already performed. Several series on the results of this technique indicate that the degree of satisfaction in patients exceeds 90% in the short term and, even in the experimental phase, its long-term results are not well known.

From then on, you should practice rehabilitation exercises to achieve a good recovery. If the indication is correct and the disc surgery technique is carefully performed, the success rates are higher than 85-90%.

However, it should be noted that, as a result of the operation, it is more likely to improve the pain radiating to the lower limb than lumbar discomfort, especially if the latter had it before. After all, the herniated disc appears in discs that already have degenerative changes, wear and tear and these can continue to give low back pain.

Endoscopic surgery is, in principle, more attractive to patients, but it is not appropriate for everyone.  Thus, even though it has been performed for more than 20 years, the gold standard continues to be laminectomy.

All surgeries carry a risk of complications, such as infection and bleeding.

Although some spinal surgeries carry additional risks, such as nerve injury, sphincter alteration or cerebrospinal fluid (CSF) fistula (leakage), most spinal surgeries are now considered quite safe.

With respect to arthroplasty, it is essential to carefully dissect and protect the large vessels and a nerve plexus located in front of the spine, since in this case retrograde ejaculation could occur in males (2%).