Q: When do I need surgery for a herniated lumbar disc? 80%-90% of patients with a first episode of lumbar disc herniation can be successfully treated conservatively, meaning that about 10-20% of patients may require surgery. Surgery is required in the above cases if symptoms are significant and conservative treatment is ineffective for 6 weeks-3 months or if symptoms are recurrent; if significant muscle weakness and atrophy occur; if urinary and bowel dysfunction and foot drop occur (cauda equina syndrome, requiring early surgery). With the accelerated pace of life, there are some patients with very severe symptoms, and conservative treatment for 4-6 weeks is ineffective can also consider surgery, especially with the advent of minimally invasive surgery, which reduces damage and recovery is very fast, more in line with modern life philosophy. Q: Do I need to be hospitalized for laminectomy? A: Hospitalization is required. The total length of stay is usually 3-5 days, and the patient is discharged 1-2 days after surgery. The hospital stay can be further reduced if the preoperative examination is completed on an outpatient basis. Day surgery for lumbar disc herniation can be carried out in foreign countries as well as in a few domestic hospitals, where the patient can be discharged after surgery with 4 hours or one night of observation, which is what we are striving for in the future. Q: How much does the surgery cost? A: According to past statistics, the total cost of the surgery is between 27,000 and 30,000. The specific cost will vary according to each person’s specific situation. The above price is the cost of Peking Union Medical College Hospital, and other hospitals can only be used as a reference. Q: Can I be reimbursed by medical insurance? A: Beijing medical insurance can reimburse the total cost of surgery between 27,000 and 30,000, and the cost for yourself is usually between 8,000 and 10,000. Foreign medical insurance requires relevant procedures, and the specific cost depends on the local reimbursement policy. Q: Is the surgery safe? A: There are risks associated with any surgery, and so is intervertebral foraminoscopy, but as long as standard operating procedures are followed, intervertebral foraminoscopy is a very safe procedure with relatively low risk. We use X-ray fluoroscopy to ensure safety during puncture and access, and local anesthesia is used. If important structures such as nerve roots are encountered, the patient can provide timely feedback and the surgeon can adjust the operation to ensure safety. Q: What is the efficacy of the surgery? A: As long as you choose the right case of lumbar disc herniation, the excellent rate of foraminoscopic surgery is 90-95%, which is comparable to the excellent rate of open surgery, and the minimally invasive surgery has less bleeding, less trauma, and faster recovery for patients. Q: Is intervertebral foraminoscopy painful? A: Spinal endoscopy for lumbar disc herniation is currently the most minimally invasive surgical procedure, using local anesthesia, some friends worry about whether it will be very painful? In fact, as long as a good local anesthetic, the procedure will not be very painful, and the recovery after local anesthesia is significantly faster than general anesthesia! Removing the protruding nucleus is like removing a cavity, which is painful, but it is not necessary to use general anesthesia, local anesthesia is enough. Local anesthesia is enough. The surgery will be supplemented with analgesic and sedative drugs. The key to local anesthesia is to find the “pain point” and to do a good infiltration of anesthesia in the fascial layer, around the joint prominence and other areas that are prone to pain. Some patients gave feedback that “the surgery was painless and the whole procedure was not tense at all”; “it was occasionally a little painful, but less painful than before the surgery”; “I felt pain briefly when the nerve was stimulated, and the pain level was similar to that before the surgery. The pain level was similar to that before surgery. (Each patient’s reaction is different, and the effect of local anesthesia may vary from one surgeon to another, for reference) Q: What is the recovery after laminectomy, will it be the same as before the lumbar disc herniation? A: The recovery after surgery is very fast, generally you can go to the ground after surgery, and you can basically take care of yourself in daily life within 2 weeks after surgery, and gradually increase your activity after 2 weeks. In order to reduce the chance of recurrence, we usually recommend 4-6 weeks of rest, and after 4-6 weeks, you can gradually return to work. Minimally invasive surgery mainly removes the herniated disc and relieves the nerve root compression, but the lumbar disc herniation is caused by the degeneration of the disc and the rupture of the annulus fibrosus, which causes the nucleus pulposus to protrude through the ruptured annulus fibrosus. Minimally invasive surgery itself does not repair the disc, and it is difficult to restore it to a completely normal disc due to the lack of blood flow to the disc. Therefore, the disc is still different after laminectomy than it was before the lumbar disc herniation. As a joint, it is still an incompletely normal joint after surgery and needs to be taken care of and compensated for by the exercise of the lumbar back muscles. Fortunately, the human lumbar spine has many segments and can be compensated by other joints and muscles. As time progresses, the degeneration of the spine will gradually stabilize itself, so some patients feel no different from normal people, and some may only experience occasional discomfort. Q: Is it easy to have a recurrence after surgery? A: The number of recurrences after intervertebral foramen surgery is a minority, averaging about 4%. The intervertebral disc is a joint in the body, like a door. The method of disc removal + nail fusion is like blocking a door, of course, the surgical decompression is very complete, but the disadvantage is that the door can not walk (sacrifice the function of movement), only support, protection function. A simple disc removal, on the other hand, preserves the three main functions of motion, support and protection of the spine, just like a door that can continue to walk after it is repaired. In this case, of course, it is possible that it may still be used badly again, may need to be repaired again, or even finally have to be blocked on as a last resort. Fortunately, however, with proper maintenance, the rate of recurrence is still in the minority. Q: Can I still play soccer after the surgery? A: Theoretically yes, if you are a professional athlete, laminectomy should have the least impact on athletic ability of any type of surgery, and you can return to sports after a good rehabilitation. However, as an average person, unless you are particularly passionate about it, we recommend caution in performing this more strenuous sport to reduce the chance of recurrence. It is usually better to engage in sports again after 3-6 months and one needs to take the risks associated with sports. Q: Doctor, by removing the protruding nucleus pulposus, does it mean cutting off the protruding part or taking out all of this nucleus pulposus? If you remove all of it, does it mean that the “cushion” is removed and the motor function is reduced (bending angle is reduced)? Is it better to consider repairing the annulus fibrosus outside the nucleus pulposus? A: Removal of the herniated nucleus pulposus by foraminotomy means removing the herniated and damaged nucleus pulposus and protecting the structure of the annulus fibrosus and end plate as much as possible, rather than removing the entire disc (the complete disc includes the nucleus pulposus, annulus fibrosus and end plate) as a “cushion”. The procedure that requires the removal of all of these structures is intervertebral fusion, where the spacer is taken out of the disc and replaced with an artificial fusion device and a bone graft, in the hope that the two vertebrae will grow together (fuse) in the future. Of course, some of the loose, degenerated nucleus pulposus inside the disc is also removed to reduce the chance of recurrence. The reduction in motor function is due to the degeneration of the disc itself, not the removal of the nucleus pulposus. Repair of the fibrous annulus is still controversial, and foraminoscopic repair of the fibrous annulus is still immature. Q: Can I still get pregnant after surgery? A: Patients with lumbar disc herniation can become pregnant, whether or not they have undergone surgery. Although back pain or low back pain during pregnancy is not uncommon, it is still a minority of cases that are truly caused by lumbar disc herniation. As long as good post-operative rehabilitation is carried out and the muscles of the lower back are strengthened, pregnancy and delivery should be relatively smooth.