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 approximately 10-20% of patients may require surgery. Surgery is required in the above cases if the symptoms are obvious and conservative treatment is ineffective for 6 weeks-3 months or if the symptoms are recurrent; if there is significant muscle weakness and atrophy; if there is urinary and fecal dysfunction and foot drop (cauda equina syndrome, which requires early surgery). With the accelerated pace of life, there are some patients with very serious symptoms, and conservative treatment for 4-6 weeks is not effective can also consider surgery, especially the emergence of minimally invasive surgery, reducing the damage, recovery is also very fast, more in line with the modern concept of life. Q: Do I need to be hospitalized for intervertebral foraminoplasty? A: Hospitalization is required. The total length of stay is usually about 5 days and the patient is discharged 3-5 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 is available in foreign countries and in a few hospitals in China, where the patient can be discharged from the hospital after 4 hours or one night of observation, and this 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 20,000 and 30,000, and the exact cost will vary depending on each person’s specific situation. Q: Can I be reimbursed by medical insurance? A: Zhuhai medical insurance can reimburse, the total cost of surgery between 20,000-30,000, the cost of their own generally in about 8000. Foreign medical insurance needs to go through the 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 it is performed according to standard operating procedures, intervertebral foraminoscopy is a very safe procedure with relatively low risk. The procedure is performed under local anesthesia, and 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 patient recovery. 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 from local anesthesia is significantly faster than general anesthesia! Removing the protruding nucleus is like pulling out a cavity, which is very painful, but you don’t need general anesthesia, local anesthesia is enough. Local anesthesia is sufficient. The surgery is 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 articular prominence and other areas that are prone to pain. Some of the patients gave feedback that “the surgery was painless and the whole procedure was not tense at all”; “a little pain occasionally, but it was less than the pain 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 is similar to that before the 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, but we suggest that patients should rest in bed within one week after surgery, so that they can go to the ground for eating, bathing, urinating and defecating; basically, they can take care of themselves in daily life within 2 weeks after surgery, and gradually increase the amount of activities after 2 weeks. In order to reduce the chance of recurrence, we generally recommend 4-6 weeks of rest, and after 4-6 weeks, patients 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 (sacrificing the function of movement), only the function of support, protection. 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 exercise vigorously after the surgery? A: In theory, yes. If you are a professional athlete, the impact of laminectomy on athletic ability should be the least of all the types 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 playing this more intense sport to reduce the chance of recurrence. It is generally better to return to sports after 3-6 months and to take the risks associated with the sport yourself.