Lumbar Disc Herniation Surgery

How Dr. Salman Falak performs the operation

Two techniques cover almost every lumbar disc herniation: microdiscectomy and endoscopic discectomy. Both remove only the piece of disc that has escaped and is touching the nerve; the rest of the disc stays, and neither involves screws or fusion.

Microdiscectomy is done under general anaesthesia with you lying face down. Dr. Salman Falak makes a small cut over the affected level, usually a few centimetres long, and works through an operating microscope. A tiny window is opened in the bone and ligament at the back of the spine. The nerve is gently moved aside and the herniated fragment is lifted out. The wound is closed with a few stitches under the skin.

Endoscopic discectomy uses a thin tube with a camera and a light at its tip, passed through a cut about the width of a fingertip. The surgeon watches the nerve on a screen and removes the fragment with fine instruments through the same tube. Depending on where the fragment lies, the tube goes in from the side of the spine or from the back, and some of these cases can be done under local anaesthesia with sedation. There is more on the endoscopic spine surgery page.

Which technique is used depends on your MRI: the level, the exact position of the fragment, whether the nerve canal is also narrow, and whether you have had surgery at that level before. Either way, the operation usually takes about an hour. Most patients are up and walking the same day or the next morning, and the hospital stay is usually one night.

What the operation can and cannot do

The main benefit is relief of leg pain. For many patients the sciatica is much better when they wake from the anaesthetic, because the pressure on the nerve is gone, and sitting and walking become easier within days. Numbness and weakness take longer. A nerve that has been squashed for months recovers slowly, and in a few patients a patch of numbness or some weakness remains even though the pain has gone.

Back pain itself is less predictable. The disc that herniated is already worn, and removing the fragment does not make it new again. Many patients find their back more comfortable once the muscle spasm settles, but the operation is done for the leg, and that is how Dr. Salman Falak describes it to every family. A small number of patients develop a second herniation at the same level later, because the weak spot in the ring can let more material through. Keeping the back strong and avoiding heavy lifting early on lowers that chance.

Who is a good candidate, and when surgery is not advised

Surgery works best when your symptoms and your MRI agree. If you describe pain in a particular leg and the scan shows a herniation pressing on that same nerve, the operation usually helps. If the scan shows a bulge on one side and the pain is on the other, or the disc looks only mildly worn, it usually does not, and Dr. Salman Falak will say so instead of operating.

Surgery is usually not advised for back pain alone without leg symptoms, because removing a disc fragment does little for a painful but stable disc. It is also not the first step for a fresh herniation of only a couple of weeks, unless there is weakness or bladder involvement. Some patients have wear at several levels or a vertebra that has slipped forward; they may need a different operation, such as a decompression with transpedicular screw fixation, and the consultation is where that is worked out. Diabetes, heart disease, blood thinners and smoking do not rule surgery out, but they need to be managed first.

Before surgery: tests and preparation

You will need a recent MRI of the lumbar spine. If yours is older than a few months, or the symptoms have changed since, a new one is usually asked for. Standing X-rays, sometimes with bending views, are added if there is any question of the vertebrae moving on each other. Routine blood tests and an ECG are done for the anaesthetist, who sees you before the operation.

Tell the team about every medicine you take. Blood thinners such as aspirin or clopidogrel are usually stopped a few days beforehand on your doctor's advice, and diabetic patients are told how to adjust their insulin or tablets. Smokers are asked to stop, because smoking slows wound healing.

On the day, bring your MRI films or CD with the report, any earlier reports, a list of your medicines, and one attendant. Patients coming from outside Lahore can send the MRI report on WhatsApp first, so that the tests are ordered before the journey and the visit is not wasted.

Recovery and follow-up

Most patients are walking within hours of the operation. Pain at the wound is usually mild and is controlled with ordinary tablets. Home is usually the next day. The wound needs to stay dry for a few days; the stitches under the skin dissolve on their own.

For the first few weeks, avoid bending forward from the waist or lifting anything heavy. Short walks several times a day are encouraged from the start. Long sitting is uncomfortable at first, so get up often. People with desk jobs usually go back within a few weeks; those with physical work or long hours of driving return later. A physiotherapist guides the exercises from around the second week.

Follow-up is usually a wound check in the first couple of weeks and a second review a few weeks later. Patients from other cities can do the later review by video, so that one journey to Lahore covers the operation. Call at once if you notice fever, discharge from the wound, new weakness in the leg, or trouble passing urine.

Where the surgery is done

Dr. Salman Falak operates in Lahore. His main OPD is at Sharif Medical City Hospital in Jati Umra on Raiwind Road, and he also sees patients at Life Hospital in Bahria Town and at Doctor Care Hospital in Al Kabir Town. Patients from the Gujranwala side can be seen first at his Friday OPD at Gujranwala Medical Complex on G.T. Road, and patients from Phool Nagar and the Kasur side at the Tuesday OPD there. The operation itself is carried out in Lahore, and the hospital and the date are fixed at the consultation.

If you live far away, start with a video consultation. Send your MRI and a short description of the pain, and Dr. Salman Falak will tell you whether surgery is needed at all and which tests to get done locally. Many families then make one trip to Lahore for the operation and go home the day after it.

Risks and how they are kept low

No operation is free of risk, and Dr. Salman Falak goes through these with every patient before asking for consent. The ones that matter for disc surgery are wound infection, a small tear in the membrane around the nerves with leakage of spinal fluid, bleeding, injury to the nerve root, failure to relieve the pain, and a second herniation later. Serious nerve injury leading to paralysis is very rare in this operation, because the surgery is on a single nerve root at the edge of the spinal canal and the spinal cord itself ends higher up in the back.

Several things keep these risks low. Magnification, through the microscope or the endoscope, lets the surgeon see the nerve clearly and handle it gently. An antibiotic at the start of surgery and a clean, dry wound afterwards guard against infection. Early walking lowers the chance of clots in the legs. And operating only when the symptoms and the MRI match avoids the commonest cause of disappointment, which is an operation that was never going to help.

Related conditions and procedures

If your main complaint is pain running down the leg, the sciatica page explains how it is assessed and treated before surgery is ever discussed, and the slipped disc page covers the condition itself, from causes to diagnosis. Patients whose disc problem comes with a slipped vertebra or a fracture may need screws and rods as well as a discectomy, and those with a narrowed canal at several levels may need a wider decompression. For a worn disc that causes back pain without leg symptoms, the answer is usually not surgery at all.