Herniated Disk Surgical Procedures

  I have a herniated disk at L4/5 (confirmed by MRI).  I believe that the injury occurred 3.5 years ago, although I just found out about it several months ago.  I have tried physical therapy, but it was unsuccessful.  The pain is tolerable if I am totally inactive, but when I try any form of exercise, I get pain in the groin and my quadricepts (sp?) get weak after I finish exercising.  Since I am very active, quitting all forms of exercise is not an option for me.  I am now considering surgery.  I know that neurosurgeons have different opinions regarding the types of surgery to perform.  I was interested to know what your thoughts are regarding endoscopic discectomies?  Any information you can pass along about what you know about this procedures effectiveness and advantages/disadvantages vis a vis a traditional micro discectomy would be greatly appreciated.  Thank you for your time.

[CCF NSG MD / gsh]

_
Dear Aaron,
There is a bit of discussion these days about endoscopic procedures and their place in the realm of spine surgery.  In the instance of a herniated disc at a single level in the lumbar spine, a traditional microdiscectomy involves a 2-3 centimeter incision.  The surgeon then takes a small bit of bone off the lamina to view the nerve root and disc, after which the disc is removed.  Patients go home the same day or the next morning.
It is the opinion of many that the open microdiscectomy is a very simple procedure with an extremely low morbidity and excellent operative results in the properly selected patient.  The benefit versus risk of an open microdiscectomy should be the benchmark against which other therapies are compared.  It is difficult to beat the success of the open procedure, and the incision isn't much larger.  The percutaneous procedure does not allow the surgeon to see the anatomy and may not be indicated in some cases of herniated discs due to the physical limitations of the instruments.
Speak to your surgeon about this controversy.  In our minds it is difficult to beat the results with the traditional open procedure.
Good luck.