Q: My wife is suffering from prolapsed disc at L5-S1 since 1997. Initially, she was treated by ultrasonic rays. Of late, she is again having pain, more so in the morning and getting up in the morning is becoming painful. I would like to know: a) Whether surgery will be helpful? b) The success rate of such surgery? c) Chances of relapse? d) The expenditure involved? e) If possible, the places which are renowned for such surgery. For your information, I stay in Kolkata.

A:a) Surgery is considered when routine conservative therapy such as rest, painkillers, muscle relaxants, balms, exercises and precautions have failed. For the persons with pain for the first time, conservative therapy avoids surgery in 80% of cases. Persistence of pain, severe pain, presence of significant neurological deficits, recurrent pain would influence the decision towards surgery. b) The success rate of such surgery depends on correlation between what nerve we feel is compressed on clinical grounds (ie on the basis of the story by the patient and examination by the doctor) and the MRI scan. A 100% correlation implies a good result, generally between 80 to 90% of cases. c) Chances of relapse: Relapse or persistent pain following surgery is between 5 to 15% due to inadequate disc removal, scar tissue, infection, residual canal stenosis (narrowing of the passage through which the nerve exits the spine) and recurrent prolapse at the same site. Surgical technique is extremely important for good results. The gold standard is a microdiscectomy (surgery using a microscope) using an incision about an inch long for a single level disc prolapse. Be wary of laser and endoscopic surgery. d) The expenditure involved: extremely variable depending on the hospital and the room category. However the average would be 30 to 70 thousand rupees. e) If possible, the places which are renowned for such surgery. This is bread and butter surgery for most neurosurgeons. The question is not which place but which surgeon. I am not familiar with the doctors at kolkata to provide this specific information. You could ask whether they perform the operation according to the gold standard.