Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
Most of the patients for whom I recommend lumbar disc surgery are curious not so much about how the operation will be performed as about the answer to the question “what is the risk of this operation?” This is an entirely correct approach. Because a good surgical decision is made by weighing together the questions “will this operation benefit me?” and “how much risk does it bring me?”
In this article, I want to explain the risks of lumbar disc surgery in clear and unexaggerated language. My aim is not to frighten you; it is to make sure you have real information in hand when you decide.
Let me set the frame from the start: lumbar disc operations today are low-risk, routinely performed surgical procedures with a high success rate. Microdiscectomy in particular is considered one of the most reliable operations in spine surgery. However, “low risk” does not mean “no risk.”
First, the Most Important Reminder: Most Patients Do Not Have Surgery Anyway
Before discussing the risks, I must note this: roughly 80–90% of lumbar disc herniations do not require surgery. With physical therapy, exercise, medication, and lifestyle adjustments, the great majority of patients find relief. What is more, a significant portion of the herniated disc fragment is reduced by the body over time.
In other words, surgery is not the first option; it is a solution that comes onto the agenda when certain conditions arise.
The Decision Has Two Sides: Not Having Surgery Carries Risk Too
This is the point most often skipped.
When assessing the risk of an operation, one must also place the risk of not having that operation on the other side of the same scale. Especially if there is an urgent picture such as progressive loss of strength or cauda equina syndrome, the price of waiting can be permanent nerve damage.
For this reason, the right question is not “Is surgery risky?” but “In my situation, which risk is the wiser one to take?”
General Surgical and Anesthesia-Related Risks
These apply to every operation:
- Bleeding: In microdiscectomy it is generally very small in amount. Rarely, a collection of blood (hematoma) can develop at the operation site, and if it presses on a nerve it may need to be drained.
- Infection: Wound infection or, rarely, inflammation of the disc space (discitis). The rate is low; preventive antibiotics are given.
- Anesthesia-related risks: These vary according to cardiac, pulmonary, and general health status.
- Blood clots (thrombosis/embolism): These increase with immobility. This is why you are gotten on your feet early after the operation.
- Difficulty passing urine: This can be seen temporarily in the first days after surgery.
Risks Specific to Lumbar Surgery
Cerebrospinal Fluid Leak (Dural Tear)
This is a tear in the membrane surrounding the nerves (the dura). It can occur if the membrane has thinned or is adherent to the herniation. It is noticed during the operation and repaired; a period of bed rest may then be needed. Rarely, a second procedure is required.
This is less frequent in first operations and more frequent in repeat (recurrence) operations because of scar tissue.
Nerve Root Injury
This is the risk patients fear most. Injury to the nerve root can lead to numbness, pain, or loss of strength in the leg. Most of the time it is temporary; permanent nerve damage is rare.
Let me share a reassuring anatomical fact here: in the lower part of the lumbar region, the spinal cord has already ended. At this level, within the spinal canal, there is a bundle of nerve roots called the “cauda equina” (horse’s tail), which is more mobile. For this reason, in lumbar surgery there is no risk of direct spinal cord injury as there is in neck surgery. Even so, protecting the nerve roots still requires great care.
Cauda Equina Syndrome
This is a very rare but serious complication; it manifests with disruption of bladder and bowel control. If these symptoms appear after surgery, urgent evaluation is required. (The same picture can also develop due to the herniation itself in patients who have not had surgery, and in that case it requires emergency surgery.)
Operating at the Wrong Level
This is a rare but recognized risk. It is prevented by confirming the level with X-ray/fluoroscopy during the operation.
Risks Related to the Postoperative Period
Recurrence of the Herniation
This is one of the most discussed risks in lumbar disc surgery. The herniation can form again at the same level; while the rate varies across different series, it is generally reported in the range of 5–15%.
Factors that increase recurrence: smoking, excess weight, returning to heavy lifting too early, not exercising, and the presence of a large tear in the annulus (the outer ring).
Epidural Fibrosis (Scar Tissue Formation)
Scar tissue forms at the operation site as part of the natural healing process. Sometimes this tissue can wrap around the nerve root and cause the pain to persist. This picture is difficult to treat; for this reason, techniques that cause the least damage to the tissue are preferred during surgery in order to prevent it.
Failed Back Surgery Syndrome
This is the persistence or recurrence of pain despite the operation. Its causes are many and varied: incorrect patient selection, scar tissue, recurrence, a new problem at an adjacent level, or nerve damage that had already persisted for a long time before the operation.
The most effective way to prevent this picture is correct patient selection. This is why the decision to operate is made by looking not at the MRI, but at the patient’s clinical picture.
Instability of the Spine
In situations requiring wide decompression, removing too much bone and ligament tissue can disrupt the stability of the spine. If this risk is anticipated, a fusion (screw-and-rod system) may be added to the surgical plan.
Risks Specific to Operations Involving Fusion
If screws and fusion are being added to your operation, the following risks also enter the list:
- Failure to fuse (pseudarthrosis): Its biggest trigger is smoking.
- Problems related to screw placement: The risk is reduced with neuronavigation and fluoroscopy.
- Adjacent segment disease: Accelerated wear in the discs neighboring the fused level.
- Increased operating time and blood loss.
Managing Expectations: What Does Surgery Promise, and What Does It Not?
I discuss this separately with every patient, because most disappointments arise from here.
The area in which surgery is at its strongest is relieving pain radiating into the leg (sciatica). In this type of pain, the results are generally very satisfying, and relief is often rapid.
In contrast:
- Low back pain itself may not respond as well as leg pain does.
- Numbness and loss of strength resolve more slowly than pain, and in a nerve that has been under compression for a long time they may not fully resolve.
- Surgery does not return your spine to the state it was in at the age of twenty; it does not undo wear or age-related degeneration.
This is why deciding in good time directly affects the outcome.
Personal Factors That Increase Risk
The same operation does not carry the same risk in every patient. The main factors that raise it:
- Smoking (it impairs healing and fusion, and increases recurrence)
- Uncontrolled diabetes (it raises the risk of infection)
- Obesity (it increases both the surgical difficulty and the risk of recurrence)
- Advanced cardiac and pulmonary conditions
- Osteoporosis (important if a fusion is to be performed)
- Use of blood-thinning medication
- Previous surgery in the same region (because of scar tissue)
- The need for a multi-level operation
- Long-standing, advanced nerve damage
How Are the Risks Reduced?
What the Surgical Team Does
- Microsurgical technique: The surgical microscope makes it possible to work through a small incision and to see the nerve tissue clearly.
- Minimally invasive/endoscopic methods: In suitable patients, they reduce tissue damage.
- Neuromonitoring: In selected cases, nerve function is monitored throughout the operation.
- Level confirmation with fluoroscopy.
- Detailed preoperative assessment and correct patient selection.
What You Can Do
- Quit smoking — this is the single most effective step.
- Lose weight and get your blood sugar under control.
- Report all the medications you use, especially blood thinners.
- Follow the postoperative recommendations: early movement, correct lifting technique, regular exercise.
- Do not neglect physical therapy. Surgery makes room for the nerve; strengthening the muscles falls to you.
Questions You Should Ask Your Surgeon
- Which method will be used in my case? (Microdiscectomy, endoscopic, fusion…)
- Is a fusion (screws) needed, and if so, why?
- What is my risk profile — not general statistics, but in my situation?
- What happens if I do not have the operation, what do I lose if I wait?
- What is my likelihood of recurrence, and what can I do to reduce it?
- When will I be on my feet, when can I return to work?
- Which movements will I need to avoid after the operation?
- How many times a year do you perform this operation?
After the Operation, for Which Symptoms Should You Seek Help Immediately?
After discharge, in the following situations go without losing any time to your doctor or to the nearest emergency department:
- Disruption of bladder or bowel control, incontinence
- Loss of sensation in the anal region and the inner thighs
- Newly starting or steadily increasing loss of strength in the leg
- Clear fluid leaking from the wound site (this may be a sign of a CSF leak)
- Increasing redness, swelling, discharge at the wound site, and fever
- Unbearable leg pain that is more severe than before the operation
- Severe headache (especially one that increases on standing up)
Frequently Asked Questions
Below, I have gathered the most frequently asked questions on this subject along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the doctor who examines you.
What are the risks of lumbar disc surgery?
The main risks are: bleeding, infection, cerebrospinal fluid leak, nerve root injury, recurrence of the herniation, scar tissue formation, persistence of pain despite the operation, and — if a fusion was performed — failure to fuse and adjacent segment problems, as well as general anesthesia-related risks. Serious complications are uncommon.
Does lumbar disc surgery cause paralysis?
Because the spinal cord has already ended in the lower part of the lumbar region, there is no risk of paralysis due to spinal cord injury in the sense there is in neck surgery. Loss of strength due to nerve root injury can occur; this is most often temporary, and permanent damage is rare.
Does the herniation recur after surgery?
Recurrence is the best-known risk of lumbar disc surgery; across different series it is generally reported in the range of 5–15%. The most effective ways to reduce the risk are: quitting smoking, weight control, correct lifting technique, and strengthening the abdominal and back muscles with regular exercise.
Why does “I had the operation but my pain didn’t go away” happen?
There can be more than one reason: scar tissue (epidural fibrosis), recurrence of the herniation, a new problem at an adjacent level, nerve damage that had persisted for a long time before the operation, or incorrect patient selection from the outset. The most effective way to prevent this picture is for the decision to operate to be made by looking at the patient’s clinical picture rather than at the MRI.
Will my numbness go away after the operation?
Pain radiating into the leg generally recedes rapidly; numbness and loss of strength, on the other hand, resolve more slowly. In a nerve that has been under compression for a long time, full recovery may not always be possible. This is why deciding early is important.
Will screws be placed during the operation?
In a straightforward lumbar disc herniation, generally no. In microdiscectomy, screws and fusion are mostly not needed. Screws come onto the agenda in situations such as spondylolisthesis, spinal instability, or those requiring wide decompression.
Is closed (endoscopic) surgery less risky?
Endoscopic and minimally invasive methods reduce tissue damage and speed up recovery in suitable patients. However, not every herniation can be safely resolved with this method, and these methods have their own specific risks too. What is decisive is that the method suitable for your picture is chosen.
What can I do before the operation to reduce the risks?
The most effective step is quitting smoking. In addition, losing weight, getting your blood sugar and blood pressure under control, reporting all your medications to your doctor, and completing all preoperative assessments markedly reduce the risk.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The rates shared above are approximate values based on the general literature; your personal risk profile may differ from them. The necessity of lumbar disc surgery, the method to be applied, the risks, and the recovery process vary greatly according to the location and type of the herniation, the degree of nerve compression, bone quality, and the person’s general state of health, and can only be determined by a doctor who evaluates you. For the decision to operate and for the risks, always discuss matters in detail with the surgeon who examines you. If the emergency symptoms mentioned above are present, go to the nearest healthcare facility without delay.