'99% Safe' Doesn't Mean '99% Successful'

The biggest source of confidence for a patient is seeing or hearing from patients who have undergone the procedure — testimonials describing next-day mobilisation are very powerful, and the Artemis Hospitals website carries many of them. Beyond that, as technology spreads to more centres and results accumulate, outcomes will speak for themselves. The current primary limitation is availability of technology, not the evidence.

Safety and success are entirely separate concepts. When we say 99% safe, we mean that out of 100 patients, 99 will not deteriorate — they will not be made worse by the surgery. Success is different: a patient who arrives already paralysed, no technology anywhere in the world can guarantee that patient will walk. Success depends on the patient's pre-operative condition, the stage of disease on MRI, and their own functional expectations — which is why a one-to-one consultation is essential before anyone is given realistic clarity on likely outcomes.

This is a very large grey zone. In general, a patient with acute pain of short duration, no neurological weakness, and quality of life not severely compromised should get a trial of conservative management first. At the other end, a patient who has tried conservative measures without relief, has developed neurological weakness or significantly impaired quality of life, and has imaging confirming nerve compression, needs an honest conversation about surgery as a genuine option. Individual lifestyle demands matter too — the same imaging findings in a sedentary 70-year-old versus someone who needs to travel and stay professionally active can lead to very different recommendations. Treatment has to be individualised.

First, preventing infection: making surgery as minimally invasive as possible, prophylactic antibiotics, and early removal of the urinary catheter, since UTIs are a common source of secondary infection. Second, wound care: dressing changes every second day until suture removal at day ten, sponge bathing rather than full immersion until healed. Third, movement precautions: for three months after discectomy or fusion, no lifting weights, no sitting on the floor, no squatting or forward bending; in the first month, no sitting or travelling continuously for more than 30 minutes without a break. We take follow-up X-rays every month for three months, then every three months up to a year.

For a sportsperson or someone with high physical demands, my approach leans towards spinal fixation rather than decompression alone, for greater long-term stability — consistent with how athletes like Tiger Woods have returned to high-level sport after spine surgery. The realistic return-to-full-sport timeline is about one year, with roughly nine months devoted to rehabilitation under sports-specialist physiotherapists focused on core training and back strengthening. The protocol is tailored to the individual, but the principle is the same: build a strong muscular support system before returning to load.

Out of 100 patients, 99 will not be made worse by the surgery. That is what "safe" measures.

No, safety and success are entirely separate concepts. Success depends on the patient's pre-operative condition, the chronicity and stage of disease on MRI, and the patient's own functional expectations.

No technology anywhere, including the best centres in the USA, can guarantee that a patient who arrives already paralysed will walk again.

Because expectations differ: someone who wants to return to running has a very different definition of success from someone who simply wants to leave the house independently.