With the advance in technology and research, new ideas and methods in treating patients keep evolving; Spine surgery is of no exception. Despite the advance in spine surgery with different thought, idea and instruments, the principles and hence indication of surgery remained the same. The main stay of treatment in spine disease is still conservative. Apart from medications and physiotherapy, injections of different target done under image guidance are also commonly done. The aim of treatment is restoration of function and relief of symptom. Prolonged bed rest even in cases of spinal instability is not indicated as prolonged bed rest carries significant disability and complications.

Although most patients can be managed conservatively with short duration of analgesics and physiotherapy, there are circumstances when the patient should be referred to an Orthopaedic surgeon. Those patients with signs and symptoms of nerve compression (radiculopathy or myelopathy) with limb pain, numbness or weakness with wasting should be referred; it should be noted that for patients with nerve compression, most patients still have intact neurology on examination; symptom is more important. Old patients with leg symptoms most commonly suffered from degenerative conditions like spinal stenosis with spinal claudication and physiotherapy is not helpful in this case. For patients with back or neck pain with red flag signs (nocturnal pain, constant pain or increasing severity despite treatment, constitutional symptom like fever, loss of weight, history of malignancy, etc), neck or back pain not responding to physiotherapy or medication for 2-4 weeks or the pain pattern different from usual presentation (mild ache on prolonged standing/ walking or sharp localized pain after sprain injury) are the indications.

In the lecture, the minimally invasive spine surgery (MED, PELD, hydro-diskectomy) was introduced. According to most literatures, the recovery time, the time before return to work and pain control were better with minimally invasive methods. The experience from the writer also showed the more complete decompression and more safe with minimally invasive method, though most papers reported revealed similar complication rates comparing with traditional open method.

More actual facts regarding the commonly asked hydrodiskectomy were discussed; the problem of general public of not knowing the risk and the efficiency of this procedure was discussed. Hydrodiskectomy can be done under local anaesthetic and the procedure is done under fluoroscopic guidance. The nerve is decompressed indirectly by "deflating" the disc protrusion which is brought about by sucking out the dissolved disc material by very high hydraulic pressure. It is not indicated in all cases of disc protrusion and only contained disc protrusion is indicated. The success rate is only around 70% and the risk of misplacement of the instrument is obvious since it is a blind procedure and the position of instruement depends only on fluoroscopic images.

Navigation surgery is also being used in spine surgery apart from total joint replacement and complicated fracture surgery in the field of Orthopaedic surgery. With this tool, the surgery could be done in more accurate way and complication could be decreased. However, support from technicians and preparations for the system before the operation are required and the time so required made the operating time much longer for the initial few cases.