The discussions and studies about incisions in the annulus are red herrings when considering MODERN endoscopic disc treatments. All of the endoscopic disc surgeries I've seen are without an incision of the annulus. A tiny needle is introduced and used as a guide for a dialator.
Think of it this way: If you put a needle through a silk blouse, you ruin it. However, you can put a knitting needle through a wool sweater and noone will ever see that it was there. The annulus is made up of criss-crossing fibers, much like a radial-ply tire. While I don't believe that there is any such thing as a 'freebie' access to the disc, in most cases, this access can be done with little or no permanent damage. Read
AnnC's story on the GPN story pages. I should add an inset with my perspective. Her L5-S1 disc had been SED'd in the past and the surgical plan included ADR at that level. When the discogram was done, not only did L5-S1 generate NO pain, that was at MAXIMUM pressure. The surgeon was pressing on the syringe as hard as he possibly could and the disc would not not accept any more contrast (this is called a firm endpoint) and there was NO PAIN. Whatever damage had been done to the disc with the original annular tears and prior discography and prior disc surgery (SED), was completely healed. (Note that a unique aspect of SED is that the surgeon can apply laser or RF energy to the INSIDE of the annulus, while he is looking at the tear. If it shrinks, as is desired, this increases the chance of proper healing. Also, because he is looking at the tear while he is doing this, he can stop if it is not going in the right direction. Also, he can very effectively remove any nucleus material that is in the tear.)
If you look at the pre-surgery images posted of Job13's disc, you'll see a substantial HIZ (high intensity zone) in the posterior annulus. This is the bright white dot. In my "I'm not a doctor/layperson/take it with a grain of salt" opinion, this represents a substantial annular tear that may be worse than average. IMHO, this type of defect in the annulus substantially reduces the odds of a successful outcome. Even if you get a successful outcome with the first surgery, the next injury and the next surgery happen to a previously compromised disc, increasing the odds of failure with future MISS's.
Again, I'm not a doctor and may be completely off base... so take everything I say for what it's worth.
Thanks everyone for participating in this discussion... IMHO, this is why we are here and I hope everyone who participates or reads it will benefit from it. Special thanks to Crystal for starting so many great threads based on her amazing research. Also to Keano who has already breezed past me on MISS knowledge.
You all rock!
Mark