Surgery for lumbar disc herniation is one of the most commonly performed operations in spine surgery but it is the most satisfying to the patient. The advent of the era of microscopic and endoscopic disc surgery did not eliminate this dissatisfaction. Surgical success is not merely contingent on operating through small holes but on the meticulous preoperative evaluation of problems that lead to unsatisfactory outcomes. Disc herniations that develop above sacralization pose a challenge. The size of the tear in the annulus is an important factor. Disc herniations attributable to Modic degeneration tend to recur. Last, individuals with weak muscle compartments are likely to develop problems after discectomy. Patients with these concomitant problems have a much higher failure rate after discectomy.