[Surgical treatment of lumbar disc herniation]

Abstract

Objective: Herniated disc tissue removal to decompress the spinal nerve/cauda equina. Minimization of iatrogenic trauma and associated injuries.

Indications: Conservative treatment did not sufficiently improve clinical symptoms. This is true for progressive or persisting neurological deficits, as well as for persisting pain which alters the quality of the patient`s life. Results of surgery are strongly dependent on the preoperative duration of symptoms. Paramount is the "timing" of surgery: poorer surgical results associated with increasing preoperative duration of symptoms.

Contraindications: Conservative treatment modalities have not been exhausted.

Surgical techniques: There are 2 technologies (endoscopic/microsurgical) and 5 different approach strategies (endoscopic: interlaminar, transforaminal; microsurgical: interlaminar, translaminar, extraforaminal), whereby the choice is determined by morphology and location of the herniated disc. All techniques are minimally invasive and lead to comparable clinical results.

Postoperative management: For all techniques, patients are mobilized early. Light sports activities allowed after 2 weeks and return to work after about 4 weeks.

Results: Good clinical outcomes in meta-analyses/large case series are between 80-95 %.

Keywords: Disc herniation; Endoscopic surgical procedure; Lumbar nerve compression; Minimally invasive surgery; Surgical decompression.