[Lumbar disc herniation].

Abstract

Background: The most common cause of disc herniation is the degeneration of the intervertebral disc. Consequently, lumbar disc herniations are amongst the most common pathologies of the lumbar spine. Factors that can increase the risk of disc herniation include genetics, weight, occupational risk factors, smoking, as well as a predominantly sedentary profession.

Clinical presentation and therapy: Pathognomonic symptoms of a herniated disc include sciatica, caused by the compression of one or more spinal nerve roots. The clinical sequelae of lumbar disc herniations range from mild low back and buttock pain to severe, immobilising cases of sciatica to cauda equina compression syndromes. In 1-1.5% of cases, a cauda equina syndrome may occur. This cauda equina syndrome may be considered an emergency situation that requires immediate attention and surgical decompression. The same applies to significant and rapidly deteriorating neurological deficits (< 24 h). In all other cases, which represents the majority of all patients, substantial pain relief can be achieved with nonsurgical measures. If an adequate and intolerable pain relief cannot be achieved despite intense conservative treatment measures after an extended period of 6-12 weeks, surgical removal of the disc herniation may be indicated.

Surgical procedures: Lumbar disc herniations may be addressed surgically with minimally invasive techniques. The goal of the surgery is full and sufficient safe removal of the herniated disc fragments in order to decompress the spinal nerves as well as the cauda equina. The two most commonly used surgical techniques (endoscopic/microsurgical) entail five different approaches (endoscopic: interlaminar, transforaminal; microsurgical: interlaminar, translaminar, extraforaminal). Patients are generally fully mobilized within hours after the surgery without any further restrictions. Postoperative rehabilitation measures are often carried out, but have no scientifically proven influence on the outcome of the operation.

Conclusion: This article sheds light on the diagnostic and therapeutic procedures, techniques and special features of this socio-medically very important clinical picture.