Herniated Lumbar Disk Evaluation and Surgical Management

Abstract

Although the incidence of low back pain is about 60 %, that of low back pain plus sciatica is only 1 %. Sciatica is most commonly due to herniation of a lumbar intervertebral disc. L4–L5 is the most frequently involved level, followed closely by L5-S1 and then L3–L4. Disc protrusion at other levels or at more than one level at any given time is rare. Other potential causes of sciatica include spondylosis, infection, neoplasm, and vascular disease. There is some controversy about the usefulness of surgery or nonoperative treatment in managing these patients. The majority of patients with lumbar disc herniations and sciatica will improve with conservative treatment and time. The natural history of lumbar disc herniations is very favorable. At times, there was a tendency, however, to operate on these patients a few weeks after the onset of their initial symptoms, especially when minimally invasive surgical (MIS) techniques could be offered. Some surgical techniques have become so minimally invasive (microendoscopic discectomy), allowing their performance on an ambulatory basis. It is our task, as consulted spine surgeons, to return a patient with sciatica in a prompt and effective manner to his or her previous level of function as soon as possible.