Herniated Lumbar Disc Disease Research Articles

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

BackgroundTrans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.MethodsRetrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.ResultsAccording to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825–(0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 min; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 min; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann–Whitney U test). Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.ConclusionThe learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

요추 전만각 증가식 견인 치료가 요추 추간판 탈출증 환자의 장기간 건강 상태를 변화시킬 수 있는가 : 무작위 대조 실험

요추 전만각 증가식 견인장치(lumbar lordoticcurve controlled traction device, LCCT)가 새롭게 개발되었으나 견인 치료 후 장기간 건강 상태의 변화를 평가한 연구는 미흡하였다. 본 연구의 목적은 LCCT와 기존의 견인장치(Standard traction, ST) 사이의 장기간 건강의 변화를 무작위 대조 시험 설계를 통해 비교하고자 하였다. 본 연구에 40명의 경한 요통이 있는 환자가 참여하였다. 모든 참가자는 LCCT 그룹 또는 ST 그룹으로 무작위 할당되었다. 환자의 전반적인 건강상태는 시각상사척도와 SF-36을 사용하여 치료 전과 치료 후 3개윌의 변화를 평가하였다. 그 결과, LCCT 그룹은 ST 그룹보다 통증 강도가 현저히 감소하고 신체기능, 신체 통증, 정서적 역할등이 크게 개선되었다. 두 그룹 모두에서 유의한 부작용은 보고되지 않았다. 척추 견인 동안 자연적인 성인의 곡선을 유지하는 이상적인 이점 때문에, 새롭게 개발된 LCCT는 종합적인 건강상태, 특히 통증점수를 개선하는 데 있어 상당한 이점을 보였다. LCCT의 임상적 이점은 장기간 지속될 것으로 보여 임상 환경에서 제안될 수 있다.

Total sitting time, leisure time physical activity and risk of hospitalization due to low back pain: The Danish Health Examination Survey cohort 2007–2008

This study aimed to test the hypotheses that a high total sitting time and vigorous physical activity in leisure time increase the risk of low back pain and herniated lumbar disc disease. A total of 76,438 adults answered questions regarding their total sitting time and physical activity during leisure time in the Danish Health Examination Survey 2007-2008. Information on low back pain diagnoses up to 10 September 2015 was obtained from The National Patient Register. The mean follow-up time was 7.4 years. Data were analysed using Cox regression analysis with adjustment for potential confounders. Multiple imputations were performed for missing values. During the follow-up period, 1796 individuals were diagnosed with low back pain, of whom 479 were diagnosed with herniated lumbar disc disease. Total sitting time was not associated with low back pain or herniated lumbar disc disease. However, moderate or vigorous physical activity, as compared to light physical activity, was associated with increased risk of low back pain (HR = 1.16, 95% CI: 1.03-1.30 and HR = 1.45, 95% CI: 1.15-1.83). Moderate, but not vigorous physical activity was associated with increased risk of herniated lumbar disc disease. The results suggest that total sitting time is not associated with low back pain, but moderate and vigorous physical activity is associated with increased risk of low back pain compared with light physical activity.

Surgical Strategy Using Endoscopy to Minimize Fetal Surgical Risks in Treating a Pregnant Woman with Herniated Lumbar Disc Disease

Pregnancy poses a special clinical challenge in surgical treatments for spinal diseases. Here we present the case of a 30-year-old woman with a ruptured lumbar disc on the right side of L5–S1. The patient was 18 weeks pregnant. Conservative managements for 3 weeks had failed to relieve her pain. We performed interlaminar percutaneous endoscopic lumbar discectomy (PELD) using spinal anesthesia. The left lateral decubitus position was chosen to minimize abdominal compression. Preoperative magnetic resonance imaging (MRI) taken after attaching few fiducial markers at patient's mid-lower back was used to secure the correct surgical level without X-rays. The surgery was successful, and the patient's pain score on a visual analogue scale was reduced from 9/10 to 3/10. Ultrasonography was used to confirm that the baby was healthy postoperatively. PELD causes less pain, and dose not require general anesthesia, which imposes a higher risk of fetal distress than regional anesthesia. Combination of the interlaminar approach of accessing from the midline and a marking MRI permitted PELD without X-ray imaging. The relative ease of performing surgery on either side of the lateral decubitus position makes PELD more feasible for pregnant patients.

Evolution and Analysis of 445 Cases of Lumbar Discal Hernia Treated with Hemilaminoforaminotomy and Discectomy

Introduction The purpose of this study is to show the good results, we can obtain by making hemilaminectomy with foraminotomy and discectomy for herniated lumbar disc disease. Lumbar disc disease is a common affliction. Surgical intervention provides excellent results in carefully selected patients. Discectomy with hemilaminoforaminotomy through a small incision with surgery loupes or microscope permits an accurate decompression of the root with results from good to excellent. Methods The surgical records of 445 patients, who underwent surgical intervention for herniated lumbar disc disease in an 18.5-year period between March 1996 and September 2014, were checked. A total 202 were women and 243 men. The range age was 14 to 83 years with an average of 48.5 years. All the patients had root pain in a dermatome pattern because of herniated lumbar disc disease with or without foramen stenosis and they were evaluated with imaging studies as: MRI and some of them with CT. Patients older than 60 years (128 patients) had foramen stenosis and they had the same procedure. They were treated with hemilaminoforaminotomy and discectomy through a small incision: 236 patients were operated on one level, 169 were operated on two levels and the other 40 patients were underwent more than two levels. The outcome results were collected at a range from 2 months to 18 years. Over 293 patients have a 10-year follow-up. The procedure was hemilaminectomy with foraminotomy and discectomy using microscope or surgery loupes. Hospitalization was from 12 to 24 hours. Results The results were defined according to Macnab scale as excellent 84, good 10, regular 4, and poor 2% (Fig. 1). Conclusion The results of these series indicate that most patients do well after hemilaminoforaminotomy with discectomy and root decompression. It is safe and it does not have destabilization risk. With this procedure, the outcomes are from good to excellent, although the patients had to be well selected by examination and radiological findings. This kind of minimal invasion surgery allows patients to have a fast recovery with low cost, it enables a quick reincorporate to work and esthetically pleasant.

Physical fitness as a predictor of herniated lumbar disc disease – a 33-year follow-up in the Copenhagen male study

BackgroundThe role of physical fitness (VO2Max (mlO2*min-1*kg-1)) as a risk factor for herniated lumbar disc disease (HLDD) is unknown. The objective of this study was to examine the association between aerobic (physical) fitness and risk of hospitalisation due to HLDD in a long-term follow up.MethodsThe Copenhagen Male Study is a prospective cohort study established in 1970–71. At baseline, 5,249 men answered a questionnaire about their history of back disease, physical and psychosocial working conditions, lifestyle and social class. Height and weight was measured and aerobic capacity (physical fitness) was estimated based on a submaximal bicycle test. Information about hospitalization due to HLDD was obtained from the National Hospital Register covering the period 1977 – 2003. Hazard Ratios (HR) were calculated by Cox’s proportional hazard regression model.ResultsAmong 3,833 men without history of low back disorders, 64 were hospitalized due to HLDD. The cumulative incidence of HLDD was 1.7% (n=34) among men with low physical fitness (15–32 ml O2*min-1*kg-1), and 1.7% (n=30) among men with high physical fitness (33–78 ml O2*min-1*kg-1). In a final model, adjusted for relevant confounders, the HR (95% CI) for HLDD for those with high physical fitness was 0.88 (0.51-1.50) compared to those with low physical fitness. In the same model, HR for men often exposed to strenuous work compared to those seldom or never exposed to strenuous work was 3.91(1.82-8.38). Also body height was a significant predictor.ConclusionsPhysical fitness is not associated with hospitalisation due to HLDD, and the only modifiable risk factor for hospitalisation due to HLDD seems to be strenuousness at work.

Endoscopic Interlaminar Lumbar Discectomy With Splitting of the Ligament Flavum Under Visual Control

Technical report and cases series. To present the technique of interlaminar endoscopic lumbar discectomy (ED) with ligamentum flavum (LF) splitting under direct visualization. The most distinguishing advantage of ED is a decrease in tissue trauma, which has been associated postoperatively with less back pain and less adhesion or scar tissue formation. In transforaminal ED the LF is completely spared, whereas in interlaminar ED the LF must be removed under direct visualization, no matter how small the opening may be (3 to 5 mm). It is also possible to keep the LF intact using serial dilators, but this procedure cannot be performed under direct visualization. We performed operations on 16 male and 14 female patients with herniated lumbar disc disease using interlaminar ED with LF splitting under direct visual control. The average age of the patients in the study was 48±15 years. The chief complaint before surgery was radiculopathy confined to 1 leg. The anatomic operative level was L3-4 in 1, L4-5 in 13, and L5-S1 in 16 patients. The ruptured disc had migrated superiorly in 4 cases and inferiorly in 7 cases, and intraoperative electromyographic monitoring was performed in all surgeries. The LF was split with a working channel under direct visualization, and after withdrawing the working channel the split LF closed on its own. The total operation time was 20 to 40 minutes, and the follow-up period was 149±108 days. There were no abnormal signals on the intraoperative electromyography in any of the cases, and the reported symptoms immediately improved in all patients after the operation. Follow-up magnetic resonance imaging showed a disappearance of the ruptured disc with almost no defect in the LF. There were no operation-associated complications. The LF could be safely split under direct visualization using a working channel with a minimal resulting defect. This technique of LF splitting endoscopic discectomy is a feasible approach, even for migrated disc herniation.

Clinical Outcomes of Percutaneous Plasma Disc Coagulation Therapy for Lumbar Herniated Disc Diseases

ObjectiveThis is prospective study of clinical outcomes of percutaneous plasma disc coagulation Therapy (PDCT) in patients with herniated lumbar disc disease (HLD) to evaluate the safety and efficacy in its clinical application and usefulness as a reliable alternative to microscopic discectomy.MethodsForty-six patients were enrolled in this study from April 2006 to June 2010. All patients had one-level HLD. Disc degeneration was graded on routine T2-weighted magnetic resonance Image (MRI) using the Pfirrmann's grading system and all index levels were grade 3 and grade 4. Indications for surgery were radiculopathy caused by disc protrusion with soft consistency. MRI was done at one month after the procedure in all patients to check post-PDCT change. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria.ResultsThis study was approved by the Institutional Review Board of our institution. The age of the study population ranged from 16 to 59 years with a mean age of 37.2 years. There were 29 males and 17 females in this study. The mean period of clinical follow-up was 21 months. The average preoperative VAS score for radiculopathy was 7.4±1.4, while the final follow-up VAS score was 1.4±0.7 (p<0.001). In MacNab's criteria, 41 patients (89.1%) had achieved favorable improvement (excellent and good) until later follow-up. There were one patient from infection and two patients who needed to convert to open discectomy.ConclusionPDCT is a safe and efficient treatment modality in a selective patient with HLD.

Percutaneous Disc Coagulation Therapy (PDCT) comparing with Automated Percutaneous Lumbar Discectomy (APLD) in Patients of Herniated Lumbar Disc Disease: Preliminary Report.

ObjectivePercutaneous techniques are rapidly replacing traditional open surgery. This is a randomized controlled trial study of clinical outcomes of Percutaneous Plasma Disc Coagulation Therapy (PDCT) in patients with HLD(herniated lumbar disc) as a new percutaneous access in comparison with Automated Percutaneous Lumbar Discectomy (APLD) in its clinical application and usefulness as a reliable alternative method.MethodsThe authors analyzed 25 patients who underwent PDCT randomized 1:1 to 25 who underwent APLD between June, 2010 and October, 2011. All patients had herniated lumbar disc diseases. The clinical outcomes were evaluated using Visual Analog Scales (VAS) score and MacNab's criteria.ResultsThe age of the patients who underwent PDCT ranged from 29 to 88 years with a mean age of 51.8 years. The age of the APLD undergone patients' population ranged from 30 to 66 with a mean age of 46.0 years. The average preoperative VAS score in PDCT was 7.60 and 1.94 at 7months post-operatively, and in APLD was 7.32, and 3.53 at 7 months post-operatively (p<0.001). In Macnab's criteria, 20 patients (80%) had achieved favorable improvement (excellent and good) in PDCT group. In Macnab's criteria, 16 patients (64%) had achieved favorable improvement in APLD group (p<0.001).ConclusionPDCT can be considered a viable option as a new percutaneous access to herniated lumbar disc. PDCT showed to be more effective than APLD in this study, allowing stable decompression and safe minimally invasive operation to an area desired by the operator in lumbar disc herniation patients, although further long term clinical evaluations are still necessary.

Occupational and Other Predictors of Herniated Lumbar Disc Disease—A 33-Year Follow-up in The Copenhagen Male Study

Cohort study. To examine the association between self-reported physical workload and risk of herniated lumbar disc disease (HLDD) in a long-term follow-up of men without a history of back disorders at baseline. Heavy physical workload is considered a risk factor for HLDD, but the issue is not definitively settled. The Copenhagen Male Study is a prospective cohort study established in 1970 to 1971. At baseline, 5245 men answered a questionnaire about history of back disease and physical workload. Psychosocial working conditions, lifestyle, social class, and measured height and weight were included as potential confounders. Information about hospitalization due to HLDD was obtained from the National Hospital Register covering the period from 1977 to 2003. Hazard ratios were calculated by Cox proportional hazard regression model. Among 3833 men without back disease history at baseline, the strongest predictor of hospitalization for HLDD was frequent strenuous physical activity at work; compared with unexposed, the hazard ratio with 95% confidence interval was 3.90 (1.82-8.38). Also, body height was a significant predictor, whereas body weight was only insignificantly associated with HLDD. Among men without history of back disease reporting of frequent exposure to strenuous physical activity at work was a strong risk factor for later hospitalization due to HLDD.

Microdiscectomia lombar tubular com o uso de seringas descartáveis de diâmetros progressivos: resultados cirúrgicos

OBJETIVO: descrever técnica minimamente invasiva para abordagem das hérnias discais com material de baixo custo. MÉTODOS: estudo prospectivo da avaliação dos resultados cirúrgicos de dez pacientes submetidos à microdiscectomia lombar tubular com uso de seringas descartáveis de diâmetros progressivos. RESULTADOS: utilizando os critérios de MacNab modificados, 60% dos pacientes apresentaram resultados considerados excelentes, 30% bons e 10% razoáveis. O tempo médio de cirurgia foi de 70 minutos e o de permanência hospitalar, de 14 horas. CONCLUSÃO: o uso de seringas descartáveis para microdiscectomia tubular foi seguro, de baixo custo e com resultados preliminares semelhantes aos da literatura para o tratamento minimamente invasivo da hérnia discal lombar.

Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain.

Clinical Outcomes of Percutaneous Endoscopic Laser Lumbar Discectomy

Background: Over the years, disc surgery has progressively evolved in the direction of decreasing trauma and its invasiveness. Conventional open surgery has many complications, such as scarring, instability, bleeding and a relative high mortality rate. Minimally invasive spinal surgery is now an alternative to a traditional discectomy. Herein, we present an operative technique, and the early results, for a percutaneous endoscopic lumbar discectomy in herniated lumbar disc disease. Methods: 43 patients, including 27 men and 16 women, with ages ranging from 18 to 66 years, were enrolled in this study. All the patients showed a protruded or extruded soft disc herniation at the lumbar level on magnetic resonance imaging and computed tomography. A percutaneous endoscopic lumbar discectomy was applied to the patients, and clinical responses evaluated using MacNab’s criteria. Results: 40 patients were regarded as showing successful responses (93.1%), and there were no severe complications, such as a hematoma, nerve injury, postoperative dysesthesia or death. One patient underwent fusion surgery for remnant back pain six month later. Conclusions: We conclude that, in properly selected patients, a percutaneous endoscopic lumbar discectomy is a safe, noninvasive and effective treatment modality for herniated lumbar intervertebral disc disease.

Clinical Outcomes of Percutaneous Lumbar Discectomy Using Dekompressor®

Background: Discogenic leg pain is a major cause of health problems, often due to herniation of the intervertebral disc, and has traditionally been treated conservatively or with an open surgical discectomy. Conventional open surgery has many complications, such as nerve root injury, discitis and a relatively high mortality rate; failure of conservative treatments is also common. Recently, the Percutaneous Lumbar Discectomy probe was developed. Herein, we present the early results for a percutaneous lumbar discectomy in herniated lumbar disc disease. Methods: Eleven patients, including 8 men and 3 women, with ages ranging from 22 to 78 years, were enrolled in this study. Those patients with a previous history of back surgery were not excluded from the study. All patients were postoperatively evaluated for their clinical outcomes, such as visual analogue scale (VAS) for pain after 1 and 3 months, reduction in analgesics, functional improvement and overall satisfaction. Results: The percutaneous lumbar discectomy was completed in 11 patients (17 levels), with average reductions in pre-VAS of 61.3 and 60.2% at 1 and 3 months, respectively. Also, 72.7% of patients reported functional improvement, with 81.1% expressing overall satisfaction. There were no procedural related complications. Conclusions: We concluded that a percutaneous lumbar discectomy is a safe and effective treatment modality for a herniated lumbar disc.

Predictors of Successful Outcome for Lumbar Chemonucleolysis: Analysis of 3000 Cases during the Past 14 Years

Among numerous minimally invasive procedures for the treatment of herniated lumbar disc disease (HLD), chymopapain chemonucleolysis has the longest history of clinical usage. Long-term studies indicated good clinical results with a low risk for patients. However, much confusion still remains about the indications. This study was conducted to evaluate the predictors of successful outcome for chemonucleolysis and to firmly establish the proper indications for this procedure. Three thousand patients with HLD were treated with chemonucleolysis between 1984 and 1999. The clinical success rate in our series was 85%. The medical history and physical and radiological findings, including the type and direction of disc herniation, were analyzed retrospectively. The patient group with the chief complaint of leg pain achieved a better clinical outcome than the patient group with low back pain (88% versus 59%, P < 0.05). A positive straight-leg-raising test was strongly correlated with good clinical outcome (P < 0.05). Patients manifesting a soft, protruded disc had a better outcome than those manifesting diffuse bulging disc (P < 0.05). Other prognostic factors favoring a good outcome were as follows: young age, short duration of symptoms, and no bony spur or calcification on radiological study. Chymopapain chemonucleolysis is a safe and effective procedure. Proper selection of patients is important for the success of treatment. We propose the following three clinical criteria (Kim's triad) for selection of patients: chief complaint of leg pain rather than back pain, positive straight-leg-raising test, and soft protruded disc.

Microendoscopic Lumbar Discectomy: Technical Note

The microendoscopic discectomy (MED) technique was initially developed in 1997 to treat herniated lumbar disc disease. Since then, thousands of cases have been successfully performed at more than 500 institutions. This article discusses the technical aspects of this procedure and presents a consecutive case series. A total of 150 consecutive patients underwent MED. MED is performed by a muscle-splitting approach using a series of tubular dilators with consecutively increasing diameters. A tubular retractor is then inserted over the final dilator, and a specially designed endoscope is placed inside the tubular retractor. The microdiscectomy is performed endoscopically while the surgeon views the procedure on a video monitor. Clinical outcomes were determined using a modified MacNab criteria, which revealed that 77% of patients had excellent, 17% had good, 3% had fair, and 3% had poor outcomes. The average hospital stay was 7.7 hours. The average return to work period was 17 days. Complications primarily included dural tears, which occurred in 8 patients (5%) and were seen early on in the patient series. Complication rates diminished as the surgeon's experience with this technique increased. MED for lumbar herniated disc disease can be performed safely and effectively, resulting in a shortened hospital stay and faster return to work; however, there is a learning curve to this procedure.

Clinical and Radiologic Factors Predicting the Low Back Pain after Discectomy

Study design : Retrospective analysis to evaluate predictive factors of low back pain after discectomy in lumbar disc herniation. Objective : We analysed clinical and radiological predictive factors which possibly contribute to postoperative low back pain in herniated lumbar disc disease. Summary of literature review : There was no statistically significant factors which contribute to postoperative low back pain. Materials and Methods : Ninety two patients with herniated lumbar disc who were treated by one level simple discectomy from June 1995 to June 2000 were included in this study. They were divided into two groups by severity of postoperative low back pain, back pain group and no back pain group. We analyzed clinical and radiological factors retrospectively in each group by medical records, preoperative radiographs and telephone interview. Then statistical analysis was performed with Chi-square test and logistic regression analysis. Confidence interval was 95%. R e s u l t s : Eighteen patients (19.6%) were in back pain group and seventy four patients (80.4%) were in no back pain group. Among patients over 50 years old and below 50 years old, the ratio of low back pain after discectomy was 33% and 13.8% respectively (Odds ratio=3.1, confidence interval 1.07~9.03). It was proved statistically that except age factor, such factors as follows did not affect postoperative lower back pain. Sex, smoking , preceeding low back pain before discectomy, level of discectomy, disc space narrowing, bony spur, grade of disc degeneration, presence of high intensity zone of disc. Conclusions : There was no other significant predictive factors of post-discectomy low back pain than the age over 50 years old.

Vascular and Visceral Injuries Associated with Lumbar Disc Surgery: Medicolegal Implications

Symptomatic perforation of the anterior annulus fibrosus/anterior longitudinal ligament during surgery for herniated lumbar disc disease is one of the more solemn and sobering complications experienced by neurosurgeons or orthopedic surgeons. This complication frequently results in the death of the patient. Its occurrence is probably more common than the medical community would expect. The authors report 21 cases since 1985 in which an injury to an intra-abdominal vessel or viscera occurred. In all cases litigation resulted and a settlement or verdict was rendered. A review of the literature is presented and the medicolegal implications of symptomatic ventral perforations of the annulus fibrosus/anterior longitudinal ligament are discussed.

Point of View: Prostaglandin E2 Content in Herniated Lumbar Disc Disease

Point of View: Prostaglandin E2 Content in Herniated Lumbar Disc Disease

Lumbar disc herniation and open limited discectomy: Indications, techniques, and results

The relationship between a herniated lumbar disc and nerve root compression is well described. The surgical treatment has evolved over the last several decades. Presently, surgical treatment offers a highly predictable and successful outcome in properly selected patients. This report discusses the indications, techniques, and results of limited discectomy for herniated lumbar disc disease.