Lumbar disc herniation

Lumbar disc herniation

Symptomatic lumbar disc herniation occurs during the lifetime in approximately 2–4% of the population. Risk factors include family history , male gender, age (30–50 years), heavy lifting or twisting, stressful occupation, lower income and cigarette smoking. Over 90% of lumbar disc herniations occur at the L4/5 or L5/S1 levels. A posterolateral disc protrusion will a ff ect the traversing root, e.g. an L4/5 disc protrusion will a ff ect the L5 nerve root. A far-lateral disc protrusion (extraforaminal) will a ff ect the exiting nerve root, e.g. a far-lateral L5/S1 disc protrusion will a ff ect the L5 nerve root. Symptoms typically commence with a period of back pain followed by sciatica. There may be paraesthesia, motor weakness, loss of reflexes and a reduction in SLR. For simple sciatica, a period of 6–12 weeks of conservative treatment is advised. Up to 70% of patients will settle within this period. A trial of pregabalin (GABA analogue) and/or a transforaminal epidural steroid injection may be helpful. Microdiscectomy is the standard surgical intervention f or those in whom conservative treatment has failed. The procedure is carried out in the prone position with radiographic confir mation of the correct level. Loupes with a headlight or use of the operating microscope greatly facilitate the procedure. the multifidus. The spinal canal is entered via r emoval of the ligamentum flavum under the lamina. The thecal sac and tra - versing nerve root are identified. T he dura and nerve root are retracted medially and the o ff ending disc prolapse incised via - a transverse annulotomy . The disc fragment is removed and the disc space cleared of any remaining nuclear material with r ongeurs and multiple washouts of the disc space. The wound is closed. Patients are generally discharged the next morning. Lumbar disc herniation

Symptomatic lumbar disc herniation occurs during the lifetime in approximately 2–4% of the population. Risk factors include family history , male gender, age (30–50 years), heavy lifting or twisting, stressful occupation, lower income and cigarette smoking. Over 90% of lumbar disc herniations occur at the L4/5 or L5/S1 levels. A posterolateral disc protrusion will a ff ect the traversing root, e.g. an L4/5 disc protrusion will a ff ect the L5 nerve root. A far-lateral disc protrusion (extraforaminal) will a ff ect the exiting nerve root, e.g. a far-lateral L5/S1 disc protrusion will a ff ect the L5 nerve root. Symptoms typically commence with a period of back pain followed by sciatica. There may be paraesthesia, motor weakness, loss of reflexes and a reduction in SLR. For simple sciatica, a period of 6–12 weeks of conservative treatment is advised. Up to 70% of patients will settle within this period. A trial of pregabalin (GABA analogue) and/or a transforaminal epidural steroid injection may be helpful. Microdiscectomy is the standard surgical intervention f or those in whom conservative treatment has failed. The procedure is carried out in the prone position with radiographic confir mation of the correct level. Loupes with a headlight or use of the operating microscope greatly facilitate the procedure. the multifidus. The spinal canal is entered via r emoval of the ligamentum flavum under the lamina. The thecal sac and tra - versing nerve root are identified. T he dura and nerve root are retracted medially and the o ff ending disc prolapse incised via - a transverse annulotomy . The disc fragment is removed and the disc space cleared of any remaining nuclear material with r ongeurs and multiple washouts of the disc space. The wound is closed. Patients are generally discharged the next morning. Lumbar disc herniation

Symptomatic lumbar disc herniation occurs during the lifetime in approximately 2–4% of the population. Risk factors include family history , male gender, age (30–50 years), heavy lifting or twisting, stressful occupation, lower income and cigarette smoking. Over 90% of lumbar disc herniations occur at the L4/5 or L5/S1 levels. A posterolateral disc protrusion will a ff ect the traversing root, e.g. an L4/5 disc protrusion will a ff ect the L5 nerve root. A far-lateral disc protrusion (extraforaminal) will a ff ect the exiting nerve root, e.g. a far-lateral L5/S1 disc protrusion will a ff ect the L5 nerve root. Symptoms typically commence with a period of back pain followed by sciatica. There may be paraesthesia, motor weakness, loss of reflexes and a reduction in SLR. For simple sciatica, a period of 6–12 weeks of conservative treatment is advised. Up to 70% of patients will settle within this period. A trial of pregabalin (GABA analogue) and/or a transforaminal epidural steroid injection may be helpful. Microdiscectomy is the standard surgical intervention f or those in whom conservative treatment has failed. The procedure is carried out in the prone position with radiographic confir mation of the correct level. Loupes with a headlight or use of the operating microscope greatly facilitate the procedure. the multifidus. The spinal canal is entered via r emoval of the ligamentum flavum under the lamina. The thecal sac and tra - versing nerve root are identified. T he dura and nerve root are retracted medially and the o ff ending disc prolapse incised via - a transverse annulotomy . The disc fragment is removed and the disc space cleared of any remaining nuclear material with r ongeurs and multiple washouts of the disc space. The wound is closed. Patients are generally discharged the next morning.