[Surgical treatment of lumbar disc herniation].
OBJECTIVE
Herniated disc tissue removal to decompress the spinal nerve/cauda equina. Minimization of iatrogenic trauma and associated injuries.


METHODS
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.


METHODS
Conservative treatment modalities have not been exhausted.


METHODS
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.


METHODS
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 %.
Schön Klinik München Harlaching, Wirbelsäulenzentrum, Akademisches Lehrkrankenhaus und Institut für Wirbelsäulenforschung der Paracelsus Medizinischen Privatuniversität Salzburg (PMU), Österreich, Harlachinger Str. 51, 81547, München, Deutschland. FHeider@Schoen-Kliniken.de.
F C
FC
Heider
Schön Klinik München Harlaching, Wirbelsäulenzentrum, Akademisches Lehrkrankenhaus und Institut für Wirbelsäulenforschung der Paracelsus Medizinischen Privatuniversität Salzburg (PMU), Österreich, Harlachinger Str. 51, 81547, München, Deutschland.
H M
HM
Mayer
D003131:Combined Modality Therapy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome
Disc herniation; Endoscopic surgical procedure; Lumbar nerve compression; Minimally invasive surgery; Surgical decompression
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