Diagnosis and Surgical Treatment of Lumbar Disc Herniation

Abstract

Among many clinical issues concerned with lumbar disc herniation, the authors discuss the pitfalls of diagnosing and surgically treating lumbar disc herniation in this article. Lumbar disc herniation is among the most common lumbar diseases, and is manifested by low back pain, leg pain, and other sensory and motor disturbance ; however, there are many other lumbar diseases that manifest similar symptoms, so that to obtain good surgical results it is necessary to clinically distinguish lumbar disc herniation from these other similar diseases. Diagnosing lumbar disc herniation has become easier since the introduction of magnetic resonance (MR) imaging ; however, improper use of this imaging method has led to abuses, such as oversurgery and misdiagnosis of the disease. MR imaging for diagnostic purposes should only be pursued after the patient is fully and appropriately examined neurologically and neuroradiologically. The only absolute indication for surgically treating lumbar disc herniation are cases manifesting the acute cauda equina syndrome that are associated with bladder dysfunctioning. For such cases, a microsurgical disectomy is a good operative procedure. The author describes methods for this surgical procedure.