Abstract
This report describes the therapeutic strategy for treating lumbar disk hernia (LDH) and lumbar canal stenosis (LCS). Determining an appropriate treatment strategy requires knowledge of the natural course of the disease, the limitations of conservative therapy and the absolute indications for surgery. Conservative treatment with drug therapy, physical therapy, or a nerve block is an effective treatment option for both diseases.
Patients that present with a posterior lumbar apophyseal ring with hernia during adolescence, cartilage endplate with hernia in the elderly and cauda equine type in the lumbar canal stenosis do not normally respond to conservative treatments, and often require surgical intervention. Surgery may be indicated in patients that do not respond to conservative therapy within 1-3 months. Surgery is also indicated in patients with acute cauda equina syndrome, rapid progressing paralysis, and excruciating pain. Epiduroscopy is a valuable modality to assess and diagnose the patient's condition. However, there are only limited data on the efficacy, invasiveness and the cost-effectiveness of epiduroscopy for both diseases.
