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Oper Orthop Traumatol. 2017 Feb;29(1):59-85. doi: 10.1007/s00064-016-0467-3. Epub 2016 Sep 29.

[Surgical treatment of lumbar disc herniation].

[Article in German]

Author information

1
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.
2
Schön Klinik München Harlaching, Wirbelsäulenzentrum, Akademisches Lehrkrankenhaus und Institut für Wirbelsäulenforschung der Paracelsus Medizinischen Privatuniversität Salzburg (PMU), Österreich, Harlachinger Str. 51, 81547, München, Deutschland.

Abstract

OBJECTIVE:

Herniated disc tissue removal to decompress the spinal nerve/cauda equina. Minimization of iatrogenic trauma and associated injuries.

INDICATIONS:

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.

CONTRAINDICATIONS:

Conservative treatment modalities have not been exhausted.

SURGICAL TECHNIQUES:

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.

POSTOPERATIVE MANAGEMENT:

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 %.

KEYWORDS:

Disc herniation; Endoscopic surgical procedure; Lumbar nerve compression; Minimally invasive surgery; Surgical decompression

PMID:
27689222
DOI:
10.1007/s00064-016-0467-3
[Indexed for MEDLINE]

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