[Surgical treatment of lumbar disc herniation]

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


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.

Publication types

  • Review

MeSH terms

  • Combined Modality Therapy / methods
  • Decompression, Surgical / methods*
  • Diskectomy / methods*
  • Endoscopy / methods*
  • Evidence-Based Medicine
  • Humans
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / surgery*
  • Lumbar Vertebrae / surgery*
  • Microsurgery / methods*
  • Spinal Cord Compression / diagnosis
  • Spinal Cord Compression / etiology
  • Spinal Cord Compression / surgery*
  • Treatment Outcome