With an annual incidence of 5 per 1000 persons, the lumbosacral radicular syndrome caused by a lumbar disk herniation (LDH) is a frequently observed problem 13. The most important symptom is lumbosacral radicular leg pain following a dermatomal pattern from below the knee till the feet and toes. The pain worsens with coughing. Other clinical findings may include unilateral spasm of the paraspinal muscles, gait deformity, limited forward flexion and sensory deficits such as muscle weakness and reflex changes 26.
Patients with symptomatic LDH can be managed variably: conservatively, with interventional pain treatment or surgically 10. In patients with persistent or progressive symptoms after 6 to 12 weeks of conservative treatment (by analgesics or by reducing pressure on the nerve root e.g. by physical therapy) surgery is indicated. A previous study showed that patients who were randomized to undergo early surgery had similar disability scores after one year versus patients undergoing prolonged conservative management 19. However, patients undergoing surgery reported earlier relief of leg pain and reported a faster rate of recovery, demonstrating the benefits of surgery. …show more content…
Since then several techniques have been described for the surgical treatment of the LDH, such as minimally invasive approaches to access a lumbar disc 12. The aim was to limit the skin incision and decrease muscle damage and epidural scarring. Several lateral percutaneous techniques have been described since. The indications for these percutaneous procedures were mostly limited to contained LDHs. The aim was to reduce postoperative radicular pain and to allow for faster rehabilitation and early return to activities of daily
Patients with symptomatic LDH can be managed variably: conservatively, with interventional pain treatment or surgically 10. In patients with persistent or progressive symptoms after 6 to 12 weeks of conservative treatment (by analgesics or by reducing pressure on the nerve root e.g. by physical therapy) surgery is indicated. A previous study showed that patients who were randomized to undergo early surgery had similar disability scores after one year versus patients undergoing prolonged conservative management 19. However, patients undergoing surgery reported earlier relief of leg pain and reported a faster rate of recovery, demonstrating the benefits of surgery. …show more content…
Since then several techniques have been described for the surgical treatment of the LDH, such as minimally invasive approaches to access a lumbar disc 12. The aim was to limit the skin incision and decrease muscle damage and epidural scarring. Several lateral percutaneous techniques have been described since. The indications for these percutaneous procedures were mostly limited to contained LDHs. The aim was to reduce postoperative radicular pain and to allow for faster rehabilitation and early return to activities of daily