| Popis: |
This chapter will discuss the pathophysiology, exam, diagnosis, and management of lumbar disc herniation (LDH). In brief, LDH is a common pathology that will affect a significant portion of the population. The natural history of LDH is favorable, and excellent results have been obtained with conservative management. Both physical therapy and epidural steroid injections play a role in nonoperative treatment. Recent data, notably the large-scale SPORT trials, suggest that patients managed with discectomy may have a more favorable outcome when compared to conservative treatment. A “mini-open” technique is the most common modality of discectomy performed; however, minimally invasive approaches are gaining popularity. Percutaneous discectomies should be avoided as they have less favorable outcomes. Use of a tubular retractor system typifies the modern minimally invasive approach. A number of randomized controlled trials comparing open discectomy to minimally invasive microdiscectomy have been performed. A pooled analysis of these trials demonstrates that both techniques seem to be equally effective at relieving pain and have comparable reherniation rates. Overall complication rates are similar between open and minimally invasive approaches; however, there number of incidental durotomies is higher with minimally invasive approaches. Minimally invasive approaches offer the potential benefit of less soft tissue trauma and faster recovery; however, they are technically demanding. Excellent results can be obtained with either a minimally invasive or open approach. |
