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Lumbar disc prolapse is a common condition which can cause lumbar nerve root compression and result in lower limb radiculopathy.
Everyone develops degenerative disc disease over the course of their life, with the lower lumbar discs generally being affected earlier than the upper lumbar discs. The vast majority develop a degenerative broad based bulge that does not cause any neural compression. However, some people will develop a focal prolapse or herniation which can cause nerve compression. The most common location for a disc herniation is paracentral which is located within the spinal canal and causes compression of the traversing nerve root in the lateral recess. Less common locations for disc herniation include central, foraminal, and far lateral.
The incidence of lumbar disc herniation is between 0.5% and 2% and is most common in people in their fourth and fifth decades of life. It can sometimes be related to a specific incident involving heavy lifting or bending, but there is often no specific causative factor.
The lower limb radiculopathy caused by the neural compression can be severe and tends to be felt in the dermatomal area of the compressed nerve. The vast majority of disc prolapses do resolve spontaneously over time and this can generally take between 3 and 12 months. As such, most patients will be able to follow a non-operative course of treatment using analgesia and activity modification. Steroid injections around the nerve may help with pain relief during this time.
For those patients who cannot tolerate the pain despite non-operative measures or those who have a progressive neurological deficit, surgery may be beneficial.
Discectomy via a large incision with no magnification was the historical operative treatment option but, currently, lumbar microdiscectomy is one of the most common spinal procedures performed. Doctors managing spinal patients should be familiar with the management of lumbar disc herniation, the treatment options available, and the principles of a microdiscectomy. A lumbar microdiscectomy generally offers a minimally invasive treatment that can be performed as a day case procedure, and offers around 80-90% chance of good improvement in the neuropathic lower limb pain.
OrthOracle readers will also find the following associated instructional techniques of interest:
Cervical microdiscectomy via posterior foraminotomy
Thoracic discectomy (access by thoracotomy)
Revision Lumbar Microdiscectomy
Lumbar microdiscectomy for cauda equina syndrome
Author: Mr Stephen Morris FRCS (Tr & Orth)
Institution: Dept of Spinal Surgery, Southmead Hospital, Bristol, UK.
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