Lumbar Herniated Nucleus Pulposus

  • Philip K. Louie
  • Gregory D. LopezEmail author


This chapter will discuss the pathophysiology, exam, diagnosis, and management of lumbar disc herniation (LDH). In brief, LDH is a common pathology that affects a significant percentage of the population. The natural history of LDH is favorable, and excellent results have been obtained following conservative management. Anti-inflammatory medications, physical therapy, and epidural steroid injections make up the mainstay of nonoperative treatment. However, large-scale SPORT suggests 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. The 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, demonstrating that both techniques are equally effective at relieving pain and have comparable reherniation rates. Overall complication rates are similar between open and minimally invasive approaches; however, the number of incidental durotomies is higher with minimally invasive approaches, likely reflective of the learning curve. 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.


Lumbar herniated disc Herniated nucleus pulposus Tubular retractor system Mini-open technique Microdiscectomy 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA

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