In medicine, a herniated disk is defined as an "intervertebral disk in which the nucleus pulposus has protruded through surrounding fibrocartilage. This occurs most frequently in the lower lumbar region.".
|Bulge||"circumferential symmetric extension of the disk beyond the interspace (around the end plates)"||52%|
|Protrusion||"focal or asymmetric extension of the disk beyond the interspace, with the base against the disk of origin broader than any other dimension of the protrusion"||27%|
|Extrusion||"more extreme extension of the disk beyond the interspace, with the base against the disk of origin narrower than the diameter of the extruding material itself or with no connection between the material and the disk of origin"||1%|
History and physical examination
|Straight leg raise||92% to 80%||28% to 40%|
|Crossed straight leg raise||28%||95%|
Randomized controlled trials address discectomy (diskectomy) versus conservative care. Microdiskectomy (with a microscope or loupe magnification) and open diskectomy are comparable according to a systematic review by the Cochrane Collaboration.
The Spine Patient Outcomes Research Trial (SPORT) of 501 patients receiving an unstated mix of surgical procedures found "patients in both the surgery and the nonoperative treatment groups improved substantially over a 2-year period. Because of the large numbers of patients who crossed over in both directions, conclusions about the superiority or equivalence of the treatments are not warranted based on the intent-to-treat analysis." The costs may be acceptable.
Timing of surgery. Surgical results in a randomized controlled trial are better if surgery occurs within six months of the onset of symptoms; however, "The relative increased benefit of surgery compared with nonoperative treatment was not dependent on the duration of the symptoms."
Regarding quicker surgery at 6 weeks, a subgroup analysis of a previous trial found "Early surgery resulted in a faster recovery of motor deficit accompanying sciatica compared with prolonged conservative treatment but the difference was no longer significant during the final follow-up examination at 1 year."
Microdiskectomy uses unilateral transflaval approach with magnification provided by either a microscope or loupe. Some authors do not consider loupe magnification to be microdiskectomy. The Leiden-The Hague Spine Intervention Prognostic Study of 283 patients found that microdiskectomy led to quicker improvement at one year, with no further changes after two years. The cost of surgery might be acceptable to some patients.
The open diskectomy uses unilateral transflaval approach without magnification.
The presence of a herniated disk (protrusion or extrusion) does not affect the prognosis of low back pain.
- National Library of Medicine. Intervertebral Disk Displacement. Retrieved on 2007-11-13.
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