Lumbar Disc Herniation

Lumbar disc herniation (LDH) is a frequent pathology that affects adults around 40 years of age, with genetics playing the most important role in the pathophysiology. A high economic burden is observed in LDH patients, and it is one of the most important causes of absenteeism from work. Diagnosis of LDH is narrowed down based on the concordance of history, clinical examination, and imaging tests. A history of sciatica and a positive straight leg raise test are suggestive of LDH. While radiographs are the first-line imaging technique, MRI is the exam of choice to reach an accurate diagnosis. The natural history of herniated lumbar disks is usually favorable, and most patients will improve independently of the method of treatment. Conservative treatment should be tried for at least 6–12 weeks, and most patients will get better in this period. Conservative management of LDH should include brief bed rest, pharmacological treatment, physical therapy, and epidural injections to offer a slight relief of symptoms. Since the effectiveness of conservative treatment has shown great variations, there is little consensus on which one is the most effective. Surgery is required for patients with cauda equina syndrome and progressive motor deficit and has a relative indication when conservative treatment fails. Microdiscectomy, tubular microdiscectomy, and endoscopic procedures are the surgical treatment of choice and indications may depend upon the surgeon's experience. Complications are rare and the most common are dural tears, infection, and recurrent herniation.