ABSTRACT
OBJECTIVE: Herniated disc tissue removal to decompress the spinal nerve/cauda equina. Minimization of iatrogenic trauma and associated injuries. INDICATIONS: Conservative treatment did not sufficiently improve clinical symptoms. This is true for progressive or persisting neurological deficits, as well as for persisting pain which alters the quality of the patient`s life. Results of surgery are strongly dependent on the preoperative duration of symptoms. Paramount is the "timing" of surgery: poorer surgical results associated with increasing preoperative duration of symptoms. CONTRAINDICATIONS: Conservative treatment modalities have not been exhausted. SURGICAL TECHNIQUES: There are 2 technologies (endoscopic/microsurgical) and 5 different approach strategies (endoscopic: interlaminar, transforaminal; microsurgical: interlaminar, translaminar, extraforaminal), whereby the choice is determined by morphology and location of the herniated disc. All techniques are minimally invasive and lead to comparable clinical results. POSTOPERATIVE MANAGEMENT: For all techniques, patients are mobilized early. Light sports activities allowed after 2 weeks and return to work after about 4 weeks. RESULTS: Good clinical outcomes in meta-analyses/large case series are between 80-95 %.
Subject(s)
Decompression, Surgical/methods , Diskectomy/methods , Endoscopy/methods , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Microsurgery/methods , Spinal Cord Compression/surgery , Combined Modality Therapy/methods , Evidence-Based Medicine , Humans , Intervertebral Disc Displacement/complications , Intervertebral Disc Displacement/diagnosis , Spinal Cord Compression/diagnosis , Spinal Cord Compression/etiology , Treatment OutcomeABSTRACT
Over the last decades, fusion of lumbar spinal motion segments has represented the mainstay of treatment of lumbar degenerative conditions which failed to respond adequately to conservative therapy. Increasing demands and expectations from patients as well as the necessity to avoid fusion related negative side effects such as adjacent level disc degeneration, considerable complication and reoperation rates, cranial facet joint violations, pseudarthrosis and others led to the development of motion preserving technologies such as total lumbar disc replacement (TDR). The first and rudimentary attempts to preserve motion of lumbar motion segments can be dated back to the early 1950s. Over the past two to three decades, a variety of new implants with different motion characteristics have been developed and introduced into the market. Despite of the extensive knowledge which has been gained in this field of research, insurers in the United States have refused to reimburse surgeons due to fear of late complications and reoperations as well as unknown secondary costs, which led to a global decline in the numbers of TDR procedures. The current literature review intends to provide a concise summary of the adequate indications for TDR as well as outcome determining factors and delineate the role of TDR in the currently available armamentarium for the treatment of low back pain (LBP) resulting from degenerative disc disease (DDD) without instabilities or deformities.
