Lumbar discectomy

Lumbar discectomy is the most common operation performed in the United States for lumbar-related symptoms. Lumbar disc herniation accounts for only 5% of all low back pain problems but is the most common cause of radiating nerve root pain (sciatica).
The natural history of lumbar disc herniation indicates that they may decrease in size or even disappear within a few weeks or months of onset. In migrated or extruded herniations, phagocytosis of the herniated disc by the macrophages occurs, while, in contained herniations, dehydration of the herniated nucleus pulposus plays a major role in the reduction of the herniated disc size.
Approximately 90% of acute sciatica attacks improve with conservative management; thus, the mainstay of treatment for a patient with symptomatic lumbar disc herniation continues to be nonoperative methods, such as treatment with anti-inflammatory medications, physical therapy, and lumbar injection, unless the patient has an acute or progressive neurological deficit.
Indications for lumbar discectomy include altered bladder and bowel function and progressive neurological deficits such as motor weakness or sensory deficit in the lower extremities. Surgery should also be considered in patients with radicular pain that persists after an adequate course of conservative management.