Lumbar disc herniation (LDH) [Neurosurgerypaedia]

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====== Lumbar disc herniation (LDH) ======

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===== General information =====

[[Lumbar]] [[disc herniation]] (LDH) is a [[degenerative disease]] of the [[lumbar spine]] and a common cause of [[low back]] and [[leg pain]]
((Wang JC, Dailey AT, Mummaneni PV, Ghogawala Z, Resnick DK, Watters WC 3rd, Groff MW, Choudhri TF, Eck JC, Sharan A, Dhall SS, Kaiser MG. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: [[lumbar fusion]] for disc herniation and radiculopathy. J Neurosurg Spine. 2014 Jul;21(1):48-53. doi: 10.3171/2014.4.SPINE14271. PMID: 24980585.))
((Marshall LW, McGill SM. The role of axial torque in disc herniation. Clin Biomech (Bristol, Avon). 2010 Jan;25(1):6-9. doi: 10.1016/j.clinbiomech.2009.09.003. PMID: 19815318.))

==== Key concepts ====

● [[Radiculopathy]]: pain and/or subjective sensory changes ([[numbness]], [[tingling]]...) in the distribution of a nerve root [[dermatome]], possibly accompanied by [[weakness]] and reflex changes of muscles innervated by that [[nerve root]]

● typical [[disc herniation]] → [[radiculopathy]] in the nerve exiting at the level below

● massive [[disc]] herniations can → [[cauda equina syndrome]] (a medical emergency). Typical symptoms:
[[saddle anesthesia]], [[urinary retention]], LE [[weakness]].

● most patients do as well with conservative treatment as with surgery, ∴ initial nonsurgical (conservative) treatment should be attempted for the vast majority

● surgery indications: [[cauda equina syndrome]], progressive symptoms or neurologic deficits despite
conservative treatment, or severe radicular pain > ≈ 6 weeks

===== Definition =====

[[Lumbar disc herniation definition]].

===== History =====

[[Lumbar disc herniation history]].

===== Epidemiology =====

see [[Lumbar disc herniation epidemiology]].

===== Classification =====

see [[Lumbar Disc Herniation Classification]].

===== Etiopathogenesis =====

[[Lumbar disc herniation]] (LDH) occurs owing to the inability of the [[posterior longitudinal ligament]] (PLL) to preserve the [[disc]] material within the [[intervertebral space]]. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH.

Kilitci et al. investigated and compared the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH.


Pathology and neurosurgery departments of a tertiary Healthcare institution. The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material was removed together, and had disc degeneration findings that were radiologically and histologically concordant.

PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histopathological findings.

Sample size: 50.

MRI and histological examinations showed fully degenerated [[black disc]]s (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients, and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades (P=.002).

Longitudinal ligament degeneration can play a significant role in the [[pathogenesis]] of LDH. This study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH
((Kilitci A, Asan Z, Yuceer A, Aykanat O, Durna F. Comparison of the histopathological differences between the spinal material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis. Ann Saudi Med. 2021 Mar-Apr;41(2):115-120. doi: 10.5144/0256-4947.2021.115. Epub 2021 Apr 1. PMID: 33818148.)).

===== Pathophysiology =====
[[Lumbar disc herniation pathophysiology]]

===== Clinical Features =====

see [[Lumbar disc herniation clinical features]].


===== Diagnosis =====

see [[Lumbar disc herniation diagnosis]].

===== Treatment =====

see [[Lumbar disc herniation treatment]].

===== Complications =====

[[Recurrent lumbar disc herniation]].

===== Case series =====

see [[Lumbar disc herniation case series]].

===== Case reports =====

[[Lumbar disc herniation case reports]].

===== Database =====
[[Gender]]

[[Age]]

Smoking status

[[Pfirrmann grading system]] grade

[[Analgesic]] use

Leg [[pain]] duration