[Surgical treatment of lumbar disc herniations]

The definitive treatment of lumbar disc herniation with radiculopathy includes interventional spine procedures and surgical treatment (open or micro discectomy). It is indicated in emergency in specific situations: in case of cauda equina syndrome, motor deficit lower or equal to 3/5 or hyperalgic radicular pain resistant to maximal medical therapy, including opioid drugs. In these situations, there is no place for percutaneous treatment techniques; treatment is surgical. Except these emergency situations, a definitive treatment is indicated in case of ineffectiveness of complete medical treatment for at least six weeks. The objective is the treatment of radicular pain; the effect on the associated low back pain is unpredictable. In this context of functional surgery, patient selection is very important. Results of interventional procedures for disc herniation are still poorly documented and should be best carried in the context of evaluation protocols. At present standard treatment remains minimal invasive discectomy.