[Lumbar disc herniation]

The annual prevalence of lumbar disc herniation (LDH) in western industrialized countries averages between 1% and 2.5% but shows a clear age dependency with a peak between the ages of 30 and 50 years. The medical history and physical examination are the most important parts of the examination, with attention being paid to so-called red flags that trigger further imaging. Most LDH can be successfully treated conservatively and tend to regress over time. It is not imaging but clinical symptoms that determine whether surgery is indicated. Patients with severe motor deficits (Medical Research Council, MRC < 2) benefit most from early surgical intervention within the first 48-72 h. Approximately 1-1.5% of patients develop acute conus/cauda symptoms, representing an absolute spinal surgical emergency. After confirmation of the diagnosis, surgical decompression should be performed without delay; decompression after more than 48 h is associated with poorer functional outcomes. Minimally invasive endoscopic discectomy shows identical results to conventional surgical techniques for LDH in terms of pain relief, functional improvement, safety and recurrence rate.