When injection-based treatment for herniated lumbar disc has not delivered sufficient improvement in pain and quality of life, a surgical protocol becomes indicated. This page outlines the escalation pathway.
The prior treatment line consisted of epidural corticosteroid injection therapy — including nerve root block — or intradiscal condoliase (chondroitin sulfate ABC endolyase) administration for radicular pain. That line aims to achieve improvement in pain and quality of life for approximately 3–12 months after administration. When those goals are not reached, escalation to the surgical protocol described here is indicated.
The next indicated step is surgical treatment targeting the herniated disc material. The protocol specifies distinct operative options — differing in the extent of tissue removed — but the full procedure selection criteria, clinical decision algorithm, and perioperative details are contained in the complete protocol.
Surgical treatment for lumbar disc herniation is indicated when conservative treatment administered for a certain period of time brings about no improvements.
Herniotomy is a procedure to remove only the degenerated nucleus pulposus that is herniated.
Discectomy is defined as a procedure involving more invasion than herniotomy, i.e., in addition to the hernia, a part of the intervertebral disc is removed.
DOI: 10.22603/ssrr.2022-0045
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