Which lumbar disc herniation patients suitable for surgery? Which is suitable for non-surgical treatment?

Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, China 150001The 1st Hospital of Harbin Medical Affiliate


Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, China 150001

The 1st Hospital of Harbin Medical Affiliated University

Ming Ming MD, Professor

1, surgical indications:

(1) the symptoms are serious, affect the life and work, after the formal non surgical treatment for 6 months invalid; or symptoms are serious, can not accept traction, massage and other non-surgical treatment.

(2) having a wide range of muscle paralysis, sensory impairment, and cauda equina nerve damage (such as saddle area sensation and bowel dysfunction, etc.), with complete or partial paraplegia. This kind of patient is central herniation, or rupture of the annulus and nucleus pulposus fragments into the canal, the formation of the nerve roots and cauda equina compression widely, should be operated as soon as possible. (3) with severe intermittent claudication, and multiple spinal stenosis, or X-ray and CT images showed the stenosis, non operative therapy does not work, are advised to early surgical treatment. (4) with lumbar spondylolysis and spondylolisthesis, appropriate surgical removal of lesions of nucleus pulposus, while on the opposite side of lamina and spinous process of interbody fusion. (5) for the young and middle-aged patients with recurrent attacks, to make them as soon as possible to restore the ability to work, may be appropriate to relax the surgical indications. Minimally invasive surgical methods should be used for the elderly and the infirm.

2, the majority of patients with lumbar disc herniation after formal conservative treatment, can be cured, only about 5% of the patients need surgical treatment, the case of patients should not be treated surgically

(1) the symptoms of lumbar intervertebral disc herniation is lighter, the rest can be improved obviously, although the duration of the disease is a long time, but it has little influence on the life and work. (2) lumbar disc herniation for the first time or multiple episodes, but the pain is not very intense, not conservative treatment. The first attack, in addition to patients with obvious symptoms of cauda equina injury (i.e., lower extremity muscle weakness and even paralysis, sensory disturbance and corresponding numbness, allergies and other sensory abnormalities, urinary incontinence, voiding dysfunction and other symptoms), otherwise inoperable.

(3) systemic or local situation is not suitable for surgical patients, such as age, poor physical condition, or lumbar disc herniation with extensive muscle fasciitis, rheumatism and other symptoms. (4) no clear diagnosis of some patients, such as patients with clinical suspicion of lumbar disc herniation, the symptoms are not typical of myelography or CT, MRI were not found with herniated disc, which can be observed, edge treatment, surgical treatment should not be.

(5) in patients with cardiovascular disease or diabetes, or have contraindications to anesthesia in patients not suitable for surgery. These patients can choose other minimally invasive treatment. Of course, but the above situation is not absolute, should be based on the patient's specific circumstances, under the guidance of the doctor, choose the appropriate treatment.



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