Lumbar disc herniation is a condition in which the annulus fibrosus of the vertebral disc tears, enabling the disc nucleus to extrude through the fibers and potentially compress the nerves around the disc. This condition typically presents with unilateral radicular pain but can cause more severe symptoms, such as severe bilateral sciatica and motor weakness or the disc can even compress the cauda equina causing weakness, saddle anesthesia, and incontinence.1,2 In 2012, there were 111 665 total discharges for lumbar disc displacement surgery, costing the United States over 6 billion in aggregate charges. It is likely that the increase of lumbar disc surgeries in the elderly will increase as the population ages.
Both medical and surgical management are often viable options. The primary rationale for lumbar decompression surgery is to relieve nerve root or cauda equinal irritation or compression due to the herniated disc material. While motor manifestations and cauda equina syndrome are far more likely to be managed surgically, there is more debate regarding the role of surgical treatment options among patients with only radicular pain. Clinical studies have shown health benefits in back and leg pain for those undergoing surgical intervention.3,4 Tosteson et al5 determined that surgery was more costly, yet led to greater quality-adjusted life years, vs nonoperative treatment for patients in their forties with a lumbar disc herniated. However, there is a debate regarding how to manage a herniated lumbar disc in the elderly, particularly when pain is the only presenting symptom.
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