This AAOS Instructional Course Lecture by Rhee, Schaufele, and Abdu examines the pathophysiology and management controversies surrounding lumbar disc herniation and radiculopathy, synthesizing basic science on mechanical and biochemical mechanisms with clinical evidence on nonoperative and surgical treatment options.
When a patient with lumbar radiculopathy has an MRI showing a large herniation, resist the urge to rush to the OR: natural history data and regression studies favor initial conservative management unless there is progressive neurological deficit or cauda equina syndrome.
Before offering discectomy for refractory pain, screen for smoking, depression, compensation status, and low education — these psychosocial variables predict surgical outcome independently of the disc pathology and should drive shared decision-making.
This AAOS Instructional Course Lecture by Rhee, Schaufele, and Abdu examines the pathophysiology and management controversies surrounding lumbar disc herniation and radiculopathy, synthesizing basic science on mechanical and biochemical mechanisms with clinical evidence on nonoperative and surgical treatment options.
When a patient with lumbar radiculopathy has an MRI showing a large herniation, resist the urge to rush to the OR: natural history data and regression studies favor initial conservative management unless there is progressive neurological deficit or cauda equina syndrome.
Before offering discectomy for refractory pain, screen for smoking, depression, compensation status, and low education — these psychosocial variables predict surgical outcome independently of the disc pathology and should drive shared decision-making.