Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California;
J Neurosurg Spine. 2014 Jul;21(1):48-53. doi: 10.3171/2014.4.SPINE14271.
Patients suffering from a lumbar herniated disc will typically present with signs and symptoms consistent with radiculopathy. They may also have low-back pain, however, and the source of this pain is less certain, as it may be from the degenerative process that led to the herniation. The surgical alternative of choice remains a lumbar discectomy, but fusions have been performed for both primary and recurrent disc herniations. In the original guidelines, the inclusion of a fusion for routine discectomies was not recommended. This recommendation continues to be supported by more recent evidence. Based on low-level evidence, the incorporation of a lumbar fusion may be considered an option when a herniation is associated with evidence of spinal instability, chronic low-back pain, and/or severe degenerative changes, or if the patient participates in heavy manual labor. For recurrent disc herniations, there is low-level evidence to support the inclusion of lumbar fusion for patients with evidence of instability or chronic low-back pain.
患有腰椎间盘突出症的患者通常会出现与神经根病一致的体征和症状。他们也可能有腰痛，但腰痛的来源不太确定，因为它可能是导致椎间盘突出的退行性过程引起的。选择的手术方法仍然是腰椎间盘切除术，但融合术已用于原发性和复发性椎间盘突出症。在原始指南中，不建议将融合术纳入常规椎间盘切除术。这一建议仍然得到了最近证据的支持。基于低水平证据，如果椎间盘突出与脊柱不稳定、慢性腰痛和/或严重退行性改变有关，或者患者从事重体力劳动，融合术的应用可以被视为一种选择。对于复发性椎间盘突出症，有低水平证据支持对有不稳定或慢性腰痛证据的患者进行腰椎融合术。
