Indications and current treatments
Symptomatic herniation (prolapse) of a lumbar intravertebral disc is a common cause of chronic low back pain and sciatica. Disc herniation is a result of the protrusion of the nucleus pulposus through a tear in the annulus fibrosus. The annulus fibrosus may rupture completely, resulting in an extruded disc, or it may remain intact but stretched, resulting in a contained (bulging) disc prolapse. Protruding discs may compress one or more nerve roots, resulting in pain and numbness in the leg.
Conservative treatment options include rest, analgesic or anti-inflammatory medication, epidural injection and physical therapies. Current surgical treatment options include microdiscectomy, percutaneous intradiscal electrothermal therapy, percutaneous intradiscal radiofrequency thermocoagulation and percutaneous disc decompression using coblation.
Surgical decompression is considered when there is nerve compression causing weakness or persistent symptoms that are unresponsive to conservative treatment.