Back to overview – Information

Treatment strategy for lumbar disc herniation

(Dr. H.Hiertz)

A herniated disc in the lumbar spine is a very common condition, with many people affected being asymptomatic and therefore not requiring special treatment. You only have to pay attention to the good structure of the muscles and avoid harmful behavior.

Konträr ist die Situation bei Patienten mit entsprechenden Beschwerden. Bei Schmerzen sollte frühzeitig eine Abklärung mit Röntgen und MRI der LWS durchgeführt werden, um eine exakte Diagnose zu erhalten. Hier ist vor allem darauf zu achten, ob eine Deformität der Wirbelsäule ( Listhese, Skoliose) vorliegt und wie die Weite vom Spinalkanal zur Darstellung kommt. Oft findet man bei einer Wirbelkanaleinengung und/oder Deformität eine Vorwölbung, die klinisch relevante Veränderung liegt aber dann natürlich nicht beim Bandscheibenvorfall sondern bei der Einengung und/oder Deformität.

The first 2 pictures show the normal situation of the intervertebral disc and the spinal canal
The 3rd and 4th pictures show the situation with stenosis with bulging of the intervertebral disc, spondylarthrosis and foramen stenosis


When pressure is applied to the spinal nerve, leg pain occurs (pain according to the affected root
in the leg, sensory motor disorder), pressure on the central caudal fibers can lead to cauda equina syndrome
Paralysis and vegetative disorders (bladder and bowel paralysis, impotence) come.

With severe wear and tear of the vertebral joints, either alone or in combination with leg pain, severe back pain with blockages or pseudoradicular pain in the leg can occur.

It is always important to examine the patient carefully, on the one hand to determine the exact location of the pain, and on the other hand to determine the neurological situation.

Therapy for leg pain without significant back pain

If the neurological condition is normal, immediate pain therapy with NSAIDs up to temporary morphine preparations, periradicular or epidural cortisone infiltration and physiotherapy.

If there is a neurological deficit or if conservative therapy does not improve after about 8-12 weeks, microsurgical disc removal is indicated.

If there is also severe back pain, which is usually the leading symptom, additional restraint should be considered. This can either be carried out dynamically with a good segment height or as a stiffening in the case of severe degeneration.

L3 / 4 disc prolapse – discectomy and dynamic fixation

Stenosis with deformity L 3-5 – decompression and fusion

Back to overview – Information

Dr. Helmut Hiertz