The lumbar intervertebral disk is made up of a fibrous outer ring called the annulus and a gelatinous inner portion called the nucleus (fig. 1). The disk acts as a cushion between the vertebral bodies. When herniation occurs, the nucleus pushes through the annulus of the disk producing pressure on the nerve root and/or cauda equina. This is demonstrated on the CT scan (fig. 2), the MRI (fig. 3) and the myelogram (fig. 4).

Nearly all patients complain of leg pain (sciatica) in the distribution of one or more nerve roots. Some have back pain as well. Frequently, patients can be treated conservatively with success. However, when their ability to perform normal day to day functions is degraded for a substantial period of time (4-6 weeks), or in the presence of progressing neurological deficit (i.e. foot drop, loss of control of bowel and bladder, cauda equina syndrome), lumbar microdiskectomy is the most effective treatment. During microdiskectomy, the offending disk fragment and much of the loose nucleus are removed through a small, one to two inch incision (figs. 5-8).

The success rate is very high for this procedure and patients are able to return to work and full activity in an average of about 10 weeks. Our group has the most extensive experience in Western New York performing outpatient microdiskectomy. In the past 3 years, we have performed more than 1000 of these procedures successfully. Patients prefer this to overnight stay in the hospital.

Some patients may be candidates for a minmially invasive procedure called Lumbar Percutaneous Diskectomy. For more information on this procedure, click here.