• 95% involve L4/5 or L5/S1 levels

• Only ~5% become symptomatic

• 3:1 male:female ratio

• Pathoanatomy: recurrent torsional strain leads to tears of outer annulus   which leads to herniation of nucleus pulposis

• Anatomic classification

  • protrusion: eccentric bulging with an intact annulus

  • extrusion: disc material herniates through annulus but remains continuous with disc space

  • sequestered fragment (free): disc material herniates through annulus and is no longer continuous with disc space

Imaging:

• Always have Xrays

• MRI (non injected). MRI with gadolinium is only useful for revision surgery (allows to distinguish between post-surgical fibrosus (enhances with gadolinium) vs. recurrent herniated disc (does not enhance with gadolinium)

Treatment

• rest and physical therapy, and antiinflammatory medications

• selective nerve root corticosteroid injections

• laminotomy and discectomy

Complications

• dural Tear

• discitis

• recurrence

• vascular