LAUSR

Lumbar disc herniation is one of the most common pathologies in the lumbar spine. The vast majority of cases can be treated conservatively. Surgery is indicated in cases where patients report excruciating pain to an extent that prohibits a conservative strategy, in cases with deteriorating neurological deficits or signs of conus/cauda compression syndrome. A variety of studies demonstrated superiority of surgically treated patients over non-surgical management of sciatica resulting from lumbar disc herniation, with a more complete relief of leg pain and improved function and satisfaction when compared with non-surgically treated patients, with observational periods exceeding 10 years of follow-up [1, 2]. To date, microsurgical techniques represent the ‘gold standard’ treatment option to address these kinds of pathologies in the lumbar spine. Microsurgical techniques served to significantly reduce the invasiveness in comparison to open techniques in the 1980s to 1990s. Hence, the advent of full endoscopic techniques managed to achieve a significant further reduction in the surgical invasiveness, which is beneficial for both young and athletic as well as elderly and multimorbid patients alike. Obese patients in particular experience significant benefits from these type of endoscopic techniques, which, as opposed to open or microsurgical techniques, may be performed through the same 6–7 mm incisions. The small skin incision, constant flow with sterile saline solution as well as the avoidance of retractor systems may explain the fact that wound healing problems or infection rates are minimal. However, a considerable and lengthy learning curve, which is required in order to fully acquire the surgical skills, has previously been reported and is considered one of the drawbacks of the technique [3, 4]. Whilst a large number of previous studies have reported beneficial results with the endoscopic technique, further studies are required in order to establish the true benefit in comparison to the ‘gold standard’ microsurgical techniques [5–7].