Selected Instructional Course Lecture   |    
Radiculopathy and the Herniated Lumbar DiscControversies Regarding Pathophysiology and Management
John M. Rhee, MD1; Michael Schaufele, MD1; William A. Abdu, MD2
1 Departments of Orthopaedic Surgery (J.M.R. and M.S.) and Physical Medicine and Rehabilitation (M.S.), Emory Spine Center, Emory University School of Medicine, 59 Executive Park South, Suite 3000, Atlanta, GA 30329
2 Spine Center, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756
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The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2007 in Instructional Course Lectures, Volume 56. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).
An Instructional Course Lecture, American Academy of Orthopaedic Surgeons

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Sep 01;88(9):2070-2080
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Lumbar disc herniations remain among the most common diagnoses encountered in clinical spine practice. The incidence of symptomatic lumbar disc herniations in the American population has been estimated to be 1% to 2%1, for which approximately 200,000 lumbar discectomies are performed annually2. Yet despite the frequency with which lumbar disc herniation occurs, there is substantial controversy regarding its pathophysiology and treatment. For example, from the standpoint of basic science, mounting evidence suggests that biochemical factors—in addition to the mechanical effects of the disc material on the nerve root—underlie the development of symptomatic radiculopathy, but those factors remain to be clearly elucidated. On the clinical end of the spectrum, large (five-to-fifteen-fold) variations3 in the rates of lumbar surgery in geographically adjacent areas suggest radical heterogeneity in the application of surgical criteria to this diagnosis. In this lecture, we examine the available basic science regarding the anatomy and pathophysiology of lumbar disc herniations as well as the clinical evidence supporting nonoperative compared with surgical management of this common, yet surprisingly poorly understood, orthopaedic disorder.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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