Surgical management of cervical and lumbosacral radiculopathies: indications and outcomes.

The most common indication for the surgical management of compressive cervical and lumbar radiculopathies is a herniated disc in a patient who has not improved with conservative management. Even though a herniated disk is a common condition, it is paramount that the examining physician considers an extensive differential diagnosis when evaluating radiculopathies, especially in patients with a history of cancer, multiple medical illnesses, secondary gain, or advanced age. This consideration has become even more important as imaging studies have improved, because previously undetected degenerative changes are now clearly visualized on MRI and CT scans. These improved studies, however, do not replace a thorough history and physical examination, because a patient's signs and symptoms may not correlate with the radiographic findings. The authors have presented a series of surgical techniques used to manage cervical and lumbar discectomies to the most recent "minimally invasive" percutaneous techniques. Much debate and controversy surround these more recent techniques. There is no controversy, however, in stating that achieving good outcomes, regardless of technique, is predicated on proper patient selection. Because patient selection is the most important predictor of outcome and because serious complications have been reported with "minimally invasive" percutaneous procedures, the authors continue to advocate the proven traditional surgical approaches until prospective, randomized studies demonstrate a clear benefit to using alternative techniques.