21.1 Introduction

Lumbar disc herniation is among the most common etiologies of lower back pain the US population. ¹ It is commonly associated with radicular symptoms, sensory disturbances, weakness in distinct nerve distributions, and lower back pain. The intervertebral disc is composed of an inner nucleus pulposus (type II collagen), an outer annulus fibrosus (type I collagen), and the vertebral endplates. ² The nucleus resists compressive loads; whereas, the annulus, which is composed of inner and outer layers, provides a dense tensile restraint via well-organized lamellae. ² Herniation of the inner nucleus can be the result of direct trauma, degenerative disease, or a combination of both. While most patients will achieve symptomatic relief through conservative measures, discectomy is utilized when these measures fail. ³ Although minimally invasive approaches are commonly utilized, we will describe an open approach for simplicity.