The document discusses the management of lumbar disc herniation with free fragments. It states that over 50% reduction in fragment size on follow-up MRI is clinically significant, and larger fragments have better chances of reduction and clinical outcome with conservative treatment. Conservative treatment is the initial protocol, including bed rest and avoidance of sitting and traction. Surgery may be considered if conservative treatment fails or neurological deficits increase.

1. Lumbar disc herniation Management of free fragments Part 2 Vinod Naneria Consultant orthopaedic surgeon Choithram Hospital & Research Centre Indore, India

3. Fragment extruded between S1 root & card - Conservative Tx Case report Mrs. W. Before & after 6 months

4. Before & after 6 months > 50% reduction in size

7. Case summary – Delayed reporting Backache sciatica Lt 3 months Had localized pain around knee joint

10. Case report – Operated for severe unbearable pain after 3 weeks of adequate treatment Fragment had transfixed S1 root - Surgery

11. Migration two level down rupture of dura – deteriorated on conservative treatment. Operated fragments removed transdurally

13. Central “Roof Disc Extrusion” Operated for developing bladder symptom

14. Fragment mainly of end-plate

22. Sitting posture increases intra-discal pressure

25. Fragment mainly of end-plate

33. Radiculopathy and the Herniated Lumbar Disc. Controversies Regarding Pathophysiology and Management J. Bone Joint Surg. Am. John M. Rhee, Michael Schaufele and William A. Abdu, 88:2070-2080, 2006. This information is current as of January 21, 2007

36. Think over it ??? ? Conservative Thank U