Lumbar disc herniation and radiculopathy: An integrative neurological review of pathophysiology, diagnosis, and evolving management paradigms

Lumbar disc herniation (LDH) is a primary cause of radiculopathy, a prevalent and debilitating neurological condition characterized by nucleus pulposus (NP) extrusion from the intervertebral disc (IVD), leading to the compression of nearby neural structures and causing neuropathic pain and neurological deficits. The pathophysiology of LDH involves progressive IVD degeneration, triggered by the accumulation of mechanical stress, inflammatory processes, and oxidative stress, leading to cellular damage, disc cell apoptosis, and extracellular matrix degradation. Clinically, LDH patients typically present with radicular pain, neurological deficits, and symptoms of sciatica, which may vary in intensity depending on the level and extent of the herniation. Diagnosis relies on clinical correlation and imaging studies, with magnetic resonance imaging as the gold standard. Treatment for a herniated NP depends on the symptoms and severity of nerve compression. Without severe or progressive neurological deficits, first-line treatment includes conservative management. Surgery is indicated when there is significant nerve compression, refractory pain, or progressive neurological deficits. This comprehensive review focuses on LDH, aiming to provide a neurologically oriented appraisal. First, it delves into the pathomechanism of LDH, offering updated insights into the biological and biomechanical processes that lead to disc herniation and subsequent nerve involvement. Second, it examines current diagnostic approaches, including advanced imaging techniques and neurological assessment methods, used to accurately identify and characterize LDH. Finally, it explores the evolving spectrum of management strategies, encompassing conservative treatments and various interventional and surgical options, with a particular emphasis on the neurological outcomes and considerations associated with each approach.