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The abstract of a research paper functions to attract readers and highlight the clinical significance of a research project in a broadly appealing manner. Abstract structure is commonly dictated by the target journal, however, a basic style typically follows the "Introduction, Methods, Results and Discussion" structure of introduction, materials/methods, results, and discussion/conclusion. The abstract itself is commonly the initial accessible portion of a research paper, so writing in an engaging while informative manner is imperative for increasing manuscript views and citations. Overall, an abstract is a to-the-point synopsis of a research project that succinctly describes the entirety of your work., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Bibliometric and visualization analysis., Objective: Lumbar spinal stenosis (LSS) has become a common health problem and the most frequent indication for spinal surgery. This study aimed to illustrate the overall knowledge structure, and development trends of LSS, using a bibliometric analysis and newly developed visualization tools., Materials and Methods: Research data sets were acquired from the Web of Science. The time span was defined as "2000-2019". VOS viewer and Citespace software was provided to analyze the data and generate visualization knowledge maps. Annual trend of publications, distribution, H-index status, co-authorship status and research hotspots were analyzed., Results: A total of 1934 publications met the requirement. The United States published most papers (521, 26.9%), both total citations (17,626) and H-index (61) ranked first of all the countries. The most productive organizations on LSS is Seoul National University (50). Spine (43) published the most papers on LSS. Quality of life, risk factor, disability, double blind trials, and decompression surgery are the research hotspots in the recent years., Conclusion: The number of publications showed an upward trend with a stable rise in recent years. The United States is a country with the highest productivity, not only in quality, but also in quantity. Seoul National University has been the largest contributor in this field. Spine is the best journal related to LSS. Quality of life, risk factor, disability, and decompression surgery are the research hotspots in the recent years. Indeed, this study provides a new insight to the growth and development of LSS. Moreover, it will contribute to the growth of the international frontier of LSS., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: Narrative review., Objective: To compare the various surgical methods of repairing spondylolysis defects in regard to improving pain, restoration of function, radiographic improvement, and complication rate., Summary of Background Data: Spondylolysis is a defect in the pars interarticularis of the vertebral arch, typically in the lumbar vertebra. Treatment can be nonoperative and/or surgical. There are various types of surgical repair including spinal compression, fusion, and direct pars repair., Methods: A comprehensive review of the English literature was performed utilizing Medline, Embase, and Web of Science. Inclusion criteria included papers or abstracts that evaluated the surgical techniques. Exclusion criteria included non-English-language papers or abstracts with inadequate information about outcomes., Results: Postoperative pain levels and patient function were consistently improved, regardless of surgical technique chosen. Positive clinical outcomes after surgery were seen more often in patients under age 20 and those who underwent minimally invasive repairs. Positive radiographic improvements were reported broadly, although some reported higher rates of nonunion with spinal compression. Complication rates were low throughout and minimally invasive techniques reported decreased blood loss and shorter hospital stays., Conclusions: Present surgical options appear largely comparable in terms of their ability to provide meaningful treatment for spondylolysis where conservative treatments have failed or otherwise remain unattempted., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: A systematic literature review and meta-analysis., Objective: The aim of this study is to compare hybrid constructs with traditional fusion-only constructs for the incidence of adjacent segment degeneration (ASDeg) and clinical outcomes in patients with degenerative lumbar diseases., Summary of Background Data: Spinal fusion is a standard surgery for various pathologies of the lumbar spine, which results in changes to the biomechanics of the spine, potentially leading to ASDeg. Although ASDeg can occur slowly as a natural course, early-onset ASDeg is regarded to be related to fusion surgery., Materials and Methods: A systematic search was conducted to identify studies that match the purpose. Included studies were compared using the incidence of ASDeg, Oswestry Disability Index, Visual Analog Score, and perioperative outcomes. We calculated the Peto odds ratio and mean difference (MD) for the continuous variables, respectively. In the hybrid group, subgroup analysis was also performed among devices., Results: Among 10 papers involving 767 patients, 372 patients underwent hybrid fusion and 395 patients underwent fusion-only. ASDeg occurred in 10.2% in the hybrid and 21.5% in the fusion-only group [Peto odds ratio, 0.39; 95% confidence interval (CI), 0.23-0.64]. The MD for Visual Analog Score were 0.45 (95% CI, 0.05-0.85) between 2 groups, which was statistically significant but was too small to have clinical significance. The MD for Oswestry Disability Index was 0.93 (95% CI, -1.016 to 2.872), which was not statistically different between 2 groups. The hybrid is superior for 18 minutes (95% CI, 5.78-30.72) shorter than typical surgery., Conclusions: Hybrid lumbar surgery decreased the incidence of early-onset ASDeg for about 2 years of follow-up. Among the hybrid constructs, the interspinous devices group accomplished favorable results with a lower risk. Adjacent segment disease was not as statistically significant as ASDeg, but adjacent segment disease may show a substantial difference for >2-year follow-up., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Spinal cord stimulator trials are indicated for the treatment of postlaminectomy syndrome with persistent severe back and limb pain which has failed conservative treatment options and where no further surgery is indicated. They are also indicated for refractory complex regional pain syndrome. This article details patient positioning and set up, step-by-step instructions for the procedure and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video, Supplemental Digital Content 1 (http://links.lww.com/CLINSPINE/A121) accompanies this paper., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

In using observational, nonrandomized data, there is often interest in studying the effect of a particular treatment on a specific outcome. However, the imbalance of potential confounding variables between the treatment groups can distort the relationship between treatment and outcome. Propensity score matching is one, increasingly utilized, method to help account for such imbalances, allowing for a more accurate estimation of the influence of treatment on outcome. In this paper, we provide the clinician with an overview of propensity score matching techniques and provide a practical example of how this has been used in clinical research relevant to spine surgery., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Study Design: A retrospective cohort study., Objective: To evaluate the effect of O-arm navigation in percutaneous surgeries for thoracolumbar fracture in comparison to the use of conventional fluoroscopic technique., Summary of Background Data: O-arm navigation is a progressive surgical tool, with extensive research papers reporting its effects. Whereas, there were not many papers describing its accuracy and facet impingement rate when compared with fluoroscopy-guided technique in percutaneous surgeries, especially at varying fracture levels., Materials and Methods: We conducted a retrospective comparative study of 97 consecutive patients of single-level neurological intact thoracolumbar fractures from November 2015 to October 2017 and they were all treated with percutaneous pedicle screw implantation. Screws were classified as 4 grades of perforations and 3 grades of facet joint violation. The association between variables such as anatomic perforation, functional perforation, and facet impingement were investigated by χ test, Fisher exact test or t test. A P-value of <0.05 was considered statistically significant., Results: A total of 573 pedicle screws were implanted and graded. The overall anatomic perforation rate and functional perforation rate were lower in the O-arm group compared with the fluoroscopy group (8.3% vs. 15.0%, P=0.013, 1.1% vs. 4.2%, P=0.024). At fracture level, the rate of grade 2 perforation of the O-arm group was lower than that of the fluoroscopy group (0% vs. 6.1%, P=0.033). Furthermore, the O-arm group obviously reduced the facet impingement rate both at all levels and at fracture levels (P=0.002; 0.02)., Conclusions: In percutaneous pedicle screw placement for neurological intact thoracolumbar fracture, the introduction of O-arm navigation improved accuracy, reduced functional perforations, and minimized serious perforations compared with conventional fluoroscopic technique. It also decreased facet joint violation observably and helped to prevent development of adjacent segment degeneration.

Propensity score matching (PSM) is a commonly used statistical method in orthopedic surgery research that accomplishes the removal of confounding bias from observational cohorts where the benefit of randomization is not possible. An alternative to multiple regression analysis, PSM attempts to reduce the effects of confounders by matching already treated subjects with control subjects who exhibit a similar propensity for treatment based on preexisting covariates that influence treatment selection. It, therefore, establishes a new control group by discarding outlier control subjects. This new control group reduces the unwanted influences of covariates, allowing for proper measurement of the intended variable. An example from orthopedic spine literature is discussed to illustrate how PSM may be applied in practice. PSM is uniquely valuable in its utility and simplicity, but it is limited in that it requires the removal of data and works primarily on binary treatments. In addition to matching, the propensity score can be used for stratification, covariate adjustments, and inverse probability of treatment weighting, but these topics are outside the scope of this paper. Personnel in the orthopedic field would benefit from learning about the function and application of this method given its common use in the orthopedic literature.

Study Design: A bibliometric review of the literature., Object: To analyze and quantify the most frequently cited papers in intervertebral disk research., Summary of Background Data: The number of citations that a paper has received reflects its impact in related research area. In the field of disk research, however, it remains unknown which papers are most cited. By searching related literature databases, we identified the most cited 100 articles that advanced the understanding of the intervertebral disk to provide a historic view of scientific research of the disk., Materials and Methods: Intervertebral disk original research-related publications from January 1, 1900 to December 31, 2017 were retrieved from the Web of Science database. Each retrieved article was analyzed using the Cited Reference Search tool to identify the most cited articles. The number of citations, year of publication, publishing journal, authorship, country of publication, and the knowledge maps of keywords were gathered and generated., Results: The number of citations of the 100 selected articles ranges from 209 to 1269, and they were published from 1953 to 2009. Basic research is the most common type of study (n=60), followed by epidemiological study (n=40). Spine published 57 of the most cited 100 papers. The greatest contribution came from the United States of America (n=41), followed by the United Kingdom (n=18) and Japan (n=9). Frequently appearing keywords classified into 3 clusters: "biological study," "clinical study," and "imageological study." The keyword "degeneration" was mentioned the most, 51 items, and the word "development" was the latest hot spot in the most cited articles., Conclusions: In the field of disk research, some papers were heavily cited more than 100 times, suggesting these studies have substantially contributed to the body of knowledge of the intervertebral disk and findings were widely accepted by related clinicians and scientists.

Study Design: Review of spine surgery literature between 2005 and 2014 to assess the reporting of patient outcomes by determining the variability of use of patient outcomes metrics in the following categories: pain and disability, patient satisfaction, readmission, and depression., Objective: Expose the heterogeneity of outcomes reporting and discuss current initiatives to create more homogenous outcomes databases., Summary of Background Data: There has been a recent focus on the reporting of quality metrics associated with spine surgery outcomes. However, little consensus exists on the optimal metrics that should be used to measure spine surgery outcomes., Materials and Methods: A PubMed search of all spine surgery manuscripts from January 2005 through December 2014 was performed. Linear regression analyses were performed on individual metrics as well as outcomes categories as a fraction of total papers reviewing surgical outcomes., Results: Outcomes reporting has increased significantly between January 1, 2005 and December 31, 2014 [175/2871 (6.1%) vs. 764/5603 (13.6%), respectively; P<0.001; R=98.1%]. For the category of pain and disability reporting, Visual Analog Score demonstrated a statistically significant decrease in use from 2005 through 2014 [56/76 (73.7%) vs. 300/520 (57.7%), respectively; P<0.001], whereas Oswestry Disability Index increased significantly in use [19/76 (25.0%) vs. 182/520 (35.0%), respectively; P<0.001]. For quality of life, EuroQOL-5 Dimensions increased significantly in use between 2005 and 2014 [4/23 (17.4%) vs. 30/87 (34.5%), respectively; P<0.01]. In contrast, use of 36 Item Short Form Survey significantly decreased [19/23 (82.6%) vs. 57/87 (65.5%), respectively; P<0.01]. For depression, only the Zung Depression Scale underwent a significant increase in usage between 2005 and 2014 [0/0 (0%) vs. 7/13 (53.8%), respectively; P<0.01]., Conclusions: Although spine surgery outcome reporting has increased significantly over the past 10 years, there remains considerable heterogeneity in regards to individual outcomes metrics utilized. This heterogeneity makes it difficult to compare outcomes across studies and to accurately extrapolate outcomes to clinical practice.

Study Design: This is a meta-analysis of controlled trials., Objective: To assess the overall condition of adjacent segment of cervical disk arthroplasty (CDA) compared with anterior cervical discectomy and fusion (ACDF)., Summary of Background Data: With the increase in CDA and ACDF, surgeons are taking more attention to adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis). There are more and more meta-analyses comparing the efficacy of CDA with ACDF, however, there are few meta-analyses referring to adjacent segment parameters, and investigators are still unable to arrive at the same conclusion., Methods: Several important databases were searched for controlled trials comparing CDA and ACDF before February 2016 according to PRISMA guidelines. The analysis parameters included follow-up time, operative segments, cervical range of motion (ROM), adjacent segment motion, ASDeg, ASDis and adjacent segment reoperation. The risk of bias scale and Newcastle-Ottawa Scale were used to assess the papers. Subgroup analysis and sensitivity analysis were used to analyze the reason for high heterogeneity., Results: Forty-one controlled trials fulfilled the inclusion criteria, including 36 English papers and 5 Chinese. The average follow-up time of all included patients was 39 months. Compared with ACDF, the rate of adjacent segment reoperation in the CDA group was significantly lower (P<0.01), and the advantage of CDA group increased with the increasing of follow-up time according to subgroup analysis. The rate of ASDeg in CDA was significantly lower than that of ACDF (P<0.01). There was no statistical difference between upper and lower ASDeg using the same surgical method (P>0.05). CDA provided a greater cervical ROM than did ACDF (P<0.01). There was a lower adjacent segment ROM and the rate of ASDis in CDA compared with ACDF (P<0.05)., Conclusions: Compared with ACDF, the advantages of CDA were lower ASDeg, ASDis, adjacent segment reoperation and adjacent segment motion; and higher cervical ROM. However, there was no statistical difference between upper and lower adjacent segment ROM/ASDeg using the same surgery.

Study Design: Systematic review., Objectives: We conducted a systematic review of the literature to answer the following questions regarding the use of steroid therapy in metastatic spinal cord compression (MSCC): 1. In cases of MSCC, what is the effect of steroid administration before definitive radiotherapy or surgery on ambulatory status, bowel and bladder function and survival? 2. What steroid dosing regimens are associated with the best outcomes concerning neurological symptoms and complication prevention in cases of MSCC?, Summary of Background Data: Currently, there is significant variation in the initial bolus dose, daily maintenance dose and duration of treatment when steroids are used as a bridge to definitive therapy for MSCC., Methods: A literature search following PRISMA guidelines was conducted in June 2016, using Medline via Ovid SP, Medline via PubMed, Embase, Biosis Previews and the Cochrane Library. Search terms used in each database varied slightly to optimize results. All generic steroid formulations were included along with spinal cord compression or myelopathy combined with metastatic or malignant tumors. Papers discussing acute traumatic causes of spinal cord compression were excluded, as were papers discussing cord compression from nonmetastatic tumors or epidural lipomatosis. Subjects were limited to adult humans undergoing definitive treatment with radiotherapy or surgery., Results: Of the 309 papers retrieved, 66 full text studies were reviewed and 6 papers were found to address the stated questions., Conclusions: There is a paucity of high quality literature evaluating the use of steroids in MSCC. On the basis of the evidence available an initial 10 mg intravenous bolus of dexamethasone followed by 16 mg PO QD has been associated with fewer complications compared with 100 mg bolus and 96 mg QD. Weaning of steroids should occur rapidly after definitive treatment. Risk of gastric bleeding or perforation can be managed with the routine use of proton-pump inhibitors., Level of Evidence: Level IIIa.

Study Design: A retrospective comparative study., Objective: To compare pedicle subtraction osteotomy (PSO) and iliac fixation (ILF) without osteotomy as methods of correcting lumbar spine deformities due to degenerative sagittal imbalance (DSI) through the evaluation of the changes in spinopelvic alignment., Summary of Background Data: Many papers have reported the surgical results after PSO and ILF for patients with fixed adult deformities. However, little is known about the difference between PSO and ILF corrections of spinopelvic alignment in adults with DSI., Methods: DSI patients who had undergone PSO or ILF with a minimum of 2-year follow-up (FU) were retrospectively studied in PSO (n=30) or ILF (n=25) groups. Lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured as spinal parameters and pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were used as measurements of pelvic parameters. Clinical outcomes were evaluated using a visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores., Results: There were no statistically significant differences between the PSO and ILF groups with regard to age and fused segments, but there were significant differences in operative time and estimated blood loss. Concerning spinal parameters, there were significant increases of LL and TK in PSO group immediate postoperatively (LL: P=0.014, TK: P=0.017) and at the 2-year FU (LL: P=0.021, TK: P=0.022), but no significant difference in SVA was evident between the 2 groups. Within the pelvic parameters, there was a significant increase of SS and decrease of PT in the ILF group immediate postoperatively (SS: P=0.013, PT: P=0.009) and at the 2-year FU (SS: P=0.024, PT: P=0.027), but the PI in both groups was not changed after surgery and there was no significant difference between 2 groups. VAS and ODI were significantly improved after surgery in both groups., Conclusions: The PSO group was better than the ILF group in the correction of the LL and TK, but not with regard to the pelvic parameters. The ILF group was superior in the correction of the pelvic orientation as compared with the PSO group when the PI was constant after surgery. Ultimately, ILF effectively achieves better correction of the pelvic parameters (SS and PT).

Study Design: A retrospective follow-up study and review of images in published papers., Objective: To determine whether true heterotopic ossification (HO) occurs in artificial disk replacement (ADR); to evaluate the incidence of paravertebral ossification (PO) and its influence on ADR., Summary of Background Data: HO is typically defined as the abnormal formation of true bone within extraskeletal soft tissues. However, HO in ADR does not fit this definition precisely, as it originates from vertebral body, making it hard to distinguish radiologically from preexisting osteophytes. In this study, the term used for bone formation around ADR is PO., Methods: First, all images in the published papers were evaluated as to whether the presented PO in ADR fit the classic definition of HO or osteophytes. Second, we studied 37 consecutive patients who underwent ADR and follow-up for minimum 24 months. The preoperative and follow-up incidence of PO and its influence on range of motion were evaluated using x-ray and computed tomography., Results: All 52 images of PO were found adjacent to the disk in 1 segment rather than entire cervical spine. Fifty (96.2%) of the POs were found to originate from the vertebral body rather than in the soft tissue. A total of 31 patients were included in the follow-up study. No significant difference was found in the incidence of PO between the follow-up and preoperation (61.29% vs. 48.39%, P>0.05). The range of motion of the ADR segment in patients with progressed PO (7.44±4.64 degrees) was significantly lower than that of patients with stable PO grade (12.13±4.42 degrees, P<0.01) at last follow-up., Conclusions: A proportion of HO might in fact be the natural development of preoperative osteophytes, which is unrelated to ADR; the remaining HO might be due to changes in biomechanical environment after surgery, which promotes the grade of osteophytes and affects the segment motion.

Study Design: This study was a case series., Objective: The purpose of this paper was to present a case series of fresh stress fractures (spondylolysis) in the lumbar spines of adult athletes., Summary of Background Data: Lumbar spondylolysis is a stress fracture of the pars interarticularis, which is generally considered a disease of children or adolescence. There is only 1 case series written in English reporting on adult-onset fresh spondylolysis., Methods: Eleven patients aged 20-27 years are included in this case series. A retrospective analysis was made of events that may cause stress fracture such as traumatic episodes or sports activities, spinal level, radiologic findings, stage of spondylolysis, treatment, and prognosis., Results: Among the 11 patients, two had bilateral early-stage spondylolysis, 7 had unilateral early-stage spondylolysis and 2 had unilateral progressive-stage spondylolysis. Three occurred subsequent to a preexisting terminal-stage spondylolysis in the contralateral side, 1 occurred subsequent to a terminal-stage spondylolysis at the adjacent spinal level, and 1 occurred subsequent to a terminal-stage spondylolysis at a distant level. Thirteen pedicles adjacent to the pars interarticularis in the 11 patients showed bone marrow edema-like signal on magnetic resonance imaging. Six spondylolyses were found at L5, 2 each at L3 and L4, and 1 spondylolysis at L2. The 11 patients were divided into 4 groups according to suspected pathogenic mechanism: preexistent spondylolysis in the contralateral side, alteration of the athletic event, apparent traumatic episode, and others. Conservative treatment was prescribed for return to sports in all cases. Although 1 patient retired because of persistent low back pain, the remaining 10 patients returned to competition., Conclusions: Although lumbar spondylolysis is generally recognized to occur in childhood or adolescence, fresh lumbar spondylolysis should be included in the differential diagnosis of adult low back pain when patients are high-level athletes. Conservative treatment should be attempted for adult patients.

Study Design: A study using intraoperative sonography (IOS) was conducted for evaluating neural mobility in anterior cervical decompression surgery., Objectives: To analyze decompression status and mobility of the spinal cord and the nerve root during anterior cervical decompression and to clarify its relevance to the postoperative neurological recovery., Summary of Background Data: Several papers introduced the usefulness of IOS assessments; however, there have been no reports systematically evaluating the neural mobility in anterior cervical decompression surgery., Methods: Eighty-four consecutive patients with compressive myelopathy who underwent anterior cervical decompression procedures were studied. The decompression status of the spinal cord was evaluated with IOS and classified into 3 grades according to the restoration pattern of the space ventral to the cord. Pulsatile motion of the spinal cord in cranio-caudal direction was named "sliding pulsation" and graded into 3 groups. The nerve root pulsation was also assessed using the IOS short-axis views. This study analyzed whether those neural mobility in anterior cervical decompression surgery had relevance to postoperative neurological recovery, which was assessed by the Japan Orthopaedic Association score., Results: The mean recovery rate of the Japan Orthopaedic Association score was 59.1% in total. According to the decompression status in IOS, 67 patients who acquired space ventral to the spinal cord indicated 64.3% of the recovery rate which was significantly higher than 36.6% of the other patients on an average. As to the sliding pulsation of the cord, 10 patients who failed to show this particular motion indicated significantly lower recovery rate as 36.9%. In addition, 6 patients who did not exhibit nerve root pulsation indicated just 29.3% of recovery rate, and 4 of them failed to show the cord sliding motion., Conclusions: Sonographic evaluation during anterior cervical decompression surgery provided very useful information of neural decompression status that had significant correlation with postoperative neurological recovery.

Study Design: Prospective study., Objective: To investigate the efficacy of transcranial electrically stimulated muscle-evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity palsy following cervical laminoplasty., Summary of Background Data: Postoperative segmental upper extremity palsy, especially in the deltoid and biceps (so-called C5 palsy), is the most common complication following cervical laminoplasty. Some papers have reported that postoperative C5 palsy cannot be predicted by TcE-MsEPs, although others have reported that it can be predicted., Methods: This study included 160 consecutive cases that underwent open-door laminoplasty, and TcE-MsEP monitoring was performed in the biceps brachii, triceps brachii, abductor digiti minimi, tibialis anterior, and abductor hallucis. A >50% decrease in the wave amplitude was defined as an alarm point. According to the monitoring alarm, interventions were performed, which include steroid administration, foraminotomies, etc., Results: Postoperative deltoid and biceps palsy occurred in 5 cases. Among the 155 cases without segmental upper extremity palsy, there were no monitoring alarms. Among the 5 deltoid and biceps palsy cases, 3 had significant wave amplitude decreases in the biceps during surgery, and palsy occurred when the patients awoke from anesthesia (acute type). In the other 2 cases in which the palsy occurred 2 days after the operation (delayed type), there were no significant wave decreases. In all of the cases, the palsy was completely resolved within 6 months., Discussion: The majority of C5 palsies have been reported to occur several days after surgery, but some of them have been reported to occur immediately after surgery. Our results demonstrated that TcE-MsEPs can predict the acute type, whereas the delayed type cannot be predicted., Conclusions: A >50% wave amplitude decrease in the biceps is useful to predict acute-type segmental upper extremity palsy. Further examination about the interventions for monitoring alarm will be essential for preventing palsy.

Lumbar disk herniations occur frequently and are often associated with leg pain, weakness, and paresthesias. Fortunately, the natural outcomes of radiculopathy due to a disk herniation are generally favorable, and the vast majority of patients improve with nonoperative care. Surgical intervention is reserved for patients who have significant pain that is refractory to at least 6 weeks of conservative care, patients who have a severe or progressive motor deficit, or patients who have any symptoms of bowel or bladder dysfunction. This paper reviews the preoperative and postoperative considerations, as well as the surgical technique, for a microdiscectomy for a lumbar intervertebral disk herniation.