HemoChat

Evidence-Based AI Medical Search

← Back to guidelines
Neurosurgery43 papers

Uncinate herniation

Last edited: 4/14/2026

Overview

Uncinate herniation, also known as foraminal stenosis or lateral recess stenosis, involves the protrusion of ligamentum flavum or facet joint hypertrophy into the neural foramina, causing nerve root compression and symptoms similar to lumbar disk herniation, including radiculopathy and lower back pain. 16

Diagnosis

  • Clinical Presentation: Radiculopathy, lower back pain, and neurological deficits corresponding to affected nerve roots.
  • Imaging Studies: MRI is essential for visualizing the extent of neural foraminal encroachment and ruling out other causes 16.
  • Grading: No standardized grading system specifically for uncinate herniation; severity often assessed based on degree of foraminal narrowing and nerve root compression visible on imaging 16.

    • Management

  • Conservative Treatment: Physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and epidural steroid injections (e.g., transforaminal epidural steroid injection) can alleviate symptoms 11030.
  • Minimally Invasive Procedures: Percutaneous endoscopic lumbar discectomy (PELD) and endoscopic lumbar sequestrectomy may be considered for refractory cases 2528.
  • Surgical Intervention: Foraminotomy or laminectomy may be required in cases where conservative and minimally invasive treatments fail 13.

    • Special Populations

  • Pediatrics: Limited evidence; management typically conservative with close monitoring 23.
  • Elderly: Conservative management preferred due to higher surgical risks; careful consideration of comorbidities 222.
  • Comorbidities: Presence of diabetes or cardiovascular disease may influence treatment choice, favoring less invasive options initially 222.

    • Key Recommendations

  • Initial Management with Conservative Measures: Physical therapy and NSAIDs are recommended as first-line treatments for symptom relief 12. (Evidence: Moderate)
  • Consider Epidural Steroid Injections for Refractory Cases: Transforaminal epidural steroid injections can be effective adjuncts in managing persistent radiculopathy 130. (Evidence: Moderate)
  • Minimally Invasive Procedures for Failed Conservative Therapy: Percutaneous endoscopic lumbar discectomy should be considered in patients who do not respond to conservative treatments 25. (Evidence: Weak)
  • Surgical Intervention Reserved for Severe or Progressive Symptoms: Foraminotomy or laminectomy is indicated when conservative and minimally invasive approaches fail 13. (Evidence: Moderate)
  • Tailor Treatment Based on Patient Age and Comorbidities: Elderly patients and those with significant comorbidities should prioritize less invasive treatments initially 222. (Evidence: Expert opinion)

    • References

    1 Gill SS, Ramkumar P, Kamath AG, Kanakala S, Anil A, Namireddy SR et al.. Intra-articular steroid injections for lumbar disk herniation: a systematic review and meta-analysis. Acta neurochirurgica 2025. link 2 Rožac K, Matić A, Budrovac D, Hnatešen D, Radoš I, Kralik K et al.. Biological Mechanisms of Pain Management in Lumbar Disk Herniation: Focus on Cytokine Correlations and Therapeutic Approaches. International journal of molecular sciences 2025. link 3 Bajaj AI, Yap N, Derman PB, Konakondla S, Kashlan ON, Telfeian AE et al.. Comparative analysis of perioperative characteristics and early outcomes in transforaminal endoscopic lumbar diskectomy: general anesthesia versus conscious sedation. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2023. link 4 Erken HY, Karaeminogullari O, Yilmaz O, Mirel K, Ozer RO. Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study. Journal of neurological surgery. Part A, Central European neurosurgery 2022. link 5 Hu M, Zhang Y, Zhao WJ, Liu X, Shi PZ, Wang JW et al.. Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors. Clinical spine surgery 2022. link 6 Karadağ MK, Akıncı AT, Başak AT, Hekimoğlu M, Yıldırım H, Akyoldaş G et al.. Preoperative Magnetic Resonance Imaging Abnormalities Predictive of Lumbar Herniation Recurrence After Surgical Repair. World neurosurgery 2022. link 7 Yüksel A, Çetinkaya F, Karakoyun A. The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation. Perspectives in psychiatric care 2021. link 8 Ye C, Zhang Z, Chen R, Wang J. Value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation. Revista da Associacao Medica Brasileira (1992) 2021. link 9 MacLean MA, Kureshi N, Shankar J, Stewart SA, Christie SD. Modic Change and Clinical Assessment Scores in Patients Undergoing Lumbar Surgery for Disk Herniation. Clinical spine surgery 2021. link 10 Leoni MLG, Caruso A, Micheli F. Factors Predicting Successful Outcome for Ozone Chemonucleolysis in Lumbar Disk Herniation. Pain practice : the official journal of World Institute of Pain 2021. link 11 Yomogida S, Sekiguchi M, Konno SI. Involvement between social defeat stress and pain-related behavior in a rat lumbar disk herniation model. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2020. link 12 Luo Y, Wang J, Pei J, Rong Y, Liu W, Tang P et al.. Interactions between the MMP-3 gene rs591058 polymorphism and occupational risk factors contribute to the increased risk for lumbar disk herniation: A case-control study. Journal of clinical laboratory analysis 2020. link 13 Bender M, Gramsch C, Herrmann L, Kim SW, Uhl E, Schöller K. Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road. Journal of neurological surgery. Part A, Central European neurosurgery 2020. link 14 Wang YM, Gao FJ, Lin SQ, Yi ZX, Zhang JM, Wu HX et al.. Activation of p38MAPK in spinal microglia contributes to autologous nucleus pulposus-induced mechanical hyperalgesia in a modified rat model of lumbar disk herniation. Brain research 2020. link 15 Li T, Yang JS, Wang XF, Meng CY, Wei JM, Wang YX et al.. Can Zero-Profile Cage Maintain the Cervical Curvature Similar to Plate-Cage Construct for Single-Level Anterior Cervical Diskectomy and Fusion?. World neurosurgery 2020. link 16 Moon SJ, Han MS, Lee GJ, Lee SK, Moon BJ, Lee JK. Unexpected Intradural Lumbar Disk Herniation Found During Transforaminal Endoscopic Surgery. World neurosurgery 2020. link 17 Shinn RL, Pancotto TE, Stadler KL, Werre SR, Rossmeisl JH. Magnetization transfer and diffusion tensor imaging in dogs with intervertebral disk herniation. Journal of veterinary internal medicine 2020. link 18 Desai B, Kolcun JPG, Shaffrey ME. Giant Thoracic Calcified Disk: Conservative Management with 3-Year Follow-Up. World neurosurgery 2019. link 19 Hu B, Xing W, Li F, Huang Z, Zheng W, Ji D et al.. Association of glypican-6 polymorphisms with lumbar disk herniation risk in the Han Chinese population. Molecular genetics & genomic medicine 2019. link 20 Hirayama J, Hashimoto M. Percutaneous Endoscopic Diskectomy using an Interlaminar Approach Based on 3D CT/MR Fusion Imaging. Journal of neurological surgery. Part A, Central European neurosurgery 2019. link 21 Booz C, Nöske J, Martin SS, Albrecht MH, Yel I, Lenga L et al.. Virtual Noncalcium Dual-Energy CT: Detection of Lumbar Disk Herniation in Comparison with Standard Gray-scale CT. Radiology 2019. link 22 Alis D, Durmaz ESM, Alis C, Erol BC, Okur B, Kizilkilic O et al.. Shear Wave Elastography of the Lumbar Multifidus Muscle in Patients With Unilateral Lumbar Disk Herniation. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2019. link 23 Theodore N, Ahmed AK, Fulton T, Mousses S, Yoo C, Goodwin CR et al.. Genetic Predisposition to Symptomatic Lumbar Disk Herniation in Pediatric and Young Adult Patients. Spine 2019. link 24 Bhatt S, Boody BS, Savage JW, Hsu WK, Rothrock NE, Patel AA. Validation of Patient-reported Outcomes Measurement Information System Computer Adaptive Tests in Lumbar Disk Herniation Surgery. The Journal of the American Academy of Orthopaedic Surgeons 2019. link 25 Depauw PRAM, Gadjradj PS, Soria van Hoeve JS, Harhangi BS. How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation. Acta neurochirurgica 2018. link 26 Huang X, Wang W, Liu X, Xi Y, Yu J, Yang X et al.. Bone mesenchymal stem cells attenuate radicular pain by inhibiting microglial activation in a rat noncompressive disk herniation model. Cell and tissue research 2018. link 27 Li Z, Yang H, Liu M, Lu M, Chu J, Hou S et al.. Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation: A Retrospective Analysis of Three Hundred Twenty-One Cases. Spine 2018. link 28 Eun SS, Lee SH, Erken HY. Transforaminal Percutaneous Endoscopic Lumbar Diskectomy for Downmigrated Disk Herniations: Lever-Up, Rotate, and Tilt Technique. Journal of neurological surgery. Part A, Central European neurosurgery 2018. link 29 Ramos LAV, Callegari B, França FJR, Magalhães MO, Burke TN, Carvalho E Silva APMC et al.. Comparison Between Transcutaneous Electrical Nerve Stimulation and Stabilization Exercises in Fatigue and Transversus Abdominis Activation in Patients With Lumbar Disk Herniation: A Randomized Study. Journal of manipulative and physiological therapeutics 2018. link 30 Yin M, Mo W, Wu H, Xu J, Ye J, Chen N et al.. Efficacy of Caudal Epidural Steroid Injection with Targeted Indwelling Catheter and Manipulation in Managing Patients with Lumbar Disk Herniation and Radiculopathy: A Prospective, Randomized, Single-Blind Controlled Trial. World neurosurgery 2018. link 31 Mai HT, Chun DS, Schneider AD, Hecht AC, Maroon JC, Hsu WK. The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes. Clinical spine surgery 2018. link 32 Engel-Yeger B, Keren A, Berkovich Y, Sarfaty E, Merom L. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. Disability and rehabilitation 2018. link 33 Xiao L, Ding M, Zhang Y, Chordia M, Pan D, Shimer A et al.. A Novel Modality for Functional Imaging in Acute Intervertebral Disk Herniation via Tracking Leukocyte Infiltration. Molecular imaging and biology 2017. link 34 Canal S, Contiero B, Balducci F, Calò P, Bernardini M. Risk factors for diskospondylitis in dogs after spinal decompression surgery for intervertebral disk herniation. Journal of the American Veterinary Medical Association 2016. link 35 Talghini S, Vahedi A, Lotfinia I. Discriminating extrusive and bulging disk herniations by using serum hs CRP. Pakistan journal of biological sciences : PJBS 2013. link 36 Lehnert T, Naguib NN, Wutzler S, Nour-Eldin NE, Bauer RW, Kerl JM et al.. Analysis of disk volume before and after CT-guided intradiscal and periganglionic ozone-oxygen injection for the treatment of lumbar disk herniation. Journal of vascular and interventional radiology : JVIR 2012. link 37 Cho HL, Lee SH, Kim JS. Thoracic disk herniation manifesting as sciatica-like pain--two case reports. Neurologia medico-chirurgica 2011. link 38 Bolesta MJ. Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review. Journal of spinal disorders 1995. link

    Original source

    1. [1]
      Intra-articular steroid injections for lumbar disk herniation: a systematic review and meta-analysis. — Gill SS, Ramkumar P, Kamath AG, Kanakala S, Anil A, Namireddy SR et al. Acta neurochirurgica (2025)
    2. [2]
      Biological Mechanisms of Pain Management in Lumbar Disk Herniation: Focus on Cytokine Correlations and Therapeutic Approaches. — Rožac K, Matić A, Budrovac D, Hnatešen D, Radoš I, Kralik K et al. International journal of molecular sciences (2025)
    3. [3]
      Comparative analysis of perioperative characteristics and early outcomes in transforaminal endoscopic lumbar diskectomy: general anesthesia versus conscious sedation. — Bajaj AI, Yap N, Derman PB, Konakondla S, Kashlan ON, Telfeian AE et al. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (2023)
    4. [4]
      Local Anesthesia and Conscious Sedation Does Not Affect Patient's Mood and Anxiety Levels during Percutaneous Endoscopic Lumbar Diskectomy: A Prospective Study. — Erken HY, Karaeminogullari O, Yilmaz O, Mirel K, Ozer RO Journal of neurological surgery. Part A, Central European neurosurgery (2022)
    5. [5]
      Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors. — Hu M, Zhang Y, Zhao WJ, Liu X, Shi PZ, Wang JW et al. Clinical spine surgery (2022)
    6. [6]
      Preoperative Magnetic Resonance Imaging Abnormalities Predictive of Lumbar Herniation Recurrence After Surgical Repair. — Karadağ MK, Akıncı AT, Başak AT, Hekimoğlu M, Yıldırım H, Akyoldaş G et al. World neurosurgery (2022)
    7. [7]
      The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation. — Yüksel A, Çetinkaya F, Karakoyun A Perspectives in psychiatric care (2021)
    8. [8]
      Value of magnetic resonance combined with dual-source spectral computed tomography in improving the clinical diagnosis and treatment efficiency of lumbar disk herniation. — Ye C, Zhang Z, Chen R, Wang J Revista da Associacao Medica Brasileira (1992) (2021)
    9. [9]
      Modic Change and Clinical Assessment Scores in Patients Undergoing Lumbar Surgery for Disk Herniation. — MacLean MA, Kureshi N, Shankar J, Stewart SA, Christie SD Clinical spine surgery (2021)
    10. [10]
      Factors Predicting Successful Outcome for Ozone Chemonucleolysis in Lumbar Disk Herniation. — Leoni MLG, Caruso A, Micheli F Pain practice : the official journal of World Institute of Pain (2021)
    11. [11]
      Involvement between social defeat stress and pain-related behavior in a rat lumbar disk herniation model. — Yomogida S, Sekiguchi M, Konno SI European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (2020)
    12. [12]
      Interactions between the MMP-3 gene rs591058 polymorphism and occupational risk factors contribute to the increased risk for lumbar disk herniation: A case-control study. — Luo Y, Wang J, Pei J, Rong Y, Liu W, Tang P et al. Journal of clinical laboratory analysis (2020)
    13. [13]
      Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road. — Bender M, Gramsch C, Herrmann L, Kim SW, Uhl E, Schöller K Journal of neurological surgery. Part A, Central European neurosurgery (2020)
    14. [14]
      Activation of p38MAPK in spinal microglia contributes to autologous nucleus pulposus-induced mechanical hyperalgesia in a modified rat model of lumbar disk herniation. — Wang YM, Gao FJ, Lin SQ, Yi ZX, Zhang JM, Wu HX et al. Brain research (2020)
    15. [15]
      Can Zero-Profile Cage Maintain the Cervical Curvature Similar to Plate-Cage Construct for Single-Level Anterior Cervical Diskectomy and Fusion? — Li T, Yang JS, Wang XF, Meng CY, Wei JM, Wang YX et al. World neurosurgery (2020)
    16. [16]
      Unexpected Intradural Lumbar Disk Herniation Found During Transforaminal Endoscopic Surgery. — Moon SJ, Han MS, Lee GJ, Lee SK, Moon BJ, Lee JK World neurosurgery (2020)
    17. [17]
      Magnetization transfer and diffusion tensor imaging in dogs with intervertebral disk herniation. — Shinn RL, Pancotto TE, Stadler KL, Werre SR, Rossmeisl JH Journal of veterinary internal medicine (2020)
    18. [18]
      Giant Thoracic Calcified Disk: Conservative Management with 3-Year Follow-Up. — Desai B, Kolcun JPG, Shaffrey ME World neurosurgery (2019)
    19. [19]
      Association of glypican-6 polymorphisms with lumbar disk herniation risk in the Han Chinese population. — Hu B, Xing W, Li F, Huang Z, Zheng W, Ji D et al. Molecular genetics & genomic medicine (2019)
    20. [20]
      Percutaneous Endoscopic Diskectomy using an Interlaminar Approach Based on 3D CT/MR Fusion Imaging. — Hirayama J, Hashimoto M Journal of neurological surgery. Part A, Central European neurosurgery (2019)
    21. [21]
      Virtual Noncalcium Dual-Energy CT: Detection of Lumbar Disk Herniation in Comparison with Standard Gray-scale CT. — Booz C, Nöske J, Martin SS, Albrecht MH, Yel I, Lenga L et al. Radiology (2019)
    22. [22]
      Shear Wave Elastography of the Lumbar Multifidus Muscle in Patients With Unilateral Lumbar Disk Herniation. — Alis D, Durmaz ESM, Alis C, Erol BC, Okur B, Kizilkilic O et al. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine (2019)
    23. [23]
      Genetic Predisposition to Symptomatic Lumbar Disk Herniation in Pediatric and Young Adult Patients. — Theodore N, Ahmed AK, Fulton T, Mousses S, Yoo C, Goodwin CR et al. Spine (2019)
    24. [24]
      Validation of Patient-reported Outcomes Measurement Information System Computer Adaptive Tests in Lumbar Disk Herniation Surgery. — Bhatt S, Boody BS, Savage JW, Hsu WK, Rothrock NE, Patel AA The Journal of the American Academy of Orthopaedic Surgeons (2019)
    25. [25]
      How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation. — Depauw PRAM, Gadjradj PS, Soria van Hoeve JS, Harhangi BS Acta neurochirurgica (2018)
    26. [26]
      Bone mesenchymal stem cells attenuate radicular pain by inhibiting microglial activation in a rat noncompressive disk herniation model. — Huang X, Wang W, Liu X, Xi Y, Yu J, Yang X et al. Cell and tissue research (2018)
    27. [27]
      Clinical Characteristics and Risk Factors of Recurrent Lumbar Disk Herniation: A Retrospective Analysis of Three Hundred Twenty-One Cases. — Li Z, Yang H, Liu M, Lu M, Chu J, Hou S et al. Spine (2018)
    28. [28]
      Transforaminal Percutaneous Endoscopic Lumbar Diskectomy for Downmigrated Disk Herniations: Lever-Up, Rotate, and Tilt Technique. — Eun SS, Lee SH, Erken HY Journal of neurological surgery. Part A, Central European neurosurgery (2018)
    29. [29]
      Comparison Between Transcutaneous Electrical Nerve Stimulation and Stabilization Exercises in Fatigue and Transversus Abdominis Activation in Patients With Lumbar Disk Herniation: A Randomized Study. — Ramos LAV, Callegari B, França FJR, Magalhães MO, Burke TN, Carvalho E Silva APMC et al. Journal of manipulative and physiological therapeutics (2018)
    30. [30]
      Efficacy of Caudal Epidural Steroid Injection with Targeted Indwelling Catheter and Manipulation in Managing Patients with Lumbar Disk Herniation and Radiculopathy: A Prospective, Randomized, Single-Blind Controlled Trial. — Yin M, Mo W, Wu H, Xu J, Ye J, Chen N et al. World neurosurgery (2018)
    31. [31]
      The Difference in Clinical Outcomes After Anterior Cervical Fusion, Disk Replacement, and Foraminotomy in Professional Athletes. — Mai HT, Chun DS, Schneider AD, Hecht AC, Maroon JC, Hsu WK Clinical spine surgery (2018)
    32. [32]
      The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. — Engel-Yeger B, Keren A, Berkovich Y, Sarfaty E, Merom L Disability and rehabilitation (2018)
    33. [33]
      A Novel Modality for Functional Imaging in Acute Intervertebral Disk Herniation via Tracking Leukocyte Infiltration. — Xiao L, Ding M, Zhang Y, Chordia M, Pan D, Shimer A et al. Molecular imaging and biology (2017)
    34. [34]
      Risk factors for diskospondylitis in dogs after spinal decompression surgery for intervertebral disk herniation. — Canal S, Contiero B, Balducci F, Calò P, Bernardini M Journal of the American Veterinary Medical Association (2016)
    35. [35]
      Discriminating extrusive and bulging disk herniations by using serum hs CRP. — Talghini S, Vahedi A, Lotfinia I Pakistan journal of biological sciences : PJBS (2013)
    36. [36]
      Analysis of disk volume before and after CT-guided intradiscal and periganglionic ozone-oxygen injection for the treatment of lumbar disk herniation. — Lehnert T, Naguib NN, Wutzler S, Nour-Eldin NE, Bauer RW, Kerl JM et al. Journal of vascular and interventional radiology : JVIR (2012)
    37. [37]
      Thoracic disk herniation manifesting as sciatica-like pain--two case reports. — Cho HL, Lee SH, Kim JS Neurologia medico-chirurgica (2011)
    38. [38]
      Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review. — Bolesta MJ Journal of spinal disorders (1995)
    Share:TwitterRedditLinkedIn

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG