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. 2010 Jul 21:3:209-14.
doi: 10.2147/ijgm.s12270.

Treatment of lumbar disc herniation: Evidence-based practice

Andrew J Schoenfeld  1 , Bradley K Weiner
Affiliations

Treatment of lumbar disc herniation: Evidence-based practice

Andrew J Schoenfeld et al. Int J Gen Med. .

Abstract

Clinical question: What is the best treatment for lumbar disc herniations?

Results: For patients failing six weeks of conservative care, the current literature supports surgical intervention or prolonged conservative management as appropriate treatment options for lumbar radiculopathy in the setting of disc herniation. Surgical intervention may result in more rapid relief of symptoms and restoration of function.

Implementation: While surgery appears to provide more rapid relief, many patients will gradually get better with continued nonoperative management; thus, patient education and active participation in decision-making is vital.

Keywords: back pain; herniation; lumbar disc; spine.

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Figures

Figure 1.
Figure 1.
Sagittal magnetic resonance image of an L5/S1 disc herniation in the setting of degenerative disc disease. The patient was a 41-year-old woman with a six-week history of right-sided radicular leg pain in an S1 nerve root distribution. The patient failed conservative treatment, including physical therapy and pain management. Her symptoms were successfully relieved with a right-sided L5/S1 microdiscectomy.
See this image and copyright information in PMC

References

Further reading

    1. Anderson PA, McCormick PC, Angevine PD. Randomized controlled trials of the treatment of lumbar disk herniation: 1983–2007. J Am Acad Orthop Surg. 2008;16:566–573. - PubMed
    1. Bono CM, Wisneski R, Garfin SR. Lumbar disc herniations. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. The Spine. 5th ed. Philadelphia, PA: Saunders; 2006.
    1. McCulloch JA. Focus issue on lumbar disc herniation: Macro- and microdiscectomy. Spine. 1996;21:45S–56S. - PubMed
    1. McCulloch JA, Edwards CC, II, Riew KD. Lumbar microdiscectomy. In: Bradford DS, Zdeblick TA, editors. Master Techniques in Orthopaedic Surgery: The Spine. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.

References

    1. Anderson PA, McCormick PC, Angevine PD. Randomized controlled trials of the treatment of lumbar disk herniation: 1983–2007. J Am Acad Orthop Surg. 2008;16:566–573. - PubMed
    1. Atlas SJ, Deyo RA, Keller RB, et al. The Maine Lumbar Spine Study, Part II. 1-year outcomes of surgical and nonsurgical management of sciatica. Spine. 1996;21:1777–1786. - PubMed
    1. Atlas SJ, Keller RB, Chang Y, Deyo RA, Singer DE. Surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: Five-year outcomes from the Maine Lumbar Spine Study. Spine. 2001;26:1179–1187. - PubMed
    1. Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study. Spine. 2005;30:927–935. - PubMed
    1. Bono CM, Wisneski R, Garfin SR. Lumbar disc herniations. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA, editors. The Spine. 5th ed. Philadelphia, PA: Saunders; 2006.