[Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests]

Abstract

Introduction: Indication for surgery in lumbar disc herniation (LDH) varies widely depending on the geographical area.

Development: A literature review is presented on the natural history, role of physical examination, timing of surgery, evidence-based treatment, and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain compared to conservative therapy, although the effect fades after a year. There is no treatment modality better than the rest in terms of pain control and neurological recovery, nor is there a surgical technique clearly superior to simple discectomy. The lack of sound scientific evidence on the surgical indication may contribute to its great geographical variability.

Conclusions: Since LDH has a favourable natural history, neuroimaging and surgery should not be considered until after a 6-week period. It is necessary to specify and respect the surgical indications for LDH, avoiding conflicts of interests.

Keywords: Ciática; Conflict of interest; Conflicto de intereses; Discectomía; Diskectomy; Hernia discal lumbar; Historia natural; Lumbar disc herniation; Micro-discectomy; Microdiscectomía; Natural history; Sciatica.