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. 2025 Jan;34(1):263-294.
doi: 10.1007/s00586-024-08528-8. Epub 2024 Oct 25.

Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review

Cesar A Hincapié #  1   2   3 , Daniela Kroismayr #  4   5 , Léonie Hofstetter  4 , Astrid Kurmann  4   5 , Carol Cancelliere  6 , Y Raja Rampersaud  7 , Eleanor Boyle  8 , George A Tomlinson  9   10 , Alejandro R Jadad  11 , Jan Hartvigsen  12   13 , Pierre Côté  6   9 , J David Cassidy  9
Affiliations

Incidence of and risk factors for lumbar disc herniation with radiculopathy in adults: a systematic review

Cesar A Hincapié et al. Eur Spine J. 2025 Jan.

Abstract

Background: Lumbar disc herniation (LDH) with radiculopathy is associated with greater pain, disability, healthcare use, and costs compared with nonspecific low back pain. Reliable information about its incidence and risk factors were lacking.

Questions: (1) What is the incidence of lumbar disc herniation (LDH) with radiculopathy in adults? (2) What are the risk factors for LDH with radiculopathy in adults?

Methods: Systematic review. We searched five electronic databases from 1970 to September 2023. Eligible cohort and case-control studies were identified and independently assessed for risk of bias. A qualitative best evidence synthesis of low and moderate risk of bias studies was conducted.

Results: We critically reviewed 87 studies and synthesised data from 59 (68%) studies; 12 were of low and 47 of moderate risk of bias. The lower and upper bound limits of the 95% CIs of annual incidence estimates ranged from 0.3 to 2.7 per 1000 persons for surgical case definitions, from 0.04 to 1.5 per 1,000 persons for hospital-based case definitions, and from 0.1 to 298.3 per 1,000 persons for clinical case definitions. Factors associated with the development of LDH with radiculopathy included middle-age (30-50 years), smoking, higher BMI, presence of cardiovascular risk factors (in women), and greater cumulative occupational lumbar load by forward bending postures and manual materials handling, with effect sizes ranging from ranging from 1.1 (1.0-1.3) to 3.7 (2.3-6.0).

Conclusions: Incidence of LDH varies in different populations and according to case definition. Risk factors include individual, behavioural, and work-related variables. Our findings support the need to develop standardised case definitions that validly classify the clinical spectrum of LDH and for future low risk of bias studies examining causal relationships for LDH with radiculopathy in adults.

Keywords: Back pain; Incidence; Radiculopathy; Risk factors; Systematic review.

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Conflict of interest statement

Declarations. Conflict of interest: The institution of one or more of the authors (CAH) has received, during the study period, funding from Canadian Institutes of Health Research and Canadian Chiropractic Research Foundation. The institution of one or more of the authors (PC) has received, during the study period, funding from Canada Research Chairs program. The institution of one or more of the authors (CAH) has received, during the study period, funding from European Centre for Chiropractic Research Excellence, European Cooperation in Science and Technology, McTimoney Chiropractic College, MSK+ Seminars, and Swiss National Science Foundation, unrelated to this research. The institution of one or more of the authors (CC) has received, during the study period, funding from Canadian Chiropractic Guideline Initiative, Canadian Chiropractic Research Foundation, Scandinavian College of Chiropractic, Workers’ Compensation Board Alberta, and World Health Organisation, unrelated to this research. The institution of one or more of the authors (PC) has received, during the study period, funding from Canadian Chiropractic Protective Association, Eurospine, and National Chiropractic Mutual Insurance Company (NCMIC), unrelated to this research.

Figures

Fig. 1
Fig. 1
Flow diagram of information through phases of the systematic review. Abbreviations: LDH, lumbar disc herniation; ROB, risk of bias
Fig. 2
Fig. 2
Infographic summarising the main findings of the systematic review showing limits of annual incidence 95% CIs and modifiable risk factors for LDH with radiculopathy in adults [–30, 32, 87, 105, 130, 131]. The lower and upper bound limits of the 95% CIs ranged from 0.3 to 2.7 per 1,000 persons for surgical case definitions, from 0.04 to 1.5 per 1,000 persons for hospital-based case definitions, and from 0.1 to 298.3 per 1,000 persons for clinical case definitions. Potential modifiable risk factors: higher BMI, smoking, cardiovascular risk factors (in women), lower education, greater cumulative occupational lumbar load by forward bending postures and manual materials handling, increased time pressure at work and lower decision latitude at work, regular or irregular three-shift work, or regular night work (in women)
See this image and copyright information in PMC

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