Acute lumbar disk pain: navigating evaluation and treatment choices

Am Fam Physician. 2008 Oct 1;78(7):835-42.

Abstract

Acute lumbar disk herniations are the most common cause of sciatica. After excluding emergent causes, such as cauda equina syndrome, epidural abscess, fracture, or malignancy, a six-week trial of conservative management is indicated. Patients should be advised to stay active. If symptoms persist after six weeks, or if there is worsening neurologic function, imaging and invasive procedures may be considered. Most patients with lumbar disk herniations improve over six weeks. Because there is no difference in outcomes between surgical and conservative treatment after two years, patient preference and the severity of the disability from the pain should be considered when choosing treatment modalities. If a disk herniation is identified that correlates with physical findings, surgical diskectomy may improve symptoms more quickly than continued conservative management. Epidural steroid injections can also provide short-term relief.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Diagnostic Imaging
  • Humans
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / diagnosis*
  • Intervertebral Disc Displacement / therapy*
  • Low Back Pain / etiology*
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Lumbar Vertebrae*
  • Neurologic Examination