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

Neurocirugia (Astur). 2017 May-Jun;28(3):124-134. doi: 10.1016/j.neucir.2016.11.004. Epub 2017 Jan 25.
[Article in Spanish]


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.

Publication types

  • Review

MeSH terms

  • Adult
  • Conflict of Interest
  • Conservative Treatment
  • Diskectomy / methods
  • Evidence-Based Medicine
  • Female
  • Humans
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / physiopathology
  • Intervertebral Disc Displacement / surgery*
  • Intervertebral Disc Displacement / therapy
  • Low Back Pain / etiology
  • Low Back Pain / therapy
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbar Vertebrae / surgery*
  • Male
  • Meta-Analysis as Topic
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Pain Management / methods
  • Physical Examination
  • Remission, Spontaneous
  • Rest
  • Sciatica / etiology
  • Sciatica / therapy
  • Treatment Outcome