Lumbar disc herniations: A review of surgical and non-surgical indications and outcomes

Abstract

Disc excision for lumbar disc herniation has become the most common surgical procedure of the lumbar spine. The United States has the highest rate of back surgery than any developed country. In this review, various surgical approaches are discussed, including simple discectomy, discectomy and fusion, chemonucleolysis, percutaneous discectomy and microdiscectomy. According to the literature, fusion does not have any added benefit, nor does there appear to be any difference among the other surgical techniques, with the exception of percutaneous discectomy. A review of the non-surgical options is also presented. There is evidence to support the immediate relief of sciatic pain with surgical intervention, although recent studies on the non-operative treatment have actually shown comparable short-term results. Regarding long term outcomes, the literature has not shown any statistical difference between surgical and non-surgical treatment options. Moreover, this review illustrates that aggressive rehabilitation with appropriate pain control may actually be the superior treatment option when one considers the cost, complications and morbidity associated with surgery. Thus, indications for surgery remain controversial, and will require further clarification. In the future, more long term, unbiased, randomized and controlled trials are needed to measure not only pain relief and reoperation rates, but also the patients' return to work and premorbid functional state.