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

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

[Article in Spanish]

Author information

1
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España. Electronic address: pedrodl@yahoo.com.
2
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.

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

PMID:
28130015
DOI:
10.1016/j.neucir.2016.11.004
[Indexed for MEDLINE]

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