Non-operative management: An evidence-based approach

Symptomatic lumbar disc herniation is a common problem encountered in both surgical and non-surgical practices. The decision between surgical and non-surgical management of this entity can be challenging for both the patient and the treating physician. A variety of non-surgical treatment options exist, many with poor evidence supporting their efficacy. Treatment algorithms are available to promote improved outcomes and cost-effectiveness and reduce unnecessary interventions. In the absence of progressive neurologic deficit or cauda equina syndrome, non-surgical treatments for symptomatic lumbar disc herniations are typically implemented for at least 6 weeks with good results. The following is an evidence-based review of the non-surgical management of symptomatic lumbar disc herniation.