Treatment of Lumbar Disc Herniation: An Evidence-Based Review

Several randomized controlled trials (RCTs) and prospective observational cohort studies have compared surgical to conservative treatment for patients with sciatica caused by lumbar disc herniation. Whereas no RCT has been able to compare surgery with nonoperative treatment without substantial crossover between treatment groups, multiple RCTs and observational studies have suggested that surgery resulted in faster improvement and a greater degree of improvement compared with nonoperative treatment. However, many patients in these studies also experienced improvement with nonoperative care without adverse sequelae. This paper critically reviews the literature comparing surgery with nonoperative treatment for lumbar disc herniation.