Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy: an outcome study

Saal JA, Saal JS

Spine 1989; 14(4): 431-437

Authors Conclusions: Persons with herniated lumbar discs can be treated nonoperative with a high degree of success; Failure of passive nonoperative treatment in not sufficient for the decision to operate; The presence of weakness does not adversely effect the outcome of nonoperative treatments, and should not be used as overwhelming evidence that surgery is necessary; The presence of disc extrusion does not adversely effect the outcome of nonoperative treatment and should not be used as overwhelming evidence that surgery is necessary; The premise that operative patients fare better in the first year is contrary to our results; Failure to improve with aggressive nonoperative measures suggests the presence of stenosis, and should probably warrant greater decompression than purely disc excision or nucleotomy; High surgical volumes of “simple” disc excisions or nucleotomies probably represent overtreatment in a group that carries a favorable prognosis in the short- and long-term by nonoperative treatment; and The decision to operate should be based on the patient’s level of function and whether that functional level can be improved by an aggressive active rehabilitation program, rather than on imaging studies and/or physical examination findings.

For more info on the study go to: http://www.ncbi.nlm.nih.gov/pubmed/2718047