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

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

Neurocirugia (Astur). 2017 Jan 24;:

Authors: Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V

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.

PMID: 28130015 [PubMed - as supplied by publisher]

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