The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations

Onur Yaman; Artem Guchkha; Sandeep Vaishya; Mehmet Zileli; Corinna Zygourakis; Joachim Oertel

doi:10.1016/j.wnsx.2024.100277

The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations

World Neurosurg X. 2024 Feb 13:22:100277. doi: 10.1016/j.wnsx.2024.100277. eCollection 2024 Apr.

Authors

Onur Yaman¹, Artem Guchkha², Sandeep Vaishya³, Mehmet Zileli⁴, Corinna Zygourakis⁵, Joachim Oertel⁶

Affiliations

¹ Department of Neurosurgery, Memorial Bahçelievler Hospital, Istanbul, Turkiye.
² Department of Neurosurgery, Research Center of Neurology, Moscow, Russia.
³ Department of Neurosurgery, Fortis Memorial Research Institute, Guragaon and Fortis Hospital Vasant Kunj, New Delhi, India.
⁴ Department of Neurosurgery, Sanko University Faculty of Medicine, Gaziantep, Turkiye.
⁵ Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.
⁶ Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany.

Abstract

Objective: To formulate the most current, evidence-based recommendations for the conservative management of lumbar disc herniations (LDH).

Methods: A systematic literatüre search was performed 2012-2022 in PubMed/Medline and Cochrane using the keywords ''lumbar disc herniation'' and ''conservative treatment,'' yielding 342 total manuscripts. Screening criteria resulted in 12 final manuscripts which were summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The Delphi method was utilized to arrive at three final consensus statements.

Results and conclusion: s: In the absence of cauda equina syndrome, motor, or other serious neurologic deficits, conservative treatment should be the first line of treatment for LDH. NSAIDs may significantly improve acute low back and sciatic pain caused by LDH. A combination of activity modification, pharmacotherapy, and physical therapy provides good outcomes in most LDH patients.

Keywords: Conservative therapy; Low back pain; Lumbar disc herniation; Radiculopathy; WFNS spine committee.

Publication types

Review