Conservative treatment for patients with lumbar disc herniation when surgery is advised

Approximately two-thirds of spinal pain diagnoses are lumbar disc herniations, and surgical intervention is on the increase.

A recent study conducted by Kim et al., (2021) performed a study whereby they observed 128 cases of patients who had lumbar disc herniation. Doctors advised surgery, however, 71 opted for conservative treatment and 57 elected surgical intervention.

There are a number of patients who are advised to have surgery, but opt for conservative methods for fear of surgery, hopes for spontaneous improvement, and a lack of regard for the modest benefits of surgery. The non-surgical cohort were offered conservative interventions, which included lifestyle modifications, exercise, physiotherapy, and/or medication. If these were not beneficial then other non-surgical interventions were used, such as spinal manipulation, therapeutic massage, and injection-based treatments. Surgical treatment either involved microscopic discectomy or full endoscopic lumbar discectomy.

Patients were followed up after monthly intervals, up to 24 months. All outcomes significantly improved their symptoms after 24 months, and surgery resulted in a faster improvement within 1 month of surgery. However, conservative methods offered the better outcomes in the mid and long-term to recovery from lumbar disc herniation.

It is generally accepted that 10% of those that suffer lumbar disc herniation are appropriate for surgery, and research proves it offers favourable improvement to symptoms in the short-term, but not necessarily in the long-term. Ultimately, both surgical and conservative interventions need to be fully explained to patients so they can make their own decisions based on the potential risks Vs benefits in the short, mid and long-term.