DOC AI’S CONSULTATION

(Consult given for webcast of Thursday, March 1, 2023 by the EANS)

Lumbar disc herniation (LDH) is a common spinal disorder that can cause severe pain and disability. The timing of treatment for LDH is an important consideration, and there is ongoing debate regarding the optimal timing for surgery. Conservative treatment is usually recommended as the initial treatment approach, with surgery reserved for cases of severe or progressive symptoms. However, there is evidence to suggest that early surgery may be beneficial for some patients, particularly those with significant neurological deficits.

Several studies have investigated the timing of surgery for LDH, with conflicting results. A randomized controlled trial by Peul et al. (2008) found that early surgery (within 2 weeks of symptom onset) was associated with faster improvement in pain and disability compared to prolonged conservative treatment. However, a systematic review and meta-analysis by Jacobs et al. (2018) found no significant differences in outcomes between early and delayed surgery.

In summary, the optimal timing of treatment for LDH remains controversial. While conservative treatment is usually recommended as the initial approach, early surgery may be beneficial for some patients, particularly those with significant neurological deficits. Further research is needed to determine the most effective timing for surgery in different patient populations.

References:

• Peul, W. C., van Houwelingen, H. C., van den Hout, W. B., Brand, R., Eekhof, J. A., Tans, J. T., & Thomeer, R. T. (2008). Surgery versus prolonged conservative treatment for sciatica. New England Journal of Medicine, 358(8), 2245-2255.
• Jacobs, W. C., van der Gaag, N. A., Tuschel, A., de Kleuver, M., & Peul, W. C. (2018). Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. European Spine Journal, 27(8), 1953-1963.