Results of surgery compared with conservative management for lumbar disc herniations.

Conservative management gives satisfactory results in a high proportion of patients with disc herniation in the course of a few months of treatment onset. This is likely to occur particularly in patients with mild or moderate nerve root compression. Surgical treatment is significantly faster in yielding a satisfactory resolution of symptoms. The chances of a successful outcome are higher in patients with a marked nerve root compression, no or mild back pain, and a short duration of symptoms. The results of surgery often deteriorate in the long and very long term because of recurrence of radicular, and especially low back, pain. In most patients, deterioration is not related strictly to surgery because chances of pain recurrence or worsening with time are similar in the patients treated conservatively and in those who undergo surgery. Microdiscectomy appears to give slightly better results than standard operation in the first few weeks or months after surgery, but not successively. Surgery usually should be undertaken if the patient does not respond after at least 2 months' conservative treatment.