Natural history and nonoperative treatment of lumbar disc herniation.

Lumbar disc herniation is a common condition with a favorable prognosis in the majority of circumstances. This article reviews the published scientific evidence regarding the impact of nonoperative care on this condition. The published studies are critiqued and evaluated on their relative strengths and weaknesses. The effect of time, medications, exercise, injection therapy, and manipulation are considered. The literature regarding the natural history process of disc resorption is reviewed, including time frames and the proposed underlying mechanisms that may enhance or impede this process. The effect of inflammation on treatment effectiveness and decision-making is evaluated. The possible impact of various types and locations of lumbar disc herniation, coexisting anatomic factors, lumbar disc herniation material type, lumbar disc herniation material chemical factors, clinical characteristics, and patient-related factors are discussed. Appropriate candidates for operative versus nonoperative care are discussed. Conclusions are drawn from this literature review that will help guide management decisions.