Lumbar disc herniation treatment

• A fully automatic MRI-guided decision support system for lumbar disc herniation using machine learning
• Recurrence of lumbar disk herniation after microdiscectomy: a two-center retrospective analysis of 1214 cases and identification of risk factors
• Prognostic factors for residual symptoms following percutaneous endoscopic lumbar discectomy
• Clinical Efficacy and Safety of a Modified Moxibustion Therapy for Low Back Pain in Lumbar Disc Herniation: A Two-Center, Randomized, Controlled, Non-Inferiority Trial
• Limited discectomy versus aggressive discectomy by spinal endoscopy with the transforaminal approach for lumbar disc herniation: a retrospective study
• Clinical efficacy and complications of MIS-TLIF and TLIF in the treatment of upper lumbar disc herniation: a comparative study
• Simultaneous L1-2 Bulged Disc and Mobile Spinal Schwannoma Causing Cauda Equina Syndrome: A Rare Case Report
• Tubular vs. mini-open lumbar discoidectomy: surgical-clinical outcome

Most patients can experience relief with non-surgical measures. However, if symptoms persist or worsen, surgery may be appropriate. ¹⁾

Lumbar disc herniation is a “preference-sensitive” condition, in which the optimal treatment choice is crucially dependent on an informed patient's goals and values. Little is known about decisional conflict, defined as an individual's level of uncertainty regarding a decision, in patients considering treatment for lumbar herniated discs. Our work aims to identify factors associated with decisional conflict and areas for improved shared decision-making.

METHODS: We prospectively surveyed patients seeking treatment for a lumbar herniated disc at L4-L5 and/or L5-S1 with a physician at the UCLA Spine Center. Decisional conflict was measured using the validated SURE questionnaire. We performed univariate and multivariate logistic analysis to identify predictors of decisional conflict.

RESULTS: 174 participants were surveyed. 47% of participants experienced decisional conflict. 44% of participants changed their treatment preference after the visit, with 61% of these opting for more invasive treatment. Participants with decisional conflict were less satisfied with their treatment decision (p<0.001), and less willing to recommend their physician (p=0.003) and physician's medical group to others (p=0.003). Multivariate analysis revealed that participants were more likely to experience decisional conflict if they consulted with a physiatrist versus a surgeon (OR 2.6, p=0.019) and if they did not feel able to discuss the various treatment options with the doctor during their visit (OR 8.5, p<0.001).

Many patients with a lumbar herniated disc experience decisional conflict when choosing a treatment option. Our results highlight the need to implement tools and strategies to improve decisional quality, such as decision aids prior to consultation ²⁾.

Initial management Conservative.

The literature recommends that refractory cases with lumbar disc herniation with the appropriate indications should be treated surgically ^{3) 4) 5)}.

see Lumbar disc herniation surgery.