When is surgery indicated for symptomatic lumbar disc disease?

Updated: Sep 25, 2018
  • Author: Kamran Sahrakar, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

The indications for surgical treatment of symptomatic lumbar disc disease are not clearly delineated. Nevertheless, situations exist in which most spine surgeons would probably agree on operative intervention. These situations include the following:

  • A patient with cauda equina syndrome

  • A patient demonstrating progressive neurologic deficit during a period of observation

  • A patient with persistent bothersome sciatic pain, despite conservative management, for a period of 6-12 weeks (a time period that varies from surgeon to surgeon)

Notably missing from this list is a patient presenting with a profound motor deficit of varying duration. In the absence of pain, whether such patients benefit from surgery is unclear. No consensus has been reached concerning how urgent surgery is for a patient who presents with a clinical picture of painful disc herniation. Unfortunately, the decision to operate emergently is often based on fear of legal repercussions rather than on scientific evidence of actual patient benefit.


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