The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations

Onur Yaman, Artem Guchkha, Sandeep Vaishya, Mehmet Zileli, Corinna Zygourakis, Joachim Oertel 
World Neurosurgery: X, Volume 22 https://doi.org/10.1016/j.wnsx.2024.100277
Objective
To formulate the most current, evidence-based recommendations for the conservative management of lumbar disc herniations (LDH).

Methods
A systematic literatüre search was performed 2012–2022 in PubMed/Medline and Cochrane using the keywords ‘’lumbar disc herniation’’ and ‘’conservative treatment,’’ yielding 342 total manuscripts. Screening criteria resulted in 12 final manuscripts which were summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The Delphi method was utilized to arrive at three final consensus statements.

Results and conclusion
s: In the absence of cauda equina syndrome, motor, or other serious neurologic deficits, conservative treatment should be the first line of treatment for LDH. NSAIDs may significantly improve acute low back and sciatic pain caused by LDH. A combination of activity modification, pharmacotherapy, and physical therapy provides good outcomes in most LDH patients.