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Online ISSN 1827-1707
Carragee E. J.
Orthopaedic Surgery Department Stanford University School of Medicine Stanford, CA, USA
Most patients with lumbar radiculopathy due to disc herniation will recover with only supportive care. Surgical treatment is reserved for patients with serious neurological loss or persistent pain and impairment. Surgical decompression is clearly superior in the short-term compared to nonoperative measures in patients with severe and persistent radicular pain. Over time, treatment with nonsurgical measures will usually result in gradual improvement, but this may take months or years. There is little clear advantage to one surgical technique over another in qualified hands. Reherniation rates appear to vary by degree of disc removed at surgery and the anular defect remaining after discectomy. Complications with modern surgical techniques are infrequent (<5%) and usually not serious.