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Vol. 28. Num. 3.May - June 2017Pages 103-158
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Vol. 28. Num. 3.May - June 2017Pages 103-158
Review article
DOI: 10.1016/j.neucie.2017.02.004
Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests
Hernia discal lumbar: historia natural, papel de la exploración, timing de la cirugía, opciones de tratamiento y conflicto de intereses
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Pedro David Delgado-López
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, Antonio Rodríguez-Salazar, Javier Martín-Alonso, Vicente Martín-Velasco
Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain
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Tables (3)
Table 1. Therapies used and abandoned or in disuse in the treatment of disc hernia.21
Table 2. Surgical treatment of sciatica due to lumbar disc hernia.1–13
Table 3. Conservative treatment of sciatica due to lumbar disc hernia.1–6,8,13,30–32
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Abstract
Introduction

Indication for surgery in lumbar disc herniation (LDH) varies widely depending on the geographical area.

Development

A literature review is presented on the natural history, role of physical examination, timing of surgery, evidence-based treatment, and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain compared to conservative therapy, although the effect fades after a year. There is no treatment modality better than the rest in terms of pain control and neurological recovery, nor is there a surgical technique clearly superior to simple discectomy. The lack of sound scientific evidence on the surgical indication may contribute to its great geographical variability.

Conclusions

Since LDH has a favourable natural history, neuroimaging and surgery should not be considered until after a 6-week period. It is necessary to specify and respect the surgical indications for LDH, avoiding conflicts of interests.

Keywords:
Lumbar disc herniation
Sciatica
Diskectomy
Micro-discectomy
Conflict of interest
Natural history
Resumen
Introducción

La cirugía de la hernia discal lumbar (HDL) es una de las intervenciones con mayor variabilidad geográfica en su indicación.

Desarrollo

Se realiza una revisión bibliográfica sobre la historia natural, el papel de la exploración neurológica, el timing de la cirugía, el tratamiento basado en la evidencia y el conflicto de intereses relativos a la HDL. La cirugía acorta significativamente el tiempo de dolor respecto al tratamiento conservador, aunque este efecto se diluye a partir del año. No parece existir una modalidad terapéutica superior al resto respecto del control del dolor o de la recuperación neurológica, ni una técnica quirúrgica claramente superior a la discectomía simple. La gran variabilidad geográfica puede deberse a una ausencia de criterios científicos sólidos en la indicación.

Conclusiones

La historia natural de la HDL es favourable y debe respetarse un mínimo de 6semanas antes de indicar pruebas de imagen o considerar la cirugía. Es preciso concretar y respetar la indicación quirúrgica, evitando los conflictos de intereses.

Palabras clave:
Hernia discal lumbar
Ciática
Discectomía
Microdiscectomía
Conflicto de intereses
Historia natural

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