The effectiveness of treatment for the prolapsed lumbar intervertebral disc: A review of the literature

Abstract

Literature relating to the management of prolapsed lumbar intervertebral discs was reviewed in order to assess the effectiveness of current medical care. Five aspects of care were addressed: the effectiveness of alternative forms of conservative treatment, the length of time necessary for a satisfactory trial of conservative management, the usefulness or otherwise of routine lumbar spine X-rays, the type of investigation best suited to confirm the nature and level of the lesion in cases where surgical intervention is considered and the form of intervention that provides the best outcome for the patient. Plain lumbar spine X-rays were found to be unnecessary as a routine investigation. All conservative treatment options were found to offer at most short-term benefit only and did not affect the long-term outcome. Computerized tomographic scans or magnetic resonance imaging are most suitable for providing confirmation of the level of the lesion. Myelograms should not be used routinely. Minimally invasive surgery appears to have the best outcomes and to be the most acceptable to the patient.