Herniated discs: when is surgery necessary?

Abstract

▪ In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits withmyelopathy or cauda equina syndrome. However, thisreview summarized the relative indications for surgery ineach level.▪ In cervical disc herniation (CDH), the indications for surgeryconsist of six months of persisting symptoms, notresponding to conservative treatment. However, highqualitystudies are lacking, and a randomized controlledtrial is now underway to clarify the indications.▪ In thoracic disc herniation (TDH), the indications for surgerycomprise failure of conservative measures and/orworsening neurological symptoms. Moreover, giant calcifiedthoracic disc herniations or myelopathy signs onmagnetic resonance imaging, even in the absence of neurologicalsymptoms, may benefit from surgical treatmentas a preventive measure.▪ In lumbar disc herniation (LDH), the indications for surgeryinclude imaging confirmation of LDH, consistent withclinical findings, and failure to improve after six weeks ofconservative care