The management of herniated lumbar discs may involve non-operative and operative treatments. The initial treatment is non-operative and includes continued activity, analgesia, and physiotherapy.8
There are many options for surgery including standard discectomy, microdiscectomy, percutaneous discectomy, or laser discectomy. The microdiscectomy provides similar results to the standard discectomy, but, as yet, there is not enough evidence to draw firm conclusions on the percutaneous or laser techniques.1
The question of whether surgery is better than conservative treatment remains unclear. Overall, surgery is associated with a quicker relief of symptoms in the short term; however, there is little evidence available to suggest that surgery is better than conservative treatment in longer term.1,3,9–11
The evidence that spontaneous resolution of a herniated disc occurs strengthens the role of a trial of conservative treatment in the absence of cauda equina syndrome before surgical intervention is undertaken.
The mechanism proposed for the reduction in the size of the herniated disc is an absorptive process that relies on neovascularisation and infiltration by inflammatory cells such as macrophages, granulocytes, and lymphocytes.12
It is also recognised that greater resorption of herniated discs occurs when there is a sequestered fragment.13,14
It is possible that this phenomenon of disappearing discs occurs more frequently. These cases are probably not detected because few patients have MRI examinations after the resolution of their symptoms. It is important to be aware that spontaneous resolution of herniated discs occurs, so that patients can be reassured and the role of conservative treatment can be emphasised.