Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1. There is little evidence to suggest that drug treatments are effective in treating herniated disc.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments, non-drug treatments, and surgery for herniated lumbar disc? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 37 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acupuncture, advice to stay active, analgesics, antidepressants, bed rest, corticosteroids (epidural injections), cytokine inhibitors (infliximab), discectomy (automated percutaneous, laser, microdiscectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction.
Herniated lumbar disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space.
The highest prevalence is among people aged 30 to 50 years, with a male to female ratio of 2:1.
There is little high-quality evidence to suggest that drug treatments are effective in treating herniated disc.
NSAIDs and cytokine inhibitors do not seem to improve symptoms of sciatica caused by disc herniation.We found no RCT evidence examining the effects of analgesics, antidepressants, or muscle relaxants in people with herniated disc. We found several RCTs that assessed a range of different measures of symptom improvement and found inconsistent results, so we are unable to draw conclusions on effects of epidural injections of corticosteroids.
With regard to non-drug treatments, spinal manipulation seems more effective at relieving local or radiating pain in people with acute back pain and sciatica with disc protrusion compared with sham manipulation, although concerns exist regarding possible further herniation from spinal manipulation in people who are surgical candidates.
Neither bed rest nor traction seem effective in treating people with sciatica caused by disc herniation.We found insufficient RCT evidence about advice to stay active, acupuncture, massage, exercise, heat, or ice to judge their efficacy in treating people with herniated disc.
About 10% of people have sufficient pain after 6 weeks for surgery to become a consideration.
Standard discectomy and microdiscectomy seem to increase self-reported improvement to a similar extent.We found insufficient evidence judging the effects of automated percutaneous discectomy, laser discectomy, or percutaneous disc decompression.