BMJ  2008;336:1317-1318 (14 June), doi:10.1136/bmj.39583.438773.80 (published 27 May 2008)

Editorials

Prolapsed intervertebral disc

Evidence supports surgery after eight weeks if symptoms persist

The first 150 words of the full text of this article appear below.

Prolapsed intervertebral disc is common—it is seen in up to a quarter of magnetic resonance scans and can be detected even in asymptomatic adults.¹ Disc prolapse is genetically driven—twin studies indicate that at least 60% of the variance can be explained on genetic grounds and not by the commonly assumed environmental factors (work, trauma, exposure to excessive driving, smoking, and so on).² In the linked randomised controlled trial, Peul and colleagues compare the effects of early surgery with conservative management at two years in 283 patients who have had sciatica for six to 12 weeks.³ A second study by van den Hout and colleagues compares the costs of each approach.⁴

Current guidelines indicate that radicular pain should improve within six to eight weeks with conservative management.⁵ Surgery should be performed before eight weeks only in patients with progressive neurological deficit, which can be detected by magnetic resonance imaging. Some people . . . [Full text of this article]

¹ Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford OX3 7L

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