1Guilherme I. Santos, 1Thalita P.M. Alineri, 1Délio T. M. Malaquias, 1Juliana Paschoal, 1Isabeli G. Oliveira, 1Brenda M.M.R. Oliveira, 1Eliza F. Prezotto, 1Isadora O. Soler, 1Bruna D. Araujo, 1Caroline P. Golin, 1Maria Gabriela S Guzzi, 1Igor F. Forechi, 1Guilherme G. Martins, 1Ana Clara F. Parreira, 1Samantha R.G. Sanches, 1Adriana F. Viana Delgado, 1Diego P. Mariz, 1Karina F. Dias, 1Agatha A.M. Faria, 1Julio E. Calheiros, 1Talita R.Q. Lopes, 1Elysa F. Camargo, 1Cristiana N.O. Beloto, 1Maria Clara G. Costa, 1Ana Clara P. R de Souza, 1Leonardo da Silva, 1Giovana R. Victorello, 1Isabela F.Krebs, 1Hiromi M.K. Fujishima, 2Thiago G. Trigueiro, 2Hamilton R. M. de O. Carriço, 4Ana Carolina R. do Vale, 5Raquel S. R. Borges, 5Camila C. Lopes, 1,6Thiago A. R. Bezerra, 7Leonardo Mendes Faria
1Academic in Medicine. University of Ribeirão Preto, Campus Guarujá, São Paulo, Brazil.
2Academic in Medicine. University Potiguar, Natal, Rio Grande do Norte, Brazil.
3Academic in Medicine. University of Southern Santa Catarina (Unisul). Tubarão, SC, Brazil.
4Medical student. Nove de Julho University, São Bernardo do Campo, São Paulo, Brazil.
5Bachelor of Medicine. Nove de Julho University, São Bernardo do Campo, São Paulo, Brazil.
6Bachelor’s degree in Physical Education. Federal University of São Carlos. MSc and PhD in Orthopaedics, Traumatology and Rehabilitation of the Locomotor System. Ribeirão Preto Medical School. University of São Paulo. Brazil.
7Bachelor of Medicine. Federal University of Minas Gerais, Belo Horizonte-MG. Medical Residency in Orthopaedics and Traumatology at Irmandade Santa Casa de Santos-SP. Specialization in Orthopaedics and Traumatology in the area of shoulder and elbow. Postgraduate Latu Sensu in Chronic Pain Intervention. Member of the Brazilian Orthopaedic Society.
ABSTRACT:
Introduction: A herniated disc occurs when the disc that acts as a cushion between the vertebrae of the spine shifts and presses on nearby nerves. The L4-L5 region refers to the lumbar vertebrae located in the lower back. A herniated disc in this region can cause pain, tingling, muscle weakness and even the inability to perform daily tasks. Evidence comparing the effectiveness of surgical and conservative treatment for symptomatic lumbar disc herniation is controversial. Objectives: The aim of this study is to discuss, through a literature review, the pros and cons of conservative and surgical treatment for herniated discs, as well as their risks and benefits according to current medical advances. Results and Discussion: Compared to conservative therapy, surgical treatment provided faster relief of low back pain symptoms in patients with lumbar disc herniation, but showed no benefits over conservative treatment in medium and long-term follow-up. Final considerations: Surgical treatment may therefore be attractive for patients with debilitating pain symptoms who are looking for rapid relief or who have not achieved satisfactory improvement with conservative treatment.
KEYWORDS:
Surgery, conservative, hernia, prolapse, sciatica.
REFERENCES :
1) ALEXANDRE, A. et al. Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments. Springer Vienna, 2011.
2) ALVES FILHO, Arnon Castro; GONÇALVES, Allana Laís Furtado; BARBOSA,
3) Amanda de Melo. Conservative versus surgical treatment in patients with lumbar disc herniation. BrJP, v. 4, p. 357-361, 2021.
4) ASGHARZADEH, Asra; KHOSHNOOD, Naeimeh. Evaluating the safety and efficacy of discogel in the treatment of herniated lumbar disc: a systematic review. Health Technology Assessment in Action, 2017.
5) BHATTI, Adnan Bashir; KIM, Sunny. Role of epidural injections to prevent surgical intervention in patients with chronic sciatica: a systematic review and meta-analysis. Cureus, v. 8, n. 8, 2016.
6) CODIGNOLE, André et al. Síndrome da cauda equina causada por compressão de hérnia de disco lombaR. RECIMA21-Revista Científica Multidisciplinar-ISSN 2675-6218, v. 2, n. 8, p. e28626-e28626, 2021.
7) DOS SANTOS, Paloma Silva et al. Estudo clínico randomizado no tratamento da hérnia de disco lombar. Revista Saúde e Desenvolvimento, v. 15, n. 21, p. 93-106, 2021.
8) FARIA, Leonardo Mendes. Entrevista com Médico Ortopedista a respeito das dores lombares (2024).
9) FOIZER, Guilherme Augusto. Existe correlação entre grau de degeneração discal e lombalgia?. 2022. Tese de Doutorado. [sn].
10) GIBSON, JN Alastair; GRANT, Inga C.; WADDELL, Gordon. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine, v. 24, n. 17, p. 1820, 2019.
11) GUIDA, Camila Almeida; FERREIRA, Valmir Juneo; DE SOUZA, Francielle Vieira.
12) Percepção do portador de hérnia de disco acerca do tratamento fisioterapêutico. Bionorte, v. 9, n. 1, p. 26-35, 2020.
13) HENNEMANN, Sergio; DE ABREU, Marcelo Rodrigues. Estenose degenerativa do canal lombar. Revista Brasileira de Ortopedia, v. 56, n. 01, p. 009-017, 2020.
14) HOMOTETSKI, Denis. Effectivness of conservative and microdiscetomy treatment for patients with lumbar disc herniation. 2014.
15) HUANG, Rongzhong et al. Nonsurgical medical treatment in the management of pain due to lumbar disc prolapse: A network meta-analysis. In: Seminars in arthritis and rheumatism. WB Saunders, 2019. p. 303-313.
16) LEFÈVRE-COLAU, M.-M.; BABINET, Antoine; POIRAUDEAU, Serge. Traitement des lomboradiculalgies. EMC-Rhumatologie-Orthopédie, v. 1, n. 4, p. 328-342, 2024.
17) LÜHMANN, Dagmar et al. Minimally invasive surgical procedures for the treatment of lumbar disc herniation. GMS health technology assessment, v. 1, 2022.
18) PERFEITO, Rodrigo Silva; MARTINS, Edivania. Hérnia de disco lombar: etiologia, diagnóstico e tratamentos mais utilizados. Revista Perspectiva: Ciência e Saúde, v. 5, n. 3, 2020.
19) MUSSI, Higor Gomes et al. Tratamento de dor radicular da hérnia de disco lombar: microdiscectomia versus abordagens fisioterapêuticas. Revista Eletrônica Acervo Saúde, v. 23, n. 10, p. e14392-e14392, 2023.
20) REIMAN, Michael P. et al. Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with metaanalysis. British journal of sports medicine, 2015.
21) RIBEIRO, WENDEL et al. Tratamento fisioterapêutico da dor lombar causada pela hérnia de disco: revisão de literatura. Revista Ciências da FAP, n. 5, 2022.
22) SOUSA, Vanessa da Costa et al. Avaliação dos parâmetros radiográficos do alinhamento sagital e espinopélvico em pacientes com osteoartrite submetidos à artroplastia total do quadril. Revista Brasileira de Ortopedia, v. 55, p. 591-596, 2020.
23) SMITH, Denis. O efeito da terapia manual no alívio da dor em indivíduos com disfunção sacroilíaca: uma revisão sistemática. Seminário Nacional de Pesquisa, p. 87, 2021.
24) SHAHBANDAR, Lena; PRESS, Joel. Diagnosis and nonoperative management of lumbar disk herniation. Operative Techniques in Sports Medicine, v. 13, n. 2, p. 114121, 2021.
25) TIENDREBEOGO/ZABSONRE, Wendlassida Joelle Stéphanie et al. Pediatrics severe low back pain by disc herniation: an uncommon entity. Pediatric Rheumatology, v. 22, n. 1, p. 1, 2024.
26) VALLS, Isabelle et al. Factors predicting radical treatment after in-hospital conservative management of disk-related sciatica. Joint Bone Spine, v. 68, n. 1, p. 50-58, 2023.
27) VAN DEN HOUT, Wilbert B. et al. Prolonged conservative care versus early surgery in patients with sciatica from lumbar disc herniation: cost utility analysis alongside a randomised controlled trial. Bmj, v. 336, n. 7657, p. 1351-1354, 2008.
28) VANGEN-LØNNE, Vetle et al. Microdiscectomy for lumbar disc herniation: a singlecenter observational study. World neurosurgery, v. 137, p. e577-e583, 2020.
29) WARDLAW, Douglas. Sciatica caused by disc herniation: Why is Chymopapain Chemonucleolysis denied to our patients?. International journal of spine surgery, v. 10, 2016.
30) WILBY, Martin John et al. Surgical microdiscectomy versus transforaminal epidural steroid injection in patients with sciatica secondary to herniated lumbar disc (NERVES): a phase 3, multicentre, open-label, randomised controlled trial and economic evaluation. The Lancet Rheumatology, v. 3, n. 5, p. e347-e356, 2021.
31) WERNER, David AT et al. A prognostic model for failure and worsening after lumbar microdiscectomy: a multicenter study from the Norwegian Registry for Spine Surgery. Acta Neurochirurgica, v. 163, p. 2567-2580, 2021.
