HNY Policy and Pathway Repository - Hull

An intervertebral disc compressing one or more spinal nerve roots.

This intervention is commissioned if there are:

• compressive nerve root signs and symptoms which have lasted for at least three months (*except in severe cases) despite best efforts with non-operative management AND
• concordant MRI changes

 

*This policy does not apply to patients who demonstrate a deterioration in neurological function (e.g. objective weakness, sexual dysfunction, cauda equina syndrome). These patients require an urgent referral to an acute spinal centre for further evaluation and imaging, as nonoperative treatment may lead to irreversible harm.

There remains a reasonable body of evidence to show that in carefully selected patients, lumbar discectomy may lead to a greater and quicker improvement in pain scores than in non-operatively treated patients.

 

In other studies, however, because of the irreversible degenerative changes, surgery has not shown a benefit over non-operative treatment in mid and long-term follow-up.

 

Lengthy periods of ineffective non-operative care may prompt repeated emergency department attendances, issues with chronic pain, significant neurological dysfunction and time off work.

Lumbar discectomy - EBI