From the Guidelines
Approximately 10-20% of patients with L5-S1 herniations require surgical intervention 1.
Key Considerations
- Surgical intervention is typically reserved for patients with neurologic deficits or spinal instability 1
- Patients who experience persistent or severe symptoms, including radiculopathy, neurological deficits, or cauda equina syndrome, may require earlier surgical consideration
- Surgical candidates are typically those who have not responded to at least 6-12 weeks of conservative treatment, including:
- Physical therapy
- Pain management with medications such as gabapentin (300-3600 mg/day) or tramadol (50-100 mg every 4-6 hours)
- Conservative management with medications such as oral steroids (e.g., prednisone 20-30 mg/day for 2-4 weeks) and non-steroidal anti-inflammatory drugs (e.g., ibuprofen 600-800 mg every 8 hours for 4-6 weeks)
Important Factors
- The decision to proceed with surgical intervention should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and response to conservative treatment 1