Herniated lumbar disc.
BACKGROUND
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 30-50 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
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 July 2008 (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).


RESULTS
We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.


CONCLUSIONS
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, microdisectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction.
Jordan
Jo
J
Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK.
Konstantinou
Kika
K
O'Dowd
John
J
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D017586:Diskectomy; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000188:drug therapy; D020393:Manipulation, Spinal; D012585:Sciatica / Q000188:drug therapy; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal