title: Herniated lumbar disc.
abstract: 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 to 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 June 2010 (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 37 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, microdiscectomy, standard), exercise therapy, heat, ice, massage, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), percutaneous disc decompression, spinal manipulation, and traction.
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Jordan
authors.forename: Kika
authors.initials: K
authors.lastname: Konstantinou
authors.forename: John
authors.initials: J
authors.lastname: O'Dowd
mesh_terms: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D017586:Diskectomy; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000601:surgery; D020393:Manipulation, Spinal; D014143:Traction
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal