An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy.
BACKGROUND
The objective of the North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions surrounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical literature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder.


OBJECTIVE
To provide an evidence-based educational tool to assist spine specialists in the diagnosis and treatment of lumbar disc herniation with radiculopathy.


METHODS
Systematic review and evidence-based clinical guideline.


METHODS
This guideline is a product of the Lumbar Disc Herniation with Radiculopathy Work Group of NASS' Evidence-Based Guideline Development Committee. The work group consisted of multidisciplinary spine care specialists trained in the principles of evidence-based analysis. A literature search addressing each question and using a specific search protocol was performed on English-language references found in Medline, Embase (Drugs and Pharmacology), and four additional evidence-based databases to identify articles. The relevant literature was then independently rated using the NASS-adopted standardized levels of evidence. An evidentiary table was created for each of the questions. Final recommendations to answer each clinical question were developed via work group discussion, and grades were assigned to the recommendations using standardized grades of recommendation. In the absence of Level I to IV evidence, work group consensus statements have been developed using a modified nominal group technique, and these statements are clearly identified as such in the guideline.


RESULTS
Twenty-nine clinical questions were formulated and addressed, and the answers are summarized in this article. The respective recommendations were graded by strength of the supporting literature, which was stratified by levels of evidence.


CONCLUSIONS
The clinical guideline has been created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients with symptomatic lumbar disc herniation with radiculopathy. The entire guideline document, including the evidentiary tables, suggestions for future research, and all the references, is available electronically on the NASS Web site at http://www.spine.org/Pages/PracticePolicy/ClinicalCare/ClinicalGuidlines/Default.aspx and will remain updated on a timely schedule.
Ahwatukee Sports and Spine, 4530 E. Muirwood Dr, Suite 110, Phoenix, AZ 85048-7693, USA. Electronic address: skreiner@ahwatukeesportsandspine.com.
D Scott
DS
Kreiner
Department of Neurosurgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111-1552, USA.
Steven W
SW
Hwang
The College of Human Medicine, Michigan State University, 12662 Riley St, Suite 120, Holland, MI 49424-8023, USA.
John E
JE
Easa
Department Neurosurgery, University of Wisconsin Medical School, K4/834 Clinical Science Center, 600 Highland, Madison, WI 53792-0001, USA.
Daniel K
DK
Resnick
Department of Neurosurgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226-3522, USA.
Jamie L
JL
Baisden
Rocky Mountain Scoliosis and Spine, 2055 High St, Suite 130, Denver, CO 80205-5504, USA.
Shay
S
Bess
Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115-6110, USA.
Charles H
CH
Cho
2918 Calcutt Drive, Midlothian, VA 23113-2681, USA.
Michael J
MJ
DePalma
2000 Van Auken Rd, Newark, NY 14513-9221, USA.
Paul
P
Dougherty
160 Cheyenne Way, Wayne, NJ 07470-4907, USA.
Robert
R
Fernand
Denver Spine, 7800 E. Orchard Rd, Suite 100, Greenwood Village, CO 80111-2584, USA.
Gary
G
Ghiselli
9120 Bear Claw Way, Madison, WI 53717-2734, USA.
Amgad S
AS
Hanna
Mayo Clinic Rochester, 200 1st St SW, Eisenberg 8G, Rochester, MN 55905-0001, USA.
Tim
T
Lamer
VACT Healthcare System, 950 Campbell Ave., Bldg 2, Floor 4, West Haven, CT 06516-2770, USA.
Anthony J
AJ
Lisi
Cleveland Clinic Spine Institute, 9500 Euclid Ave., C21, Cleveland, OH 44195-0001, USA.
Daniel J
DJ
Mazanec
2152 Susquehanna Rd, Abington, PA 19001-4408, USA.
Richard J
RJ
Meagher
6322 Gunn Hwy, Tampa, FL 33625-4105, USA.
Robert C
RC
Nucci
University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5000, USA.
Rakesh D
RD
Patel
University of Minnesota, 2450 Riverside Ave. S., Suite R200, Minneapolis, MN 55454-1450, USA.
Jonathan N
JN
Sembrano
Spine and Pain Medicine, 2 Mockingbird Drive, Colts Neck, NJ 07722-2228, USA.
Anil K
AK
Sharma
NewSouth NeuroSpine, 2470 Flowood Drive, Flowood, MS 39232-9019, USA.
Jeffrey T
JT
Summers
Cumberland Brain and Spine, 3901 Central Pike, Suite 455, Hermitage, TN 37076-3490, USA.
Christopher K
CK
Taleghani
3413 Mount Ariane Drive, San Diego, CA 92111-3910, USA.
William L
WL
Tontz
4866 Hoen Ave., Santa Rosa, CA 95405-7452, USA.
John F
JF
Toton
D017586:Diskectomy; D019317:Evidence-Based Medicine; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery*; D011843:Radiculopathy / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome
D005938:Glucocorticoids
Guideline; Lumbar disc herniation; Radiculopathy