title: Treatment of lumbar disc herniation with radiculopathy. Clinical practice guidelines endorsed by The Polish Society of Spinal Surgery.
abstract: BACKGROUND
  Herniated lumbar disc (HLD) is arguably the most common spinal disorder requiring surgical intervention. Although the term is fairly straightforward, the exact pathology and thus the clinical picture and natural history may vary. Therefore, it is immensely difficult to formulate universal guidelines for surgical treatment.
  
  
  OBJECTIVE
  The aim of this paper is to organize the terminology and clear the inconsistencies in phraseology, review treatment options and gather available published evidence to address the clinical questions to create a set of clinical guidelines in relevant to the topic.
  
  
  RESULTS
  Twelve queries, addressing optimal surgical treatment of the HLD have been formulated. The results, based on the literature review are described in the present work. The final product of the analysis was a set of guidelines for the surgical treatment of symptomatic HLD. Categorized into four tiers based on the level of evidence (I-III and X), they have been designed to assist in the selection of optimal, effective treatment leading to the successful outcome.
  
  
  CONCLUSIONS
  The evidence based medicine (EBM) is becoming ever more popular among spinal surgeons. Unfortunately this is not always feasible. Lack of uniform guidelines and numerous conflicts of interest introduce flaws in the decision making process. The key role of experts and professional societies is to provide high value recommendation based on the most current literature. Present work contains a set of guidelines for the surgical treatment of HLD officially endorsed by the Polish Spine Surgery Society.
authors.affiliation: Department of Neurosurgery, Regional Medical Center, Opole, Poland. Electronic address: dlatka@mp.pl.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Latka
authors.affiliation: Department of Neurosurgery, Specialist Medical Center, Polanica-Zdroj, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Miekisiak
authors.affiliation: Department of Neurosurgery, Regional Neurosurgery and Neurotrauma Center, Zielona Gora, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Jarmuzek
authors.affiliation: Medical University of Warsaw, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Lachowski
authors.affiliation: Department of Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kaczmarczyk
mesh_terms: D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000592:standards*; D019637:Orthopedic Procedures / Q000592:standards*; D011044:Poland; D017410:Practice Guidelines as Topic / Q000592:standards*; D011843:Radiculopathy / Q000601:surgery*; D012955:Societies, Medical / Q000592:standards*
keywords: Degenerative disc disease; Guidelines; Herniated lumbar disc; Radiculopathy; Spinal surgery