title: [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests].
abstract: BACKGROUND
  Indication for surgery in lumbar disc herniation (LDH) varies widely depending on the geographical area.
  
  
  METHODS
  A literature review is presented on the natural history, role of physical examination, timing of surgery, evidence-based treatment, and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain compared to conservative therapy, although the effect fades after a year. There is no treatment modality better than the rest in terms of pain control and neurological recovery, nor is there a surgical technique clearly superior to simple discectomy. The lack of sound scientific evidence on the surgical indication may contribute to its great geographical variability.
  
  
  CONCLUSIONS
  Since LDH has a favourable natural history, neuroimaging and surgery should not be considered until after a 6-week period. It is necessary to specify and respect the surgical indications for LDH, avoiding conflicts of interests.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España. Electronic address: pedrodl@yahoo.com.
authors.forename: Pedro David
authors.initials: PD
authors.lastname: Delgado-López
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rodríguez-Salazar
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Martín-Alonso
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Martín-Velasco
mesh_terms: D000328:Adult; D016265:Conflict of Interest; D000072700:Conservative Treatment; D017586:Diskectomy / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D017116:Low Back Pain / Q000209:etiology / Q000628:therapy; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D059408:Pain Management / Q000379:methods; D010808:Physical Examination; D012075:Remission, Spontaneous; D012146:Rest; D012585:Sciatica / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
keywords: Ciática; Conflict of interest; Conflicto de intereses; Discectomía; Diskectomy; Hernia discal lumbar; Historia natural; Lumbar disc herniation; Micro-discectomy; Microdiscectomía; Natural history; Sciatica