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The best approach to a patient with acute lumbar disk herniation is unclear, to some extent because strictly randomized trials in this area are difficult to conduct. Three studies suggest that patient choice might be the most important factor.
In one study, 472 U.S. patients with acute lumbar radicular pain and corresponding positive imaging results were randomized to diskectomy or conservative care. Crossover to the alternate intervention was relatively common (40%–45%). Both groups improved substantially after 2 years of follow-up, with no difference noted by an intent-to-treat analysis. In an accompanying observational study of 743 patients who declined randomization, 528 chose surgery and improved somewhat more in pain and physical funct…