Recovery of motor deficits after lumbar disc herniation: commentary on Overdevest et al.

Lumbar discectomy for relief of sciatica in patients with intervertebral disc herniation (IDH) is one of the most wellresearched and common indications for spine surgery. There is good evidence that lumbar discectomy for carefully selected patients with sciatica as the result of lumbar disc herniation provides faster relief of symptoms than nonoperative treatment [1,2]; however, randomized trials suggest that longer-term outcomes are equivalent between a strategy of early surgery or an extended course of nonoperative treatment followed by surgery as needed in the subset of patients that fail to improve [3–5]. The evidence supports shared-decision making in which patients are informed of the options and can choose between surgery to achieve early symptomatic relief if they are unable to tolerate their symptoms or can safely choose to pursue nonoperative treatment for awhile with a reasonable likelihood of improvement and the option to pursue surgery later on if they do not improve sufficiently [6]. Motor deficits not infrequently accompany sciatica as the result of lumbar disc herniation and their presence can be extremely frightening and distressing to patients [7]. The evidence on the role of surgery in recovery of motor deficits in IDH has been somewhat conflicting. Overall,