Is prophylactic lumbar discectomy ever indicated?

375 With the wide availability of non-invasive imaging techniques, the occurrence of a patient with a large disc herniation who ultimately has complete disappearance of the herniation on imaging without surgery is not rare.1-4 It is unclear how common this is, as most patients who recover from sciatica do not get repeat imaging. Alternatively, how commonly cauda equina syndrome subsequently occurs in patients with improving sciatica and/or asymptomatic lumbar disc herniations is not clearly known. Questions about the role of prophylactic lumbar discectomy have not been explored, and if performed by surgeons, have not been reported in the literature. But they are very relevant due to the frequency of lumbar disc disease and within the context of other prophylactic surgeries including appendectomy, colectomy, cholecystectomy, oophorectomy, thyroidectomy, mastectomy, aortic aneurysm repair, and in the realm of the neurosurgeon carotid endarterectomy and intracranial aneurysm repair.