[The delayed OP--indications for surgery of lumbar disc herniations]

In Germany, lumbar disc herniations require surgical treatment in about 50,000 patients/year. The clinical and socio-economical results are determined by the preoperative duration of symptoms and preoperative time out of work (highly predictive). Other parameters such as severity of neurological deficits, morphology of disc herniation, age, associated diseases, type of surgery, working conditions or litigation processes are only weak predictors of outcome. Postoperative improvement of clinical symptoms as well as professional reintegration is strongly determined by the time period between onset of symptoms and surgery. Surgery performed "too early" diminishes the chance for improvement by conservative therapy. If surgery is performed "too late" the risk of a bad result is high, and the reintegration of the patient into his preoperative social and professional activities may be prevented. The duration of conservative therapy including so-called semi-invasive procedures is critical in this sense. If a therapeutic success (= professional and social reintegration) cannot be achieved by conservative measures and if there is a clear morphological correlate (= disc herniations with corresponding clinical symptoms) of the clinical symptoms an early change of the strategy towards surgical therapy is recommended.