LUMBAR DISC HERNIATION IN ADULTS: FACTORS ASSOCIATED WITH SURGICAL INDICATION AND FUNCTIONAL OUTCOMES

Abstract

Introduction: Lumbar disc herniation in adults is characterized by the displacement of disc material, potentially causing nerve root compression, low back pain, sciatica, sensory changes, and motor deficits; the clinical course varies, with the possibility of spontaneous improvement in a significant proportion of patients. Surgical intervention is primarily indicated in cases of persistent, incapacitating radicular pain, failure of conservative treatment, progressive neurological deficit, significant motor impairment, and cauda equina syndrome. Objective: To analyze, through a systematic literature review, the main clinical and neurological factors associated with the indication for surgery in adult lumbar disc herniation and their effects on pain, functionality, neurological recovery, and quality of life. Methodology: The review followed PRISMA checklist recommendations, considering scientific articles published over the last 10 years and identified in the PubMed, SciELO, and Web of Science databases. Five descriptors were used: “lumbar disc herniation,” “lumbar radiculopathy,” “spine surgery,” “discectomy,” and “functional outcomes.” Included studies involved adults diagnosed with lumbar disc herniation, research evaluating surgical or conservative treatments, and studies reporting clinical or functional outcomes. Case reports, animal experiments, and publications unrelated to surgical indications or functional outcomes were excluded. Results: Studies demonstrated that persistent radicular pain, motor deficits, progressive neurological impairment, and a lack of response to conservative treatment were the primary factors associated with the indication for surgery. Discectomy provided faster pain reduction and functional improvement, particularly in the short term, whereas, during long-term follow-up, outcomes tended to converge with those observed with conservative treatment. Conclusion: The literature indicated that the decision regarding surgery should have been individualized, taking into account the intensity and duration of symptoms, neurological changes, clinical characteristics, and response to conservative treatment. Surgery led to faster recovery from pain and functional impairment in selected patients, whereas long-term benefits showed less significant differences compared to non-operative treatment.