Público alvo: técnico.
Na edição de hoje do NEJM, os pontos-chave para reconhecimento e conduta desta comum situação na prática clínica. Muito importante, 87% dos pacientes não necessitam cirurgia.
KEY CLINICAL POINTS
Herniated Lumbar Intervertebral Disk
Herniated lumbar disks are the leading cause of sciatica, but they also are detected on imaging (MRI or CT) in asymptomatic persons.
The natural history of herniated lumbar disks is favorable. One study showed that without surgery, pain decreases in approximately 87% of patients within 3 months.
MRI or CT is indicated in patients with persistent sciatica that lasts 4 to 6 weeks and in whom epidural glucocorticoid injections or surgery are being considered.
Oral medications and supervised exercise provide slight relief of symptoms. Epidural glucocorticoid injections are an option for patients with severe persistent sciatica, but they do not reduce rates of subsequent surgery.
Patients with severe or progressive neurologic deficits require a referral for surgery. Elective surgery is an option for patients with congruent clinical and MRI findings and a condition that does not improve within 6 weeks. The major benefit of surgery is relief of sciatica that is faster than relief with conservative treatment, but results of early surgical and prolonged conservative treatment tend to be similar at 1 year of follow-up. Patients and physicians should share in decision making.