Professional Statements and Societal Positions Guidelines
Practice Guidelines and Position Statements
North American Spine Society
In 2014, the North American Spine Society published evidence-based clinical guidelines on the diagnosis and treatment of lumbar disc herniation with radiculopathy. The table below summarizes the recommendations specific to open discectomy or microdiscectomy.
Recommendations for Treating Lumbar Disc Herniation With Radiculopathy
| Recommendations |
GORa |
| Endoscopic percutaneous discectomy is suggested for carefully selected individuals to reduce early postoperative disability and reduce opioid use compared with open discectomy. |
B |
| There is insufficient evidence to make a recommendation for or against the use of automated percutaneous discectomy compared with open discectomy. |
I |
| Discectomy is suggested to provide more effective symptom relief than medical/interventional care for individuals whose symptoms warrant surgical care. In individuals with less severe symptoms, both surgery and medical/interventional care appear to be effective in short and long term relief. |
B |
| Use of an operative microscope is suggested to obtain comparable outcomes to open discectomy for individuals whose symptoms warrant surgery. |
B |
| There is insufficient evidence to make a recommendation for or against the use of tubular discectomy compared with open discectomy. |
I |
GOR: grade of recommendation.
a Grade B: fair evidence (level II or III studies with consistent findings); grade I: insufficient evidence.
In 2011, the North American Spine Society published evidence-based clinical guidelines on the diagnosis and treatment of cervical radiculopathy from degenerative disorders. The guidelines included evaluations of anterior cervical discectomy (ACD), ACD with fusion, ACD with instrumented fusion, ACD with fusion plus plate, and posterior laminoforaminotomy. Recommendations are listed in the table below.
Recommendations Treating Cervical Radiculopathy from Degenerative Disorders
| Recommendations |
GORa |
| Surgical intervention is suggested for the rapid relief of symptoms when compared to medical/interventional treatment. |
B |
| Surgery is an option to produce and maintain favorable long-term (>4 years) outcomes. |
C |
| Both ACD and ACDF are suggested as comparable treatment strategies, producing similar clinical outcomes. |
B |
| ACDF and total disc arthroplasty are suggested as comparable treatments, resulting in similarly successful short-term outcomes. |
B |
| Both ACDF with and without a plate are suggested as comparable treatments, resulting in similar clinical outcomes and fusion rates. |
B |
| Either ACDF or PLF are suggested for treatment of single level degenerative cervical radiculopathy secondary to foraminal soft disc herniation to achieve comparably successful clinical outcomes. |
B |
ACD: anterior cervical discectomy; ACDF: anterior cervical discectomy with fusion; GOR: grade of recommendation; PLF: posterior laminoforaminotomy.
a Grade B: fair evidence (level II or III studies with consistent findings); grade C: poor quality evidence (level IV or V studies).
International Society for the Advancement of Spine Surgery
In 2019, the International Society for the Advancement of Spine Surgery published a policy on the surgical treatment of lumbar disc herniation with radiculopathy. This policy contained a review of available clinical evidence and concluded that discectomy (open, microtubular, or endoscopic) is a medically necessary procedure for the treatment of individuals who do not respond to nonsurgical care or have severe and deteriorating symptoms. Per the policy, documentation requirements include confirmation of radiculopathy based on history/physical examination AND either the presence of disabling leg or back pain refractory to 6 weeks of conservative care or progressive neurologic deficit AND level appropriate documentation of nerve root compression on imaging and/or nerve conduction velocity/electromyogram.