Lumbar disc herniation occurs in about 1-2% of people during their lifetime, and is most common in men between the ages of 40 and 60 years old. Although the symptoms vary greatly between individuals, most of them suffer from sudden onset of unilateral or bilateral neurogenic leg pain, often accompanied by low back pain. 70% of the patients with leg pain can be relieved within 6 weeks after the onset of the symptoms. Therefore, conservative treatment is usually the first option for lumbar disc herniation, including health education and counseling, non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics, physical therapy and epidural injections. Most international guidelines recommend that surgery should be considered if symptoms persist after a certain period of regular conservative treatment. However, it is not clearly established whether the prolonged duration of symptoms associated with lumbar disc herniation will have an impact on the final outcome, and whether this impact differs between conservative and surgical treatments. The Spine Patient Outcomes Research Trial (SPORT) addressed this question in a prospective randomized controlled study with an observational comparison based on the duration of symptoms associated with lumbar disc herniation for 6 months. Included patients were randomized to either conservative or surgical treatment, with traditional posterior open discectomy as the “minimum non-operative treatment,” which included active physical therapy, health education and counseling, as well as instruction in home rehabilitation and NSAIDS medication. In addition to these basic measures, patients who were treated conservatively could also choose other non-surgical treatments under the guidance of their physicians. A total of 1192 eligible patients were enrolled, of which 927 patients had a disease duration of less than 6 months and 265 had a disease duration of more than 6 months. Regular follow-up was done for at least 4 years after inclusion in the study. It was found that patients with a disease duration of more than 6 months ended up with poorer primary outcome assessment indicators, regardless of whether they were treated conservatively or surgically. In the surgical treatment group, those with a disease duration of less than 6 months compared with those with a disease duration of more than 6 months showed a significant improvement in SF-36 physical pain values from baseline at the start of treatment to 4 years of follow-up (mean improvement, 48.3 vs. 41.9, p < 0.001), with a greater improvement in motor function (47.7 vs. 41.2; p < 0.001), and a greater improvement in the Oswestry dysfunction index ( C41.1 vs C34.6; p < 0.001). Results in the non-surgical treatment group followed a similar trend to the surgical treatment group, with those with less than 6 months of disease compared to those with more than 6 months of disease, with specific results for SF-36 (mean improvement, 31.8 vs. 21.4, p < 0.001), motor function (29.5 vs. 22.6, p = 0.015), and Oswestry dysfunction index (-24.9 vs. 18.5, P=0.006). In addition, all the main indexes were better in the surgical treatment group than in the non-surgical treatment, but there was not much relationship with the length of symptom duration. That is to say, the longer the duration of symptoms before starting treatment for lumbar disc herniation, the worse the final outcome of treatment, both surgical and non-surgical treatments. And while surgical treatment is more effective than non-surgical treatment, it is not related to the length of time the disease has lasted before treatment. From this study, both patients and orthopedic surgeons should recognize that the treatment of lumbar disc herniation should be intervened as early as possible, both surgically and non-surgically.