The U.S. Preventive Services Task Force’s grading scheme for evaluating the quality of evidence for treatment or screening: * Level I evidence: evidence from at least one well-designed randomized controlled clinical trial; * Level II-1 evidence: evidence from well-designed non-randomized controlled trials; * Level II-2 Level II-2: Evidence from well-designed cohort or case-control studies (preferably multicenter); * Level II-3: Evidence from multiple time-series studies with or without interventions. Level III evidence: authoritative opinion from clinical experience, descriptive studies, or expert committee reports. U.S. Preventive Services Task Force (U.S. Preventive Services Force) Recommendation Evaluation Criteria: * Level A Recommendation: Good scientific evidence that the benefit of the medical practice substantially outweighs its potential risks. Clinicians should discuss the medical practice with applicable patients; * Level B recommendation: At least fair evidence that the benefits of the medical practice outweigh the potential risks. Clinicians should discuss the medical practice with applicable patients; * Level C Recommendation: At least fair scientific evidence that the medical practice provides benefit, but the benefit is so close to the risk that a general recommendation cannot be made. Clinicians are not required to offer this medical practice unless certain individual considerations exist; * Level D recommendation: At least fair scientific evidence suggests that the potential risks of the medical practice outweigh the potential benefits; clinicians should not routinely perform the medical practice in asymptomatic patients; * Level I recommendation: The medical practice lacks scientific evidence, or the evidence is of low quality or conflicting, e.g., the risks and benefits cannot be measured and assessed. Clinicians should help patients understand the uncertainty of the medical practice. To further improve the diagnosis and treatment of lumbar herniated disc radiculopathy, the Lumbar Herniated Disc Radiculopathy Task Force of the North American Spine Surgery Society (NASS) Committee on Evidence-Based Clinical Guideline Development summarized and synthesized the available clinical medical evidence Definition and Natural History Question 1: What is the most accurate definition of lumbar herniated disc radiculopathy? A condition in which material misalignment of a disc beyond the normal disc boundary compresses the nerve, resulting in pain, weakness, ganglion paralysis, or abnormal distribution of sensation in the dermatome. Working Group Expert Consensus Question 2: What is the natural course of herniated lumbar disc radiculopathy? Because there are no studies on the natural course of herniated lumbar disc radiculopathy, the working group agreed that most patients with herniated lumbar disc radiculopathy improve with or without treatment. Atrophy/degeneration of the herniated disc tissue usually occurs over time. Many, but not all, studies show progressive improvement in clinical function as the herniated disc decreases Working Group Expert Consensus Diagnosis and Imaging Question 3: What history and physical examination findings diagnose herniated lumbar disc radiculopathy? Physical findings such as muscle strength, sensation, supine straight leg raise test, Lasegue’s sign, and contralateral Lasegue’s sign can assist in the diagnosis of herniated lumbar disc radiculopathy. Grade of recommendation: A Supine straight leg raise test and comparison with sitting straight leg raise test are helpful in the diagnosis of lumbar herniated disc radiculopathy. Grade of recommendation: B There is insufficient evidence to support or oppose the usefulness of the cough impact test, Bell test, overdraw test, femoral nerve pull test, lumbar kinematics, and loss of reflexes in the diagnosis of lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 4: What is the most appropriate method to diagnose lumbar herniated disc radiculopathy? When is it necessary to apply the above methods? There are no high-quality clinical studies demonstrating the benefits of imaging for the diagnosis of lumbar herniated disc radiculopathy. Our experts recommend MRI as the most appropriate non-invasive imaging test for patients with a history of lumbar herniated disc radiculopathy and a positive physical examination. If MRI is contraindicated or the patient is unable to determine the results after testing, CT is recommended as a secondary player segment. Working Group Expert Consensus Noninvasive MRI is recommended as the imaging test of choice for patients with a diagnosis of lumbar herniated disc radiculopathy and a corresponding history and positive physical examination findings. Recommendation grade: A CT, myelography, or CT myelography is recommended as an alternative imaging test for patients with a diagnosis of lumbar herniated disc radiculopathy and a corresponding history and positive physical examination. Recommendation grade: A Currently, electrodiagnostic study for the diagnosis of nerve root compression is widely used in clinical practice, but this test cannot identify the cause of nerve compression. The expert group believes that the first choice for the diagnosis of lumbar disc herniation radiculopathy should still be an axial imaging film of the corresponding site, and that electrodiagnostic study should only be used as an adjunct to identify other possible comorbidities. Working Group Expert Consensus Somatosensory excitation potentials can be used as an adjunct to imaging to determine the presence of nerve root compression, but the specificity of this test for diagnosing compressed segments is not high. Recommendation grade: B Electromyography, nerve conduction velocity, and F waves are of limited significance in the diagnosis of lumbar disc herniation radiculopathy. H-reflex waves are useful in the diagnosis of S1 radiculopathy, but are not specific. Recommendation grade: B There is no clear clinical evidence for or against the use of motor-excited potentials or toe-shortening reflexes in the diagnosis of lumbar herniated disc radiculopathy. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence to support or oppose the use of thermal induction testing or LCD in the diagnosis of lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Prognostic indicators Question 5: What are the best indicators for assessing prognosis after treatment of lumbar herniated disc radiculopathy? NASS has published a guideline book on this issue entitled: Compendium of Outcome Instruments for Assessment and Research of Spinal Disorders, which can be found in the relevant section of the book. Drug or interventional therapy Question 6: What is the role of drug therapy in the management of herniated lumbar disc radiculopathy? Tumor necrosis factor alpha inhibitors are not recommended in patients with herniated lumbar disc radiculopathy. Grade of Recommendation: B There is no clear clinical evidence for or against the use of single doses of intravenous hormones, guanfacine, 5-hydroxytryptamine agonists, gabapentin, and amitriptyline in patients with lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 7: What is the role of physical therapy in the treatment of lumbar herniated disc radiculopathy? There is no clear clinical evidence for or against the use of physiotherapy/structured rehabilitation exercises as a single treatment for lumbar herniated disc radiculopathy. Recommendation Level: I (Insufficient Evidence) In the absence of firm evidence at this time, the Working Group recommends a limited structured rehabilitation exercise strategy as a treatment option for patients with mild to moderate symptomatic lumbar herniated disc radiculopathy. Working Group Expert Consensus Question 8: What is the role of spinal manipulation in the management of lumbar herniated disc radiculopathy? Spinal manipulation alone can be a treatment option for patients with lumbar herniated disc radiculopathy. Grade of Recommendation: C There is no clear evidence for or against spinal manipulation being more effective than disc ablation. Recommendation grade: I (insufficient evidence) Question 9: What is the role of traction (manual or mechanical traction) in the treatment of herniated lumbar disc radiculopathy? There is no clear clinical evidence for or against the use of traction in patients with lumbar herniated disc radiculopathy. Recommendation level: I (insufficient evidence) Question 10: Are enhanced myelography-guided dural hormone-like injections (ESIs) necessary for the treatment of lumbar herniated disc radiculopathy? Enhanced myelography-guided dural hormone-like injections (ESIs) are recommended for the treatment of herniated lumbar disc radiculopathy. Recommendation grade: A Question 11: What is the role of ESIs in the treatment of lumbar herniated disc radiculopathy? Transtentorial ESIs are recommended as a short-term pain management option in patients with lumbar herniated disc radiculopathy. Grade of Recommendation: A Interlaminar ESI may be an option for the treatment of herniated lumbar disc radiculopathy. RECOMMENDATION GRADE: C There is no clear clinical evidence for or against the efficacy of transforaminal ESI for lumbar herniated disc radiculopathy after 12 months. Recommendation grade: I (insufficient evidence) Question 12: Is there an optimal time interval or injection dose for ESI for lumbar herniated disc radiculopathy? There is no clinical literature reporting on this issue. Question 13: Does the route of injection of ESIs affect the outcome of treatment of lumbar herniated disc radiculopathy or increase the risk of injection? There is no clear clinical evidence for or against the superiority of one route of injection over another. Recommendation grade: I (insufficient evidence) Question 14: What is the role of various spinal interventions in the treatment of herniated lumbar disc radiculopathy? There is no clear clinical evidence for or against intradiscal ozone injections for lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Endoscopic percutaneous discectomy can be used as a treatment for lumbar herniated disc radiculopathy. Grade of Recommendation: C Endoscopic percutaneous discectomy used in patients with carefully screened indications can effectively reduce the use of postoperative pain medication and improve patient discomfort in the low back. Grade: B Automatic percutaneous discectomy can be used as a treatment for herniated lumbar disc radiculopathy. Grade of Recommendation: C There is no clear clinical evidence for or against automated percutaneous discectomy being more effective than open discectomy. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence for or against the use of ionic disc decompression (Plasma disc decompression, essentially equivalent to radiofrequency ablation)/myeloplasty in patients with herniated lumbar disc radiculopathy. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence to support or oppose the superiority of ionic disc decompression over transvertebral foraminal ESIs. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence to support or oppose the use of intravertebral injection of hyperbaric saline and electrothermal disc decompression for the treatment of herniated lumbar disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 15: What is the role of adjunctive therapeutic measures such as bracing, electrical stimulation, acupuncture, and transcutaneous electrical stimulation in the treatment of lumbar herniated disc radiculopathy? There is no clear clinical evidence for or against the use of the above adjuvant therapeutic measures in the treatment of lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 16: What is the likelihood that patients diagnosed with lumbar herniated disc radiculopathy will have a good/good functional prognosis in the short (less than 6 weeks), medium (6 weeks to 2 years), or long term (greater than 2 years) when treated with the corresponding pharmacologic or interventional therapy? Pharmacologic or interventional therapy improves the clinical functional prognosis of most patients with lumbar herniated disc radiculopathy. Recommendation Grade: B Transforaminal ESIs improve the clinical prognosis in most patients with lumbar herniated disc radiculopathy. There is no clear clinical evidence for or against chiropractic care improving the clinical prognosis of patients with lumbar herniated disc radiculopathy Recommendation: I (insufficient evidence) Question 17: Are there predictive factors (e.g., age, duration of symptoms, severity of symptoms, etc.) corresponding to a diagnosis of lumbar herniated disc radiculopathy that predict short-term (less than 6 weeks), intermediate (6 weeks to 2 years), or long-term (greater than 2 years) outcomes? (6 weeks to 2 years) or long-term (>2 years) likelihood of a good/good functional prognosis? Patient age (<40 years) and shorter duration of clinical symptoms (<3 months) are associated with a better clinical functional prognosis after percutaneous discoscopic treatment. Level of Evidence: II The available research evidence does not suggest a significant prognostic difference in the treatment of different types of lumbar disc herniation radiculopathy with percutaneous ESI. Level of Evidence: II/III The available research evidence suggests a negative correlation between the degree of nerve root compression and clinical functional prognosis. Level of Evidence: II/III There is no clear clinical evidence that correlates patient age with the effectiveness of pharmacologic or interventional therapy. Recommendation level: I (insufficient evidence) Question 18: What is the utility ratio of pharmacologic or interventional treatment for lumbar herniated disc radiculopathy? Some studies have concluded that transvertebral foraminal ESI has a good efficacy ratio. Question 19: Is there a clinical sign or symptom that suggests a good prognosis for surgical treatment of lumbar herniated disc radiculopathy? A preoperative evaluation is recommended for patients with lumbar herniated disc radiculopathy who have depression. Patients with psychiatric depression have a poorer postoperative functional prognosis. RECOMMENDATION GRADE: B There is no clear clinical evidence to support or oppose the association between preoperative patient symptom duration and functional prognosis in lumbar herniated disc radiculopathy with cauda equina symptoms. Recommendation grade: B Question 20: What is the role of ESI or selective nerve blocks in the selection of patients for subsequent surgical treatment? There are no relevant studies on this issue. Q21: When is the best time for surgical intervention? Surgery within 6 months is recommended for patients with lumbar herniated disc radiculopathy who are severely symptomatic and require surgical treatment. Available evidence suggests that patients with early surgical intervention (6 months - 1 year) have a faster postoperative recovery and a better long-term neurological prognosis. Recommendation grade: B There is no clear clinical evidence for or against emergency spinal surgery for patients with motor dysfunction due to disc herniation. Recommendation grade: I (insufficient evidence) Question 22: Is discectomy better than drug or interventional therapy alone for the treatment of lumbar herniated disc radiculopathy? There is evidence that discectomy therapy is better than drug or interventional therapy for symptom relief in patients with lumbar herniated disc radiculopathy who have severe symptoms and require surgical treatment. In patients with mild clinical symptoms, surgery or drug/interventional therapy may provide better short-term and long-term functional improvement. Recommendation Grade: B For patients with strictly selected indications, automated percutaneous discectomy can achieve similar results to open discectomy. However, this entry is not applicable to all patients. Level of Evidence: II/III There is no clear clinical evidence for or against compression chiropractic as an alternative therapy for patients with severe symptoms requiring discectomy. Level of Recommendation: I (Insufficient Evidence) Question 23: Are there specific situations in the clinic that require lumbar fusion for a good functional prognosis? There is no clear clinical evidence for or against spinal fusion in specific patients with lumbar herniated disc radiculopathy. Recommendation level: I (insufficient evidence) Question 24: Are there different clinical prognoses or complications associated with different surgical approaches for lumbar herniated disc radiculopathy? When a patient has an indication for surgery, either resection of the bone block for decompression or radical discectomy for decompression is an option, as there is no significant difference in reherniation rates between the two. Grade of Recommendation: B There is no clear clinical evidence for or against osteotomy or discectomy for the relief of chronic low back pain in patients with lumbar herniated disc radiculopathy requiring surgical treatment. Level of Recommendation: I (Insufficient evidence) In patients with lumbar herniated disc radiculopathy requiring surgical treatment, discoscopic treatment can achieve the same results as open disc surgery. Grade of Recommendation: B There is no clear clinical evidence for or against medial synovectomy for lumbar herniated disc radiculopathy to improve functional prognosis. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence to support or oppose a new surgical approach for the treatment of radiculopathy due to very lateral disc herniation. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence to support or oppose that access discectomy results in a better functional prognosis than open discectomy. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence to support or oppose the use of glucocorticoids or/and fentanyl after lumbar decompression to improve perioperative pain in patients for a short period of time. Grade of Recommendation: I (Insufficient Evidence) Glucocorticoids or/and fentanyl are not recommended after lumbar decompression to improve long-term postoperative pain in patients. There is no clear clinical evidence for or against localized fat flap coverage of the decompression site after lumbar decompression. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence for or against the use of Oxiplex/SP gel or ADCON-L in discectomy. Recommendation grade: I (Insufficient evidence) Question 25: What is the short-term (1-4 years) and long-term (>4 years) functional prognosis for surgical treatment? In patients with lumbar herniated disc radiculopathy requiring surgical treatment, decompression surgery may provide better short-term symptom relief than pharmacologic or interventional therapy. Recommendation Grade: B Decompression surgery may provide long-term symptom relief. However, it is important to note that chronic back or leg pain may develop after surgery in some patients (23-28%). Level of Evidence: IV Question 26: Are there differences in the clinical functional prognosis or complications of surgical treatment of lumbar herniated disc radiculopathy between providers? There are no relevant studies on this question. Value of surgical treatment of the spine Question 27: What is the utility of surgery for lumbar herniated disc radiculopathy? There are more studies suggesting that surgical treatment has a better utility ratio in patients who are strictly selected for surgical indications. Q28: Do different surgical approaches affect the benefit of treatment for lumbar herniated disc radiculopathy? There are no relevant studies on this issue. Question 29: Do different providers affect the benefit of treatment for lumbar herniated disc radiculopathy? There are no relevant studies on this issue.