Question 1: 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 grade: I (insufficient evidence) This requires a combination of physician and patient to choose the approach and timing of treatment. My opinion on this issue is that I do not agree with fusion surgery for lumbar disc herniation. What kind of conditions do you do fusion surgery for? Fusion surgery is only considered for conditions such as those with clear cauda equina symptoms, those with predominant lumbar spinal stenosis symptoms, and those with predominant lumbar instability. For patients with indications for surgery, the guidelines recommend early surgery. Question 2: When is the best time for surgical intervention? For patients with lumbar herniated disc radiculopathy with severe symptoms requiring surgical treatment, surgery is recommended within 6 months. Available evidence suggests that patients with early surgical intervention (6 months-1 year) have faster postoperative recovery and 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 3: 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 pharmacologic/interventional therapy may provide better short-term and long-term functional improvement. Recommendation grade: B Question 4: What is the short-term (1-4 years) and long-term (>4 years) functional prognosis for surgical treatment? For 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 5: What is the utility of surgery for lumbar herniated disc radiculopathy? There are more findings suggesting that surgical treatment has a better utility ratio for patients who are strictly selected for surgical indications. Question 6: 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. Recommended grade: B Question 7: What is the most accurate definition of lumbar herniated disc radiculopathy? A disease in which the material of the disc is misaligned beyond the normal disc boundary, compressing the nerves and causing pain, weakness, ganglion paralysis or abnormal distribution of sensation in the dermatome. Question 8: What is the natural course of herniated lumbar disc radiculopathy? Because there are no studies related to 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 Question 9: 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 help in the diagnosis of herniated lumbar disc radiculopathy. Recommendation grade: A Supine straight leg raise test and comparison with sitting straight leg raise test are helpful in the diagnosis of lumbar herniated disc radiculopathy. Recommendation grade: B There is insufficient evidence to support or oppose the usefulness of the cough impact test, Bell test, overdraw test, femoral nerve pull test, slump test, lumbar kinematics, and loss of reflexes in the diagnosis of lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 10: 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 there are contraindications for patients to undergo MRI, or if the results cannot be determined after testing, CT is recommended as a secondary player segment. For patients with a diagnosis of lumbar herniated disc radiculopathy and the presence of a corresponding history and positive physical examination findings, noninvasive MRI is recommended as the preferred method of imaging testing. Recommendation grade: A CT, myelography, or CT myelography is recommended as an alternative for imaging testing in patients with a diagnosis of lumbar herniated disc radiculopathy and the presence of a corresponding history and positive physical examination findings. Recommendation grade: A The current electrodiagnostic study for the diagnosis of nerve root compression has been used more widely in clinical practice, but this test cannot identify the cause of nerve compression. In the opinion of the panel, the first choice for the diagnosis of lumbar disc herniation radiculopathy should still be an axial imaging film of the corresponding site, and electroneurography should only be used as an adjunct to identify other possible comorbidities. 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 a compressed segment 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 helpful in the diagnosis of S1 radiculopathy, but the specificity is not good. Recommendation grade: B There is no clear clinical evidence for or against the use of motor-excited potentials or the toe short extensor reflex 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) Question 11: What is the best judge of 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. Question 12: What is the role of pharmacotherapy in the treatment 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 13: What is the role of physical therapy in the treatment of lumbar herniated disc radiculopathy? There is no clear clinical evidence for or against 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 14: 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 15: What is the role of traction (manual or mechanical traction) in the treatment of lumbar herniated disc radiculopathy? There is no clear clinical evidence for or against the use of traction in patients with lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 16: 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 lumbar herniated disc radiculopathy. Recommendation grade: A Question 17: What is the role of ESIs for the treatment of lumbar herniated disc radiculopathy? Transtentorial ESIs are recommended as a short-term pain control option in patients with lumbar herniated disc radiculopathy. Grade of Recommendation: A Interlaminar ESIs may be an alternative option for the treatment of lumbar herniated disc radiculopathy. Grade of Recommendation: 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 18: 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 19: 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 20: 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 lumbar herniated 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 lumbar herniated disc radiculopathy. Recommendation grade: I (insufficient evidence) Question 21: 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 22: What is the likelihood that patients diagnosed with lumbar herniated disc radiculopathy will have a good/good functional prognosis in the short term (less than 6 weeks), medium term (6 weeks to 2 years), or long term (greater than 2 years) when receiving the corresponding pharmacologic or interventional treatment? Pharmacologic or interventional treatment improves the clinical functional prognosis of most patients with lumbar herniated disc radiculopathy. Grade of Recommendation: B Transsphenoidal ESIs improve the clinical functional 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 level: I (insufficient evidence) Question 23: 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? 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 when treating different types of lumbar disc herniation radiculopathy with transdural 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. Level of recommendation: I (insufficient evidence) Question 24: 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 utility ratio [46.47]. Question 25: Is there a clinical sign or symptom that suggests a good prognosis for surgical treatment of lumbar herniated disc radiculopathy? 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 26: 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. Q27: When is the best time for surgical intervention? For patients with lumbar herniated disc radiculopathy with severe symptoms requiring surgical treatment, surgery is recommended within 6 months. Available evidence suggests that patients with early surgical intervention (6 months-1 year) have faster postoperative recovery and 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 28: 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 pharmacologic/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 29: Are there specific situations in the clinic that require lumbar fusion to achieve 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 30: 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. Grade 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 surgical treatment. 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 a herniated disc on the very lateral side. 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) The use of glucocorticoids or/and fentanyl after lumbar decompression is not recommended to improve long-term postoperative pain in patients. Grade of Recommendation: B There is no clear clinical evidence to support or oppose the application of localized fat flap coverage at the decompression site after lumbar decompression. Grade of Recommendation: I (Insufficient Evidence) There is no clear clinical evidence supporting or opposing the use of Oxiplex/SP gel or ADCON-L in discectomy. Recommendation grade: I (Insufficient evidence) Question 31: 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 32: 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. Question 33: What is the utility of surgery for lumbar herniated disc radiculopathy? There are more studies suggesting that surgical treatment has a better utility ratio for patients with strictly selected surgical indications. Q34: Do different surgical approaches affect the benefit of treatment for herniated lumbar disc radiculopathy? There are no relevant studies on this issue. Question 35: Do different medical institutions affect the benefit of treatment for lumbar herniated disc radiculopathy There are no relevant studies on this issue.