Since surgery to treat a herniated disc should rarely be done during the first 4 weeks of symptoms, NAI need not be done during this time period. Since NAI will not change management during this time period, it does not meet the criteria which define a useful diagnostic test in the first 4 weeks of low back pain. One cannot predict which patient will be in the group which will improve. Therefore, in the absence of a serious cause of LBP, patients should be given at least 4 weeks, and up to 7 weeks, to demonstrate whether they will recover before NAI is considered. Those who have sciatica may have a herniated disc causing their symptoms.
Surgical treatment can speed recovery in such patients.
The more long-term outcome, however, is not much different for patients undergoing surgery compared to those not operated on initially. This difference was not statistically significant. Ten years out the results were equivalent between the 2 groups. Over the long-term, both groups demonstrated equivalent levels of function, including work disability. Surgery therefore speeds recovery, but does not change the ultimate outcome for a patient whose back pain and sciatica are due to a herniated disc.