A significant proportion of patients with lumbar disc herniation do not achieve adequate pain relief or functional recovery through first-line conservative management. When conservative therapy has been given a reasonable trial — typically around three months — without reaching the goals of pain alleviation and improved physical function, the clinical situation calls for a structured next-line approach.
Standard first-line care includes conservative treatment: pharmacotherapy with NSAIDs or oral corticosteroids in the acute phase, agents for neuropathic pain, and physical therapy (exercise, traction, ultrasound), along with local stabilisation supports. The target is alleviation of pain and improvement of physical function, with spontaneous resorption of the herniated mass possible over roughly three months. When these goals remain unmet, escalation is indicated.
For patients who have not responded sufficiently to conservative measures, the next-line protocol involves targeted procedures that deliver agents directly into the epidural space for radicular pain. A separate intradiscal option is available for patients meeting specific criteria. The complete agent selection, sequencing, and clinical decision algorithm are in the full protocol.
The primary aim is improvement of pain and quality of life (QOL) for approximately 3–12 months following administration — providing meaningful, sustained relief for patients who did not benefit adequately from conservative therapy.
DOI: 10.22603/ssrr.2022-0045