There is a need for quality trials that study optimal selection and timing of surgical treatment options. Studies are needed of cost-effectiveness and effect on long-term improvement. Until data from such studies are available, primary physicians should follow the guidelines on conservative management and aggressively evaluate the red flags of low back pain, immediately refer for neurologic deficit and bowel or bladder compromise, and focus treatment on modalities with high-quality evidence-based information. Patients who do not improve can be referred to surgeons with experience and expertise in discectomies.
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