The inflammatory response in the regression of lumbar disc herniation LDH spontaneous resorption is well documented clinically and in preclinical studies. Spine surgeons are becoming increasingly aware of this phenomenon and many recognize the usefulness of conservative treatment for LDH and advise patients accordingly. Different forms of nonsurgical treatments should be exhausted before considering surgery in acute stages of LDH, unless conservative treatment is contraindicated for reasons such as neurological deficit and intolerable pain despite administration of adequate pain medications. It is clear that the inflammatory response that occurs associated with LDH is crucial to its spontaneous resorption. Therefore, inflammation in this specific clinical context is a good prognostic indicator and should not be halted. Still, it is exactly an inflammatory response that causes a harmful effect on the adjacent nerve roots, causing pain. The control of the inflammatory reaction in this setting is an important challenge when treating patients with LDH. The combination of knowledge from the biological mechanisms behind LDH resorption and the detailed personalized diagnosis will be the determinant to tailor treatment to each individual patient and may ultimately lead to reduction in costs to the health system.
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