Prognosis

About 70% to 85% of adults experience low back pain (LBP) at some point during their life.[4] Approximately 90% of these individuals will have resolution of symptoms within 3 months of onset, with or without treatment.[4] The majority of patients with acute exacerbations of discogenic back pain will improve by 4 weeks.[173]

The natural history of LBP suggests that it is reasonable to initially treat all patients conservatively. However, cases presenting with a neurological emergency and those with red flags (night pain, unexplained weight loss, fever, known history of malignancy, intravenous drug user, or tuberculosis exposure) warrant urgent imaging and treatment for the specific underlying pathology. Once all conservative measures have been exhausted or if the symptoms warrant, surgical intervention may be necessary.

Recurrences are common; however, the severity is usually less. Only a small proportion (5%) of people with an acute episode of LBP develop chronic LBP and related disability.[100]

Outcomes after surgery: one study showed superior outcomes for a well-informed and selected group of patients receiving fusion for severe chronic LBP compared with those receiving non-surgical treatment.[145] Several factors have been analysed with regards to the surgical result after fusion. Interestingly, poor surgical outcome has been correlated with patients receiving workers' compensation, the number of previous low back operations, low income, increased age, and litigation.[174][175] Another study has shown that smoking, depression, and litigation are predictive factors of a poor outcome despite the successful achievement of fusion.[176] Although there is a continuous evolution in spine surgery with the use of new improved instrumentation and more effective medications, a review of the literature suggests that the results of fusion are still controversial.[145][177][178] One systematic review investigating the efficacy of conservative and surgical managements for lumbar disc herniation in athletes found the percentages of athletes returning to their original levels of sporting activity to be 78.9% for conservative treatment, 85.1% for microdiscectomy, and 69.9% for percutaneous discectomy.[179]

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