Caudal Lumbar Disc Herniations Are More Likely to Require Surgery for Symptom Resolution

Anmol Gupta, Shivam Upadhyaya, Caleb M. Yeung, Peter J. Ostergaard, Harold A. Fogel, Thomas Cha, Joseph Schwab, Chris Bono, Stuart Hershman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Study Design: Retrospective study. Objectives: We examined the impact that location of a lumbar disc herniation has on the likelihood that a patient will require surgery after at least 6 weeks of nonoperative management. Methods: Using ICD-10 codes M51.26 and M51.27, we identified patients at a single academic institution from 2015 to 2016 who received a diagnosis of primary lumbar radicular pain, had magnetic resonance imaging confirming a lumbar disc herniation, and underwent at least 6 weeks of nonoperative management. Patients experiencing symptoms suggesting cauda equina syndrome or progressive motor deficits were excluded. Results: Five hundred patients met inclusion/exclusion criteria. Twenty-nine (5.8%) had L3-L4 herniations, 245 (49.0%) had L4-L5 herniations, and 226 (45.2%) had L5-S1 herniations. Overall, 451 (90.2%) patients did not undergo surgery within 1 year of diagnosis. Nonsurgical patients had an average herniation size occupying 31.2% of the canal, compared with 31.5% in patients who underwent surgery. While herniation size, age, sex, and race failed to demonstrate a statistical association with the likelihood for surgery, location of disc herniation demonstrated a strong association. L3-L4 and L4-L5 herniations had odds ratios of 0.19 and 0.45, respectively, relative to L5-S1 herniations (P =.0047). Patients were more than twice as likely to require a surgery on an L5-S1 herniation in comparison with an L4-L5 herniation (P <.05). L3-L4 herniations rarely required surgery. Conclusions: Patients with caudal lumbar disc herniations were more likely to require surgery after at least 6 weeks of conservative management than those with disc herniations in the mid-lumbar spine.

Original languageEnglish
Pages (from-to)359-364
Number of pages6
JournalGlobal Spine Journal
Issue number3
StatePublished - Apr 2021


  • disc herniation
  • discectomy
  • low back pain
  • lumbar
  • lumbosacral
  • nonoperative management
  • orthopaedic
  • radiculopathy
  • radiology
  • spine


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