Review Article An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy D. Scott Kreiner, MD a, * , Steven W. Hwang, MD b , John E. Easa, MD c , Daniel K. Resnick, MD d , Jamie L. Baisden, MD e , Shay Bess, MD f , Charles H. Cho, MD, MBA g , Michael J. DePalma, MD h , Paul Dougherty, II, DC i , Robert Fernand, MD j , Gary Ghiselli, MD k , Amgad S. Hanna, MD l , Tim Lamer, MD m , Anthony J. Lisi, DC n , Daniel J. Mazanec, MD o , Richard J. Meagher, MD p , Robert C. Nucci, MD q , Rakesh D. Patel, MD r , Jonathan N. Sembrano, MD s , Anil K. Sharma, MD t , Jeffrey T. Summers, MD u , Christopher K. Taleghani, MD v , William L. Tontz, Jr., MD w , John F. Toton, MD x a Ahwatukee Sports and Spine, 4530 E. Muirwood Dr, Suite 110, Phoenix, AZ 85048-7693, USA b Department of Neurosurgery, Tufts Medical Center, 800 Washington St, Boston, MA 02111-1552, USA c The College of Human Medicine, Michigan State University, 12662 Riley St, Suite 120, Holland, MI 49424-8023, USA d Department Neurosurgery, University of Wisconsin Medical School, K4/834 Clinical Science Center, 600 Highland, Madison, WI 53792-0001, USA e Department of Neurosurgery, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI 53226-3522, USA f Rocky Mountain Scoliosis and Spine, 2055 High St, Suite 130, Denver, CO 80205-5504, USA g Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115-6110, USA h 2918 Calcutt Drive, Midlothian, VA 23113-2681, USA i 2000 Van Auken Rd, Newark, NY 14513-9221, USA j 160 Cheyenne Way, Wayne, NJ 07470-4907, USA k Denver Spine, 7800 E. Orchard Rd, Suite 100, Greenwood Village, CO 80111-2584, USA l 9120 Bear Claw Way, Madison, WI 53717-2734, USA m Mayo Clinic Rochester, 200 1st St SW, Eisenberg 8G, Rochester, MN 55905-0001, USA n VACT Healthcare System, 950 Campbell Ave., Bldg 2, Floor 4, West Haven, CT 06516-2770, USA o Cleveland Clinic Spine Institute, 9500 Euclid Ave., C21, Cleveland, OH 44195-0001, USA p 2152 Susquehanna Rd, Abington, PA 19001-4408, USA q 6322 Gunn Hwy, Tampa, FL 33625-4105, USA r University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5000, USA s University of Minnesota, 2450 Riverside Ave. S., Suite R200, Minneapolis, MN 55454-1450, USA t Spine and Pain Medicine, 2 Mockingbird Drive, Colts Neck, NJ 07722-2228, USA u NewSouth NeuroSpine, 2470 Flowood Drive, Flowood, MS 39232-9019, USA v Cumberland Brain and Spine, 3901 Central Pike, Suite 455, Hermitage, TN 37076-3490, USA w 3413 Mount Ariane Drive, San Diego, CA 92111-3910, USA x 4866 Hoen Ave., Santa Rosa, CA 95405-7452, USA Received 7 August 2013; accepted 14 August 2013 Abstract BACKGROUND CONTEXT: The objective of the North American Spine Society’s (NASS) Ev- idence-Based Clinical Guideline for the Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy is to provide evidence-based recommendations to address key clinical questions sur- rounding the diagnosis and treatment of lumbar disc herniation with radiculopathy. The guideline is intended to reflect contemporary treatment concepts for symptomatic lumbar disc herniation with radiculopathy as reflected in the highest quality clinical literature available on this subject as of July 2011. The goals of the guideline recommendations are to assist in delivering optimum efficacious treatment and functional recovery from this spinal disorder. FDA device/drug status: Not applicable. Author disclosures: Listed at the end of this article. * Corresponding author. Ahwatukee Sports and Spine, 4530 E. Muir- wood Dr., Suite 110, Phoenix, AZ 85048-7693, USA. Tel.: (480) 763- 5808. E-mail address: skreiner@ahwatukeesportsandspine.com (D.S. Kreiner) 1529-9430/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.spinee.2013.08.003 The Spine Journal 14 (2014) 180–191