Abstract Different authors recommend different time spans for conservative treatment before considering sur- gery in patients suffering from lumbar disc herniation. We analyzed the time of onset of symptoms such as pain, sensory deficit, and motor deficit in a surgically treated group in comparison to outcome after surgery in order to define a time threshold when surgical results deteriorate and operation should therefore be considered. General data, symptoms, signs, and neurological findings of 219 patients were preoperatively recorded. The outcome was evaluated according to the Prolo scale after a mean of 9.9 months. In the statistical workup, we calculated the duration of symptoms, sensory deficits, and motor deficit as continuous variables. Additionally, the population was divided into three groups of duration of symptoms, sen- sory deficit, or motor deficit for ≤30 days, 30–60 days, and >60 days. Statistically significant predictors for un- favourable outcome were, for example, a longer duration of preoperative pain and motor and sensory deficit. Pa- tients suffering for more than 60 days from disc hernia- tion were found to have statistically worse outcome than patients suffering for 60 days or less. Findings were sim- ilar for the different time groups concerning the duration of sensory deficit but not for duration of motor deficit. The overall outcome seems to be better when patients are operated on for lumbar disc herniations within 2 months after onset of symptoms and sensory deficits. Due to these findings, we recommend conservative treat- ment up to 2 months and, if conservative management does not succeed, consideration of surgery. Keywords Lumbar disc surgery · Conservative treatment · Surgery Introduction According to Postacchini et al., many operations for lumbar disc herniation could probably be avoided if en- ergetic conservative management were continued for longer periods before considering surgery. On the con- trary, it is clearly a mistake and potentially dangerous obstinately to carry out conservative treatment in all pa- tients with herniated discs, especially because many re- ports indicate that patients with long-standing preopera- tive symptoms have fewer chances of obtaining satisfac- tory results from surgery than those whose symptoms are of short duration [2, 7, 11, 14]. Therefore, two requisites should be borne in mind: to avoid excessively prolonged conservative treatment and to avoid surgery in herniated disc patients who may become asymptomatic through conservative therapy. Thus the crucial question is when conservative treat- ment for lumbar disc herniation should be ceased and surgery should be considered. We tried to answer this question by analyzing the duration of symptoms such as pain, sensory deficit, and motor deficit in a prospective, consecutively sampled, surgically treated group in com- parison to outcome after surgery in order to define a time threshold when surgical results deteriorate. Materials and methods In this prospective consecutive study, we included patients who underwent surgery on monosegmental lumbar disc herniations for the first time. General data, symptoms, signs, and neurological findings of 219 patients were preoperatively recorded. In all pa- tients, lumbar disc herniation was the leading pathophysiological process. Patients with concentric spinal canal stenosis as well as those showing only lateral canal stenosis were excluded. Before surgery, all patients received a visual analogue rating scale (VAS) (0 = no pain to 100 = worst pain the patient could imagine) to classify their individual pain level as described elsewhere [1, 6, 13]. The standard operation procedure was a conventional discec- tomy via an extended interlaminar fenestration. All patients re- ceiving laminectomy or hemilaminectomy were excluded. The level operated on was verified by radioscopy intraoperatively. The R.D. Rothoerl ( ✉ ) · C. Woertgen · A. Brawanski Department of Neurosurgery, University of Regensburg, Franz Josef Strauss-Allee 11, 93053 Regensburg, Germany e-mail: rolf.rothoerl@klinik.uni-regensburg.de Tel.: +49-941-9449001, Fax: +49-941-9449002 Neurosurg Rev (2002) 25:162–165 DOI 10.1007/s101430100184 ORIGINAL ARTICLE Ralf D. Rothoerl · Chris Woertgen Alexander Brawanski When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Received: 11 May 2001 / Accepted: 13 July 2001 / Published online: 5 December 2001 © Springer-Verlag 2001