This scoping review summarizes emerging evidence supporting a potential biological role of the microbiome in lumbar disc herniation (LDH). By synthesizing 26 preclinical and clinical studies, the authors describe how gut microbiota dysbiosis may modulate systemic inflammation, neuroimmune signaling, and pain sensitization in experimental LDH models. In parallel, clinical studies report the presence of low-pathogenic bacteria, particularly Cutibacterium acnes, in surgically excised intervertebral discs, potentially associated with Modic changes and chronic pain.
Overall, this article introduces the gut-disc axis as a biologically plausible but still preliminary concept in LDH pathophysiology, highlighting the need for standardized, contamination-controlled studies to clarify causality and therapeutic potential.
This cross-sectional survey, led by AO Spine, comprehensively describes global practice patterns for the surgical treatment of primary lumbar disc herniation (LDH). Based on responses from 714 surgeons across five geographic regions, the study demonstrates that neurological status is the primary determinant of early surgery in non-urgent cases, while bladder/bowel dysfunction and severe motor impairment were the primary reasons for emergency surgery. Most surgeons preferred minimally invasive procedures with partial laminectomy and partial discectomy. Notably, regional and educational differences significantly influenced surgical approaches and the number of procedures performed.
These findings highlight substantial international variability in LDH management and emphasize the need for harmonized, evidence-based guidelines to optimize surgical decision-making and patient outcomes worldwide.
This large-scale systematic review and meta-analysis evaluates preoperative risk factors associated with recurrent lumbar disc herniation following discectomy. Analyzing 51 studies involving over 52,000 patients, the recurrence rate was 12.2%. The meta-analysis found that high body mass index, diabetes, increased sagittal segmental motion, and the presence of Modic changes were significantly associated with recurrence, while other proposed factors showed no consistent effect.
These results provide strong evidence supporting preoperative risk stratification and highlight the importance of metabolic and radiological factors in recurrence. This study suggests the need for future prospective validation and may provide useful information for patient counseling and tailored surgical decisions.
This systematic review and meta-analysis compared endoscopic discectomy (ED) with conventional microdiscectomy (MD) for the treatment of lumbar disc herniation. Seventeen studies involving over 3,100 patients were analyzed. ED demonstrated significantly shorter hospital stays and greater short-term functional improvements, while long-term outcomes and pain relief were similar between the two procedures. ED had a lower rate of wound-related complications, but transforaminal ED had a higher recurrence rate.
Overall, this study suggests that ED offers significant perioperative benefits but does not yet replace MD as the standard treatment. Endoscopic techniques using interlaminar and dual approaches appear promising, but high-quality, long-term randomized controlled trials are needed before reestablishing the standard treatment.
This narrative review examines the biological mechanisms underlying the spontaneous resorption of herniated lumbar discs, a key factor in recovery with conservative treatment. The authors highlight the role of immune cell infiltration, cytokine signaling, and proteolytic activity in disc regression, while noting that conventional anti-inflammatory therapies may inadvertently hinder this reparative process. Clinical outcomes are further influenced by rehabilitation strategies, lifestyle, herniation type, and host immune status, yet reliable predictive biomarkers remain unestablished.
By addressing critical knowledge gaps, this paper highlights the potential for harnessing intrinsic disc healing mechanisms and supports a more personalized, biology-informed approach to the nonsurgical treatment of lumbar disc herniation.
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