Optimal duration of conservative management prior to surgery for cervical and lumbar radiculopathy: a literature review.

Global spine J 2014 Dec;4(4):279-86.

Alentado VJ et al

 Conclusions: There are limited studies supporting any optimal duration of conservative treatment prior to surgery for cervical and lumbar radiculopathy. Therefore, evidence-based conclusions cannot be made. Based on the available literature, we suggest that an optimal timing for surgery following cervical radiculopathy is within 8 weeks of onset of symptoms. A shorter period of 4 weeks may be appropriate based on natural history studies. Additionally, we found that optimal timing for surgery following lumbar radiculopathy is between 4 and 8 weeks. A prospective study is needed to explicitly identify the optimal duration of conservative therapy prior to surgery.

Comment: Many of us prevaricate as to when to refer…and often IF it is in the patients’ best interest. Though the latter question is always open to argument the decision in the population of “surgical-likely” patients does appear to be about 8 weeks. UPMC in 2012 adopted a 12 week conservative-failure prior to referral to expensive imaging or invasive options. Clearly some patients have ominous symptoms requiring an earlier (4 week) referral.