Surgical versus conservative management of lumbar disc prolapse: A systematic review and meta-analysis

Lumbar disc prolapse is a common spinal pathology leading to significant pain, disability, and socioeconomic burden. Treatment remains controversial, with both surgical and conservative options widely practiced. This review aimed to systematically compare surgical versus conservative management of lumbar disc prolapse, focusing on pain relief, functional recovery, and long-term outcomes. A systematic search of PubMed, Embase, Cochrane Library, and Scopus databases was conducted for randomized controlled trials and high-quality cohort studies published between 2000 and 2024. Studies comparing surgical discectomy with conservative treatment modalities were included. Outcomes assessed were pain intensity, functional status, quality of life, recurrence, and complications. Data were pooled using a random-effects meta-analysis model. A total of 20 studies encompassing 4,965 patients were included. Surgical intervention provided superior short-term outcomes in terms of pain reduction and functional improvement at 3–6-month post-treatment ( P < 0.01). However, no significant difference was observed in long-term outcomes beyond 24 months. Reoperation rates following surgery ranged from 8% to 12%, while conservative management carried risks of prolonged pain, delayed return to work, and opioid dependency. Surgery offers faster symptomatic relief and earlier functional recovery, whereas conservative management achieves comparable long-term outcomes. Treatment choice should be individualized, taking into account symptom severity, neurological status, patient preference, and socioeconomic context.