The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations Lumbar disc herniation (LDH) is a common spinal condition, affecting 2-3% of the population. Conservative treatment is recommended as the first-line approach for LDH in patients without serious neurological deficits, such as cauda equina syndrome or motor deficits. NSAIDs are effective for acute low back and sciatic pain caused by LDH. A combination of activity modification, pharmacotherapy, and physical therapy provides good outcomes for most LDH patients. The World Federation of Neurosurgical Societies (WFNS) Spine Committee reviewed recent literature and conducted two international consensus meetings to formulate evidence-based recommendations for conservative treatment of LDH. The Delphi method was used to reach three final consensus statements. Conservative therapy includes non-surgical treatments such as pharmacological and non-pharmacological interventions. Pharmacological treatments include acetaminophen, NSAIDs, muscle relaxants, and opioids. NSAIDs are effective for reducing inflammation and pain. Muscle relaxants may be used for acute low back pain, though they are generally not recommended for low back pain due to their therapeutic purposes for other conditions. Opioids are controversial due to their potential for dependency and adverse effects, though tramadol may be beneficial for radicular pain with fewer side effects. Non-pharmacological treatments include physical therapy, traction therapy, bed rest, and traditional medicine. Physical therapy, such as back extension exercises, can improve low back pain. Traction therapy may provide temporary relief but poses risks. Bed rest may not be more effective than waiting for pain relief. Traditional medicine, such as acupuncture, may provide short-term relief for chronic low back pain but lacks strong evidence for discogenic pain. Injections and intradiscal interventions may be beneficial for selected patients but have worse long-term outcomes compared to surgery. The WFNS Spine Committee recommends that NSAIDs have a significant positive effect on acute low back and sciatic pain caused by LDH, and conservative treatment is recommended as the first-line treatment for LDH in patients without neurologic deficits.The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations Lumbar disc herniation (LDH) is a common spinal condition, affecting 2-3% of the population. Conservative treatment is recommended as the first-line approach for LDH in patients without serious neurological deficits, such as cauda equina syndrome or motor deficits. NSAIDs are effective for acute low back and sciatic pain caused by LDH. A combination of activity modification, pharmacotherapy, and physical therapy provides good outcomes for most LDH patients. The World Federation of Neurosurgical Societies (WFNS) Spine Committee reviewed recent literature and conducted two international consensus meetings to formulate evidence-based recommendations for conservative treatment of LDH. The Delphi method was used to reach three final consensus statements. Conservative therapy includes non-surgical treatments such as pharmacological and non-pharmacological interventions. Pharmacological treatments include acetaminophen, NSAIDs, muscle relaxants, and opioids. NSAIDs are effective for reducing inflammation and pain. Muscle relaxants may be used for acute low back pain, though they are generally not recommended for low back pain due to their therapeutic purposes for other conditions. Opioids are controversial due to their potential for dependency and adverse effects, though tramadol may be beneficial for radicular pain with fewer side effects. Non-pharmacological treatments include physical therapy, traction therapy, bed rest, and traditional medicine. Physical therapy, such as back extension exercises, can improve low back pain. Traction therapy may provide temporary relief but poses risks. Bed rest may not be more effective than waiting for pain relief. Traditional medicine, such as acupuncture, may provide short-term relief for chronic low back pain but lacks strong evidence for discogenic pain. Injections and intradiscal interventions may be beneficial for selected patients but have worse long-term outcomes compared to surgery. The WFNS Spine Committee recommends that NSAIDs have a significant positive effect on acute low back and sciatic pain caused by LDH, and conservative treatment is recommended as the first-line treatment for LDH in patients without neurologic deficits.