It is evident when to make a surgery for lumbar disc herniation?

The literature supports both conservative management and surgical intervention as viable options for the treatment of radiculopathy caused by lumbar disc herniation. However, the majority of available literature is limited to retrospectives, meta-analyses or literature reviews. Methodological drawbacks and difficulties limit the effect of performed prospective, randomized, controlled trials. That may be the reason why no "gold standard" treatment has yet been established. Surgery may result in faster relief from pain than conservative treatment and earlier restoration of the function of the affected root, although long-term results appear to be similar regardless the type of management. The optimal timing of elective surgery is not clear; only a broad time frame (2-12 months) could be derived from the review of literature; a preponderance of studies reported that surgical interventions should be performed within 6 months. We usually prefer 6-7 weeks in the case of failure of conservative treatment. The current available evidence is not robust enough for answering the question in which time period can surgical intervention be effective in patient with paresis due to herniated lumbar disc. Although the evidence is still lacking, we feel that in patients with unbearable pain and severe paresis, we should prefer early surgical intervention. Age, initial severity of neurological deficit, sensory involvement, the duration of paresis has been postulated to influence neurological recovery.