Low back pain can’t be definitively diagnosed in up to 85% of patients. But the herniated lumbar disc (HNP) is the most common specific cause of LBP.  HNP treatment is either conservative or surgical, the latter usually restricted for patients with severe symptoms.  One way to measure the value of surgery is to compare matched patient with the same HNP findings, one treated with surgery and the other given non-surgical management.

In Sweden, the cost and utility of surgery for a HNP was determined simultaneously from a single group. Ninety-two individuals in a cohort of 1,146 Swedish subjects underwent lumbar disc herniation surgery during a 2-year study. Each person operated on was individually matched with one having a similar HNP but treated conservatively. The effects and costs of the treatments were determined individually. By estimating quality of life before and after the treatment, the number of quality adjusted life years (QALY) gained with and without surgery was calculated. The medical costs were much higher for surgical treatment; however, the total costs, including disability costs, were lower among those treated surgically. Surgery meant fewer recurrences and less permanent disability benefits. The gain in QALY was ten times higher among those operated on. Lower total costs and better utility resulted in a better cost utility for surgical treatment. This Swedish study concluded that surgery for HNP is cost-effective. The total costs for surgery were lower due to lower recurrence rates and fewer disability benefits; surgery improved quality of life much more than nonsurgical treatments.