Recommendations of the Ameican Academy of Orthopedic Surgeons (AAOS):
(1) functional, incapacitating pain in the leg, extending below the knee, and having a nerve root distribution.
(2) signs of nerve root tension, such as a positive straight leg raising test, with or without neurologic abnormalities, fitting the radiculopathy.
(3) failure of clinical improvement after 4-8 weeks of conservative treatment.
(4) confirming imaging study (such as myelogram, computed tomogram or magnetic resonance image) which correlates with the physical signs and distribution of the pain.
Spengler et al list 5 criteria for elective discectomy:
(1) impaired bladder or bowel function
(2) progressive motor weakness
(3) objective evidence of increasing impairment of nerve-root conduction despite complete bed rest
(4) severe sciatic nerve pain associated with tension on the nerve root that increases or persists despite complete bed rest
(5) recurrent incapacitating episodes of sciatic pain with tension on the nerve root and/or impairment of nerve root conduction.
