Recent advances and evolving strategies in the treatment of lumbar disc herniation

Lumbar disc herniation (LDH) remains a leading cause of low back pain and sciatica, imposing a considerable global health and socioeconomic burden. Over the past decades, substantial progress has been made in both conservative and surgical interventions, yet controversies persist regarding optimal treatment strategies, long-term efficacy, and recurrence prevention. This review provides a comprehensive overview of current therapeutic approaches, including pharmacological management, physical therapy, minimally invasive and open surgical techniques, as well as emerging biological therapies. Special attention is given to platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and chemonucleolysis, which demonstrate potential in delaying disc degeneration and enhancing tissue repair. Moreover, we highlight the growing role of artificial intelligence (AI) in diagnosis, surgical planning, prognosis prediction, and rehabilitation monitoring, along with the increasing emphasis on multidisciplinary team (MDT) management. Finally, we discuss ongoing challenges, such as the need for standardized long-term outcome evaluation, individualized treatment pathways, and the clinical translation of regenerative medicine. By integrating traditional strategies with novel technologies, this review underscores the evolving paradigm of LDH management toward more minimally invasive, personalized, and multidisciplinary approaches.