• Nadia Khan, Caroline E Drolet, Farrokh Farrokhi, Venu Nemani, Jean-Christophe A Leveque, Katie Krause, Andrew S Friedman, Aiyush Bansal, and Philip K Louie.
• Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle, Washington, USA; School of Medicine, University of Washington, Seattle, Washington, USA.
• World Neurosurg. 2023 Oct 1; 178: e682e691e682-e691.

ObjectiveTo compare information online regarding lumbar disc herniation (LDH) on commonly searched websites and compare those findings with the evidence-based recommendations listed in the North American Spine Society (NASS) clinical practice guidelines.MethodsNASS Clinical Practice Guidelines, Internet searches were performed utilizing three common search engines (Google, Bing, Yahoo) and keywords associated with LDH. The top 20 websites from each search were selected. The content regarding diagnosis and treatment of LDH was compared to the NASS clinical practice guidelines.ResultsOn average, websites mentioned only 59% of recommendations supported by Level I evidence. Websites included an average of 3 recommendations not discussed in the NASS guidelines out of an average of 12 total recommendations. Muscle and sensory testing and physical therapy were the most frequent recommendations, appearing on over 80% of websites. Websites were equally likely to contain recommendations backed by high-quality evidence as recommendations not included in NASS guidelines.ConclusionsThis study demonstrates that websites regarding LDH contain a mix of information, with only a fraction of recommendations aligning with NASS clinical guidelines. Patients who use these websites are presented with unsubstantiated information, conceivably impacting their understanding, expectations and decision-making in physician offices.Copyright © 2023 Elsevier Inc. All rights reserved.

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