Prolonged Physiotherapy versus Early Surgical Intervention in Patients with Lumbar Disk Herniation: Short-term Outcomes of Clinical Randomized Trial

STUDY DESIGN: Randomized controlled trial. PURPOSE: We compared the disability and functional outcome after conservative treatment with prolonged physiotherapy versus early surgical intervention in patients with lumbar disk herniation. OVERVIEW OF LITERATURE: Lumbar disk herniation is one of the most common causes of job-related disability in individuals less than 45 years old. Conservative treatment is the initial pathway for the majority of patients but the duration of conservative treatment remains debatable and the adverse effects of prolonged conservative treatment are still unclear. Prolonged duration of symptoms before surgical intervention is associated with worse outcomes than a short period of symptoms. METHODS: From June 2011 to July 2013, 60 patients with lumbar disk herniation at our institute were randomized into two groups. Group I was treated with prolonged physiotherapy and rehabilitation for 6 months, while group II was treated with early surgical discectomy. Oswestry disability index was used to assess disability, while the Prolo economic outcome rating scale was used to assess the work status. RESULTS: Most patients were males between 21 and 45 years old (mean age, 35.88±7.15). There was significant improvement in the disability and work status in both groups without statistically significant differences in the disability score at the second or third assessment. However, the Prolo scale became significantly better in group I than in group II patients during the second and third assessments. CONCLUSIONS: A prolonged physiotherapy and rehabilitation program is a beneficial and successful treatment in patients with recently diagnosed lumbar disk herniation.

effects of estrogen receptor gene-alpha polymorphism on bone mineral density and serum osteoprotegerin levels in postmenopausal Egyptian women

The gene coding for estrogen receptor-alpha [ER-a] is a potential candidate for the regulation of bone mineral density [BMD] in postmenopausal women. The present study was aimed at elucidating the role of two restriction fragment lengths Pvu II and Xba I polymorphisms of the ER-a gene as determinants of bone mineral density; special attention was paid to the correlation between serum osteoprotegerin [OPG] levels and BMD in different ER-a genotypes in postmenopausal [PM] Egyptian women. BMD was measured at the femur neck [FN-BMD]. ER-a gene polymorphisms were detected by PCR-RFLP. Serum OPG levels were measured by an enzyme linked immunosorbent assay. There were significant differences in BMD and OPG according to different genotypes of Pvu II Single-nucleotide polymorphism [SNP]. Carriers of the pp genotype were more likely to have lower BMD and lower OPG values than noncarriers. While there was no significant relationship between Xbal polymorphism and these variables. Postmenopausal [PM] women were stratified into; those with osteoporosis and those without osteoporosis. The difference in BMD and OPG among genotypes were significant in PM with osteoporosis. Further we confirmed that the frequency of p allele. and pp genotype of Pvu II polymorphism were significantly higher in PM with osteoporosis as compared to PMwithout osteoporosis. Xba I failed to show any significant difference in genotype and allele frequencies between the two groups. Genotypes modulate the relationships between BMD and OPG levels, in women with the PP [r=0.512, p<0.000l] and Pp [r=0.346, p<0.0009] genotypes but not in women with the other genotypes [p>0.05]. These results suggest that the Pvu II polymorphism of ER-a may be associated with the FN-BMD in PM Egyptian women. Further, P allele carriers supposed to protect against PM osteoporosis at least partly by increasing serum OPG