Conservative Treatment of Lumbar Disc Herniation: A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal

ABSTRACT

STUDY DESIGN: Prospective study. OBJECTIVES: To investigate the clinical results of conservative treatment for mid-to-large lumbar disc herniation diagnosed via magnetic resonance imaging (MRI) and the factors influencing treatment. SUMMARY OF LITERATURE REVIEW There is limited information regarding the clinical results of conservative treatment for lumbar disc herniation. The recent studies using MRI have suggested favorable treatment results. MATERIALS AND METHODS: The study subjects were 39 cases of herniated disc patients with over a 1/3 spinal canal encroachment -- based on MRI -- that were followed up for at least 1 year. The average age was 42.6-years-old (range of 12-76 years-old), and the average follow-up period was 28 months. The neurological deficit and the visual analogue scale (VAS) of back pain and radiating pain at the time of initial diagnoses and final follow-ups were compared, and the clinical results were evaluated based Kim & Kim's criteria. RESULTS: Although 4 of the 39 patients needed to undergo surgery during the follow-up period, 33 of the remaining 35 patients showed satisfactory (excellent and good ratings) results: 27 excellent, 6 good, 2 fair, i.e., a 85% (33 out of 39) satisfactory results. Of the 14 cases that had neurological defect at the initial diagnosis, only 1 case needed surgery, thereby resulting in a 93% (13 out of 14) satisfactory result. There were no statistically significant correlations among the degree of spinal canal encroachment and other factors such as age, sex, herniation type, and neurological deficit at initial diagnosis, and the clinical results at the final follow-up, conversion to surgery during follow-up, and remaining pains. CONCLUSIONS: The clinical results of conservative treatment in lumbar disc herniation were satisfactory even in cases of high degree of spinal canal encroachment. Therefore, conservative treatment of lumbar disc herniation should be considered first before resorting to surgical treatment.