A long-term follow-up study of treatment of lumbar disc herniation with operative or non-operative methods / 解放军医学杂志

ABSTRACT

Objective A retrospective study of the results of surgical or non-operative treatment in patients with herniation of lumbar disc 10 years or longer before,in order to evaluate the efficacy of different therapeatic strategies for lumbar disc herniation. Method Definite diagnosis of lumbar disc herniation was made in all cases before treatment,and the follow-up period was 10 to 38 years. The patients were divided into three groups according to different treatment methods: non-operative group,simple nucleus resection group,and nucleus resection combined with space fusion group. The long term therapeutic effects and image change of the three groups were observed. The difference of height of intervertebral space at the herniation site was measured before treatment and at the latest follow-up. Adjacent spaces were also observed. The data were analyzed statistically by t -test and ? 2 -test. Results Among 98 cases in non-operative group,85 cases enjoyed almost a normal life and work;vertebral canal decompression was performed for the rest 13 cases because of intermittent claudication. The protruded space was narrowed for 3.17?1.65mm in height in average after non-operative treatment,and there was degeneration of adjacent spaces in 13 cases. Among the 84 cases in simple nucleus resection group,relative good outcome was seen in 71 patients,and the remaining 13 cases had to receive a second operation because of symptom relapse. The protruded space was decreased 5.50?1.51mm in height in average as measured at the latest follow-up comparing with that of before operation. The degeneration of the adjacent space was observed in 15 cases. In 71 patients who received nucleus resection combined with space fusion experienced a good relief of symptoms. The space,where disc herniation had occurred,fused very well and no re-narrowing occurred. Degeneration of the adjacent space was observed in 39 cases,but the patients were symptomless. Conclusions The effect of either non-operative therapy or operation for patients with lumbar disc herniation was good after a long-term follow-up if the indication was chosen properly. We suggest that non-operative therapy should be the first choice for the lumbar disc herniation. The relatively normal nucleus should be preserved as much as possible when nucleus resection was performed. Intervertebral fusion was a relative better treatment comparing with the other two treatments.