J Korean Soc Spine Surg.  2011 Sep;18(3):123-131.

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

• Shin BJ
• Lee JC
• Lee HH
• Jang HD

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.

Keyword

Lumbar Disc Herniation; Conservative Treatment; MRI; Spinal Canal Encroachment

MeSH Terms

Back Pain
Follow-Up Studies
Health Resorts
Humans
Intervertebral Disc Displacement
Magnetic Resonance Imaging
Prospective Studies
Spinal Canal

Figure

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  Fig. 1. Spinal canal area and herniated disc size were measured on MRI axial images.

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  Fig. 2. VAS score at initial visit and the final followup

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  Fig. 3. Clinical outcome at the final followup (four patients who converted to surgery were defined as “poor”)

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  Fig. 4. Thirty five year old male patient suffering from bilateral buttock and right leg pain showed canal encroachment about 53% on MRI axial image at the first visit(A). After conservative treatment for 17 months, pain subsided and herniated disc material was absorbed at the final follow up(B).

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