Developing a clinical prediction rule to identify patients with lumbar disc herniation who demonstrate short-term improvement with mechanical lumbar traction

Abstract

Objective: To develop a clinical prediction rule (CPR) that predicts treatment responses to mechanical lumbar traction (MLT) among patients with lumbar disc herniation (LDH). Method: This studywas an uncontrolled prospective cohort study. The subjects included 103 patients diagnosed with LDH for which they underwent conservative therapy. The subjects received MLT for 2 weeks, and the application of any other medication was left at the discretion of the attending physician. The initial evaluation was performed prior to the initiation of treatment. The independent variables from the initial evaluation were imaging diagnosis, Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire score, visual analog scale, medical interview, physical examination. The patients whose ODI after 2 weeks of treatment improved by ! 50% of that at the initial evaluation were defined as responders. Results: Of the 103 subjects, 24 were responders, and the five predictors selected for the CPR were limited lumbar extension range of motion, low-level fear-avoidance beliefs regarding work, no segmental hypomobility in the lumbar spine, short duration of symptoms, and sudden onset of symptoms. For the patients with at least three of the five predictors, the probability of their ODI greatly improving increased from 23.3% to 48.7% compared with the patients without these predictors (positive likelihood ratio, 3.13). Conclusion: Five factors were selected for the CPR to predict whether patients with LDH would demonstrate short-term improvement following conservative therapy with MLT.

Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls

“…However, that trial, which showed no benefit from inversion, was in patients with non-specific back pain rather than MRI-proven disc protrusion with sciatica, as in our study. By contrast, in patients with lumbar disc protrusions, mechanical lumbar traction (not inversion) was effective at improving the Oswestry Disease Index in patients using a 5 point predictive scoring system 19) . Similarly, mechanical lumbar traction in patients with low back and leg pain due to nerve root compression produced greater improvements in disability and fear avoidance beliefs at 2 weeks but not at 6 weeks compared with controls 20) .…”