Development and clinical application of grading and classification criteria of lumbar disc herniation

Abstract

This study aimed to develop new grading and classification criteria for lumbar disc herniation (LDH). First, from January 1993 to January 2003, we collected the detailed information of 1127 patients with LDH and, based on that information, developed a new grading classification termed the 6-score-V-type criteria wherein conservative treatment is recommended for patients with type I, II, or IIIA, surgical treatment is recommended for type IIIC, IV, and V, and 3 months of conservative followed by surgery if no improvements are obtained during the conservative treatment period is recommended for type IIIBe. The distribution of types among the 1,127 patients was: type I (7.9%), type II (22.9%), type III (34.1%), type IV (22.2%), and type V (12.6%). Type III cases were subdivided into type IIIA (9.9%), type IIIB (13.3%), and IIIC (10.8%). Second, from February 2003 to December 2009, we treated a separate group of 1130 patients with LDH according to this 6-score-V-type classification rubric and monitored them for 24 months. Therapeutic efficacy was assessed in 1130 patients with a standard evaluation for leg pain. Overall, 85.3% of the patients in the first year and 84.1% in the second year had good or excellent response ratings. The inter-examiner reliability was 98%. Assignment of therapeutic protocols according to the 6-score-V-type classification yielded satisfactory outcomes, indicating that the 6-score-V-type criteria are straightforward and practical.

The effect of the preoperative uric acid level and neutrophil lymphocyte ratio on preoperative and postoperative visual pain scores in patients with lumbar disc hernia: a cross-sectional study.

“…L umbar disc herniation (LDH) is the leading cause of lower back and leg pain. LDH may clinically manifest as dull or sharp pain in the lower back or lower extremities, muscle spasms, sciatica, paresthesia, and muscle weakness in the lower extremities (10). Uric acid (UA) is the final waste product of purine metabolism.…”

The Pattern of Lumbosacral List Curve in Patients with Lumbar Disc Herniation

“…When a take-off is found in L3 -L4 or L4 -L5 levels, there is a disc extrusion in 75% of the cases in L4 -L5 and L5 -S1 levels. This finding is interesting since most of the hernias are found at one of these two levels (96%) (14).…”

Effect of Hydrotherapy on Pain Intensity and Functional Ability in Lumbar Disk Herniation (LDH) Patients that Undergo Non-operative Procedure

“…This is related to work activities such as lifting heavy loads which is mostly done by men. 2 However, another research conducted by Hao et al, (2017) shows that women suffer from LDH more than men. 7 It is associated with hormonal factors.…”

“…2 However, another research conducted by Hao et al, (2017) shows that women suffer from LDH more than men. 7 It is associated with hormonal factors. Women will experience degenerative processes faster than men, including intervertebral disc degeneration.…”

“…However, surgery has a high risk of causing trauma. 7 On the other hand, conservative therapy with analgesics is only symptomatic, that is mean patients must take it continously for long time so that it can cause side effects such as gastrointestinal bleeding, liver and kidney damage. 8 Other conservative therapies that can be given to LDH patients are physical exercise which can be done on land (land-based exercise) or in water (water-based exercise or hydrotherapy).…”