Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study

Abstract

Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.

Effect of Implementing a Protocol of Nursing Care on Clinical Outcomes for Patients Undergoing Lumbar Spine Disc Prolapse Surgeries

“…Also, it was in the same line with Kim et. al, (2020) (30) who reported that more than one third of the patients undergoing disc surgeries were smokers . Furthermore, it was in the same line with Ali and Hamed (2019) (31) who mentioned that two thirds of the studied group patients undergoing disc surgeries had a herniated lumbar disk from 6 to 9 months.…”

“…The sample size was calculated based on Epidemiological Information 7 statistical Program. The final acceptable sample size was estimated to be 60 patients.They were divided into two equal groups; 30 patients for each group as following: Group (1): Control group, Consisted of (30) patients who were exposed to routine hospital care. Group (2): Study group, Consisted of (30) patients who were exposed to the protocol of care that was designed and implemented by the researcher.…”

Spinal Mobilization With Leg Movement Versus Traction Straight Leg Raise in Low Back Pain Patients Due to Hernia Nucleus Pulposus

“…HNP accounts for about two-thirds of spinal pain diagnoses. L4-L5 and L5-S1 are the most frequently affected by herniation [9], [10], [11] and the pain radiates to the lower extremities [12] Its prevalence is approximately 40% in the adult population and disc herniation is the cause [13]. In the United States, HNP is 1 of the 10 most common diseases with a prevalence ranging from 7.6-37% and is found at the age of 45-60 years.…”

Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis

“…The LDH is common in people aged 25 to 55 spending large percent of times sitting or standing with heavy workload. Current clinical treatment of LDH includes surgical treatment and nonsurgical treatment [ 3 , 4 ]. Although the effect of surgical treatment is good, it faces the risk of nerve injury and adjacent vertebral bodies and recurrence [ 5 ].…”