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Abstract
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 followup 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 followups 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 followup 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 followup, conversion to surgery during followup, and remaining pains.
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Figures and Tables%
 | Fig. 3.Clinical outcome at the final followup (four patients who converted to surgery were defined as “poor”) |
 | 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). |
Table. 1.
Kim & Kim's criteria of clinical outcome
Table 2.
Summary of cases
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