Prolonged Physiotherapy versus Early Surgical Intervention in Patients with Lumbar Disk Herniation: Short-term Outcomes of Clinical Randomized Trial

Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To investigate the effectiveness and safety of surgery compared with non-surgical treatment for sciatica.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, Embase, CINAHL, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organisation International Clinical Trials Registry Platform from database inception to June 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials comparing any surgical treatment with non-surgical treatment, epidural steroid injections, or placebo or sham surgery, in people with sciatica of any duration due to lumbar disc herniation (diagnosed by radiological imaging).

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data. Leg pain and disability were the primary outcomes. Adverse events, back pain, quality of life, and satisfaction with treatment were the secondary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). Data were pooled using a random effects model. Risk of bias was assessed with the Cochrane Collaboration's tool and certainty of evidence with the grading of recommendations assessment, development, and evaluation (GRADE) framework. Follow-up times were into immediate term (≤six weeks), short term (>six weeks and ≤three months), medium term (>three and <12 months), and long term (at 12 months).

RESULTS

24 trials were included, half of these investigated the effectiveness of discectomy compared with non-surgical treatment or epidural steroid injections (1711 participants). Very low to low certainty evidence showed that discectomy, compared with non-surgical treatment, reduced leg pain: the effect size was moderate at immediate term (mean difference -12.1 (95% confidence interval -23.6 to -0.5)) and short term (-11.7 (-18.6 to -4.7)), and small at medium term (-6.5 (-11.0 to -2.1)). Negligible effects were noted at long term (-2.3 (-4.5 to -0.2)). For disability, small, negligible, or no effects were found. A similar effect on leg pain was found when comparing discectomy with epidural steroid injections. For disability, a moderate effect was found at short term, but no effect was observed at medium and long term. The risk of any adverse events was similar between discectomy and non-surgical treatment (risk ratio 1.34 (95% confidence interval 0.91 to 1.98)).

CONCLUSION

Very low to low certainty evidence suggests that discectomy was superior to non-surgical treatment or epidural steroid injections in reducing leg pain and disability in people with sciatica with a surgical indication, but the benefits declined over time. Discectomy might be an option for people with sciatica who feel that the rapid relief offered by discectomy outweighs the risks and costs associated with surgery.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021269997.

Reabsorption of intervertebral disc prolapse after conservative treatment with traditional Chinese medicine: A case report

BACKGROUND

Conservative treatments have been reported to diminish or resolve clinical symptoms of lumbar intervertebral disc herniation (LIDH) within a few weeks.

CASE SUMMARY

Computed tomography and magnetic resonance imaging (MRI) of the lumbar region of a 25-year-old male diagnosed with LIDH showed prolapse of the L5/S2 disc. The disc extended 1.0 cm beyond the vertebral edge and hung along the posterior vertebral edge. The patient elected a conservative treatment regimen that included traditional Chinese medicine (TCM), acupuncture, and massage. During a follow-up period of more than 12 mo, good improvement in pain was reported without complications. MRI of the lumbar region after 12 mo showed obvious reabsorption of the herniation.

CONCLUSION

A conservative treatment regimen of TCM, acupuncture, and massage promoted reabsorption of a prolapsed disc.

Effect and Clinical Value of Protective Motivation Intervention Rehabilitation Model on Pain Perception and Dysfunction in Patients with Lumbar Disc Herniation: Based on a Retrospective Cohort Study

Objective

To examine the potential medical benefits of protective motivation intervention rehabilitation mode on pain perception and dysfunction in patients with lumbar disc herniation (LDH).

Methods

140 LDH patients hospitalized from January 2021 to September 2021 were totally selected. The control group received regular rehabilitation, and the research group received protective motivation intervention rehabilitation. The comparisons of scores of disease knowledge, visual analogue scale (VAS), pain belief and perception scale (PBPI), Japanese Orthopedic Association Score (JOA), Roland-Morris dysfunction (RMDQ), and quality of life scale (SF-36) were made across different groups.

Results

The scores of disease knowledge in the two cohorts at 1 month, 2 months, and 3 months after intervention were greater than those before intervention, and the difference is statistically significant (P < 0.05). The scores of VAS, PBPI, JOA, and RMDQ at 1 month, 2 months, and 3 months after intervention were downregulated. At 1 month, 2 months, and 3 months after intervention, the experimental scores of VAS, PBPI, JOA, and RMDQ were markedly fewer than the control group, and the difference is statistically significant (P < 0.05). The scores of SF-36 after intervention were statistically upregulated, and the difference is statistically significant (P < 0.05). After intervention, the score of SF-36 in the research group was significantly higher than that in the control group, and the difference is statistically significant (P < 0.05).

Conclusion

The application of protective motivation intervention in rehabilitation of LDH patients can more effectively improve their cognitive level, reduce their pain perception, improve their lumbar function, and enhance their well-being.