Goal of the Study?
In this follow-up cohort study published in the Karger Open Access Journal 1 the authors assessed clinical and radiological follow-up results of surgical and non-surgical patients with a sequestered Lumbar Disc Herniation (LDH). The goal was to determine if a difference existed between patients that had early surgery versus ones that had no surgical intervention.
Why are they doing this study?
The authors state that clinical and radiological follow-up studies on sequestered LDH patients who underwent surgery with those who had conservative treatment without surgery are very rare. Some previous research has shown that early surgical intervention reduced pain faster in the short term, but both treatments had similar benefits in the medium and long term. In this study, both pain and MRI images were used to analyze the difference between these two treatment modalities.
What was done?
LDH patients were identified by detecting a minimum of one plane herniated disc mass (fragmented) separated from the disc. Of these 98 patients, 32 of them had had surgery within the first month of diagnosis. These were designated the operated group. The other 66 patients in the non-operated group were treated conservatively with a variety of analgesic or myorelaxant drugs, physical therapy, exercises, lumbosacral orthosis rest, and epidural steroids. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were measured at the outset and at the first, third and six-month visits. Radiological evaluation was performed by measuring the sequestered LDH level and herniation volume using MRI at the outset and at four and six months. Based on the MRI images at the fourth month, the non-operated group was divided into 3 categories; non-regression (no change in disc volume), partial regression (> 25% herniation reduction) and complete resolution where herniated disc volume is absent. Statistical techniques were used to compare the various groups.
What did they find?
In a comparing the group that had surgical intervention versus the group that did not have surgery, it was found that:
- As a group, the 32 patients in the operated group had significantly lower ODI scores than the 66 patients in the non-operated group after the first and third months. At the sixth month, both groups had similar clinical pain measurements.
- Radiological improvements were observed in approximately 90% of non-operated patients who received conservative treatments.
- At the outset there was no significant difference in the initial VAS and ODI pain measurement scores between the three non-operative subgroups; non-regression, partial regression and complete resolution, but at month one, three and six there were significantly higher pain scores for the non-regression group.
Why do these findings matter?
Based on this study, the authors recommend that patients with sequestered LDH receive conservative treatments and not surgical intervention at least for the first six months. At the end of six months if spontaneous regression is not observed only then should surgery be considered.
At Dynamic Disc Designs, we take our education seriously and craft models to help you deliver important clinically relevant, evidence-informed, patient education. In the case of a sequestered lumbar disc herniation, these authors suggest you give it six months of conservative care before considering surgery. Our Professional LxH Model can help show the patient the nucleus and its potential for resorption.
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