Conservative Treatment of Lumbar Disc Hernia

Altun and Yüksel, in their 2016 article, aim to evaluate the therapeutic outcomes of conservative treatment in patients with lumbar disc hernia (LDH). The conservative approach consisted of limited bed rest and medical therapy, with NSAIDs and muscle relaxants prescribed for management. Five patients received hospitalization and intravenous tramadol and hydrochloride due to intractable pain. Patients were encouraged to stay active and resume regular activities of daily living when feasible, with guidance from a neurosurgeon when needed. Sensation, strength, and reflexes were evaluated and the Laségue (straight-leg-raise) test was used to rule in LDH.

The participants for this study were 23 adults with radiating pain and/or paresis below the knee, LDH at the corresponding level and side, and MRI verification. Cases that required emergent surgical intervention were excluded, as well as cases of urinary retention, fecal incontinence, or saddle anesthesia. Also excluded were patients with a history of osteoporosis, immunosuppression, chronic corticosteroid use, intravenous drug use, fever of unknown origin, cancer, unexplained weight loss, progressive or disabling symptoms, or focal neurologic deficits.

Included in the authors’ background introduction is mention that conservative and surgical treatment yielded no noteworthy difference in therapeutic outcomes after 2 years. However, patients may have a strong preference for one approach over the other due to cost, time commitments, or personal ability. All patients in this study were able to perform activities of daily living without restriction once treatment was completed, leading to the authors’ conclusion that a conservative approach may be adequate for healing many cases of LDH.

Two details missing that really stand out to me is the length of time for this study and how frequently the patients were evaluated. This, combined with the other limitations duly noted by the authors, make generalizing this study on its own impossible. I believe the topics of interest are worthy of further study but this one does not stand alone as a thorough, reliable source. I was also disappointed that physical therapy was not part of the conservative treatment method for this study and would love to spend some time looking into studies that do utilize it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256262/#maincontent