Factors Predicting Failure of Conservative Treatment
in Lumbar-Disc Herniation
Chaiyuth Sutheerayongprasert MD*, Sompoch Paiboonsirijit MD*,
Verapan Kuansongtham MD*, Surapong Anuraklekha MD*,
Nanthadej Hiranyasthiti MD*, Sumroeng Neti MD*
Affiliation :
* Bumrungrad Spine Institute, Bumrungrad International Hospital, Bangkok, Thailand
Objective : To explore factors predicting failure of conservative treatment in lumbar-disc herniation.
Background : Sciatica due to lumbar-disc herniation is a common complaint of spine patients. Even though the natural course
is favorable, surgery is necessary in at least 10% of cases. Current trends show surgery to be more cost-effective than
prolonged conservative care. However, there is limited information about the usefulness of clinical and radiographic
parameters to classify patients who are likely to fail conservative treatment.
Material and Method: Medical records of patients diagnosed with lumbar-disc herniation between January 1, 2007 and
December 31, 2009 were studied. The records of patients in conservative and surgery groups were compared, for clinical
features, MRI results and treatment modalities.
Results : Fifty cases (discectomy) and 50 controls (successful conservative treatment) were enrolled. Demographic data,
presenting symptoms and physical examination did not differ, apart from duration of symptoms. Logistic regression analysis
did not find a significant association between percentage of canal compromised after controlling for disc-fragment size,
duration of symptoms and types of disc herniation. However, disc fragment size was strongly associated with surgical
outcome (OR = 2.6). Duration of symptoms (OR = 1.2) and sequestered type of lesion (OR = 12.3) were associated with
surgery in this model. The use of physiotherapy and epidural steroid injections was lower, but the failure rate was higher.
Conclusion : Long-duration, sequestered herniation and large fragment are predictive of failure in the conservative treatment
of lumbar-disc herniation.
Keywords : Lumbar-disc herniation, Disc-fragment size, Sequestered disc lesion
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