Observations on the natural history of massive lumbar disc herniation

Cribb, G.L.; Jaffray, David; Cassar‐Pullicino, Victor N.

doi:10.1302/0301-620x.89b6.18712

Cited by 99 publications

(65 citation statements)

References 18 publications

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“…These results are similar to the recent studies done using MRI; Cribb et al 15) reported that, by following up on 15 cases with more than 50% spinal canal encroachments for 24 months, in 14 of the 15 cases, improvement of clinical symptoms was shown without surgery, and reported that on average 80% reduction in size was shown, hence suggested that a careful consideration needs to be given regarding surgery due to potential surgical complications. In addition, Benson et al 16) by following up on 37 cases with more than 50% spinal canal encroachments for 23 months, reported that 83% satisfactory results were obtained, while only 4 cases required surgery.…”

Section: ) Agesupporting

confidence: 89%

Conservative Treatment of Lumbar Disc Herniation - A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal -

Shin

Lee

et al. 2011

J Korean Soc Spine Surg

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Section: ) Agesupporting

confidence: 89%

Conservative Treatment of Lumbar Disc Herniation - A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal -

Shin

Lee

et al. 2011

J Korean Soc Spine Surg

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“…45 Greater than 70% of patients with radiculopathy will recover within 6 months, 46,47 and a similar proportion will experience resorption of a herniated disk within 1 year of presentation. 48,49 Another rationale for the use of ESI is that the evidence in support of the procedure is more robust (ie, more clinical trials showing benefit), and the risk-benefit ratio more favorable, compared with other treatments. Among randomized clinical trials evaluating surgery for neuropathic LBP and neck pain irrespective of etiology, most demonstrate temporary (ie, 6 months) but not long-term benefit.…”

Section: Efficacy and Type Of Injectionmentioning

confidence: 99%

Epidural Steroids

Cohen¹,

Bicket

Jamison

et al. 2013

Regional Anesthesia and Pain Medicine

300

114

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Epidural steroid injections (ESIs) are the most widely utilized pain management procedure in the world, their use supported by more than 45 placebo-controlled studies and dozens of systematic reviews. Despite the extensive literature on the subject, there continues to be considerable controversy surrounding their safety and efficacy. The results of clinical trials and review articles are heavily influenced by specialty, with those done by interventional pain physicians more likely to yield positive findings. Overall, more than half of controlled studies have demonstrated positive findings, suggesting a modest effect size lasting less than 3 months in well-selected individuals. Transforaminal injections are more likely to yield positive results than interlaminar or caudal injections, and subgroup analyses indicate a slightly greater likelihood for a positive response for lumbar herniated disk, compared with spinal stenosis or axial spinal pain. Other factors that may increase the likelihood of a positive outcome in clinical trials include the use of a nonepidural (eg, intramuscular) control group, higher volumes in the treatment group, and the use of depo-steroid. Serious complications are rare following ESIs, provided proper precautions are taken. Although there are no clinical trials comparing different numbers of injections, guidelines suggest that the number of injections should be tailored to individual response, rather than a set series. Most subgroup analyses of controlled studies show no difference in surgical rates between ESI and control patients; however, randomized studies conducted by spine surgeons, in surgically amenable patients with standardized operative criteria, indicate that in some patients the strategic use of ESI may prevent surgery.

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“…Large LDH has been reported to have a greater tendency to resolve in clinical and pathomorphological evolutions 7910111213. The ‘massive’ LDH, which was defined in previous studies as the disc material occupying >50% of the spinal canal on axial magnetic resonance (MR) images, showed a successful outcome with nonoperative treatment 1415. Therefore, operative treatment of massive LDH can be deferred unless significant neurological symptoms are observed.…”

Section: Introductionmentioning

confidence: 99%

Massive lumbar disc herniation with complete dural sac stenosis

Jeon

Chung

Son

et al. 2013

IJOO

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Background:Large lumbar disc herniation (LDH) has been reported to have a greater tendency to resolve in clinical and pathomorphological evolutions. However, various definitions of large LDH have been used without validation, and the clinical symptoms of large LDH have not been fully elucidated. We conducted a retrospective analysis to determine the clinical characteristics and treatment outcome of massive LDH with complete dural sac stenosisMaterials and Methods:We retrospectively reviewed 33 cases of LDH with complete dural sac stenosis on magnetic resonance imaging. Complete dural sac stenosis was defined as no recognizable rootlet and cerebrospinal fluid signal on T2-weighed axial MR images. The clinical outcome parameters included back pain, leg pain, Oswestry disability index (ODI), and neurological dysfunction. The paired t-test and Wilcoxon's signed rank test were used to compare serial changes in back pain, leg pain and neurological dysfunction.Results:Mean duration of followup was 66 months (range 24 - 108 months). There were 24 male and 9 female. The mean age was 37 years (range 20 - 53 years). At presentation, mean visual analogue scales for back pain and leg pain were 75.3 ± 19.1 (range 12 - 100) and 80.2 ± 14.6 (range 0 -100), respectively. Mean ODI was 67.1 ± 18.8 (range 26 - 88). Neurological dysfunction was found in 9 patients (27.3%), and the bowel/bladder dysfunction was found in 2 patients (3.1%). Conservative treatment was performed in 21 patients (63.6%) with satisfactory results. Seven patients underwent decompressive surgery, and 5 underwent posterolateral fusion.Conclusions:A massive LDH with complete dural sac stenosis was found to be associated with severe back and leg pain at presentation, however surgical treatment can be deferred unless significant neurological symptoms occur.

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Observations on the natural history of massive lumbar disc herniation

Cited by 99 publications

References 18 publications

Conservative Treatment of Lumbar Disc Herniation - A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal -

Conservative Treatment of Lumbar Disc Herniation - A Prospective Study of Disc Herniation Encroaching More than One-third of Spinal Canal -

Epidural Steroids

Massive lumbar disc herniation with complete dural sac stenosis

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