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Chiropractic Research Review

Conservative Care for Lumbar Herniated Discs

A retrospective study has observed different types of disc herniations, the duration of symptoms, and evaluated a trial of longer conservative treatment to reduce the number of operations. This study attempted to observe whether noncontained and contained herniated discs have different clinical courses, and to evaluate the results of a longer clinical trial of conservative treatment prior to considering surgery.

The possibility of a difference in clinical features between contained and noncontained disc herniation has been previously suggested.

Contained discs are within an intact outer annulus or a capsule composed of the outer annulus and the posterior longitudinal ligament. By contrast, noncontained discs are in direct contact with epidural tissue. It has been theorized that exposure of the disc tissue induces an absorptive reaction of the herniated tissue by neovascularization and the infiltration of macrophages. This could explain why patients with either contained or noncontained disc herniation demonstrate different clinical courses.

This report describes two studies. In the first study, the medical history and intraoperative findings were reviewed for 156 patients who had undergone herniotomy. In the second study, conservative treatment of at least two months' duration prior to surgery was recommended for all 390 patients with lumbar disc herniation. The conservative management used in this study consisted of bed rest, non-steroidal anti-inflammatory medication and sacral epidural block.

In the first study, patients with noncontained herniations rarely went to surgery within 2 or more months after onset of symptoms. In the second study, the patients were asked to wait for 2 months prior to surgery, which resulted in the reduction of the number of herniotomies required, especially for the patients with noncontained disc herniation.

Conclusion: the authors suggest that if patients with disc herniations can be conservatively treated for 2 months or longer "surgical treatment might not be necessary." However, patients with cauda equina symptoms or motor weakness should not be included in this category.

Ito T, Takano Y, Yuasa N. Types of lumbar herniated disc and clinical course. Spine 2001:26(6), pp. 648-651.

Chiropractic Research Review

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