Resolution of lumbar disc herniation without surgery

Lumbar disc herniation has an uncertain natural history. Data from clinical trials suggest that patients who have herniated lumbar discs have similar long-term outcomes whether they undergo surgery or elect conservative management (i.e. physiotherapy). However too many people still take the surgical route instead of the less invasive, more cost effective conservative route.  Hopefully these pictures with the accompanying story will help in our efforts to change this.

physiotherapy and physical therapy resolves lumbar disc herniation

These images relate to a 29-year-old woman who presented to the spine clinic with new-onset pain in her right leg, accompanied by paresthesia. She reported that she began to have back pain after playing volleyball several years before presentation, whereas the pain and paresthesia in her leg began 6 months earlier and were not associated with a precipitating event. There were no bowel or bladder symptoms. Magnetic resonance imaging (MRI) of the lumbar spine revealed a lumbar disk herniation resulting in substantial spinal stenosis and nerve-root compression (Panel A, arrow). She elected conservative treatment with physical therapy and an epidural injection of glucocorticoids. A second MRI obtained at follow-up 5 months after presentation showed resolution of the herniation (Panel B, arrow). Her clinical symptoms resolved, and she was discharged from the clinic, with follow-up recommended as needed.

This story evidences a very positive story for conservative management of disc herniation.  What experiences do you have in treating patients who have undergone surgery for similar conditions?

Neck Pain

Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability and 21st in terms of overall burden.

Comments

Jessica
Jessica
April 29, 2016 at 11:42 pm

Are there any details of the Physio treatment available? That would be wonderful to know 🙂

Ruben
Ruben
May 3, 2016 at 12:22 am

Yes, i’m with Jessica. We would like to know what kind of specific physiotherapy treatment was made to this patient?

Rachael Lowe

Hi Ruben and Jessica. All I can suggest is that you contact the authors, the article didn’t mention the treatments utilised. Rachael

Pavlos
Pavlos
May 5, 2016 at 4:13 am

Hello, I went through the original article from the website and it is a pdf with a very brief explanation about the effect and nothing else and I am really wondered how this paper got published. If you have the full article I am highly interested to read it. There is no information about the degree of the disc herniation and what was exactly the conservative treatment. Anyway case reports studies are good for publications of something rare but there are vulnerable to potential bias.

Rachael Lowe

Good comments Pavlos, I believe the disc herniation can be seem in the mage and we have contacted the authors for details of the treatment as many people have asked the same thing. Rachael

Grant plumbley
Grant plumbley
May 7, 2016 at 3:15 am

Also worth considering that changes seen on MRI no matter what they look like, do not always correlate with function or pain, and as you say most LBP resolves within 1 year despite what is done, or not done, sometimes with and sometimes without, changes to MRI

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