Comparative Effectiveness of Surgical and Nonsurgical Management for Patients with Single Level Lumbar Disc Herniation in terms of Symptom Severity and Quality of Life

Abstract

Background: Sciatica is one of the most severe forms of low back pain, with a lifetime prevalence of approximately 30 percent. Aim: To assess the short-term and long-term efficacy of surgical and conservative care in the incidence of sciatic symptoms and quality of life in standard clinical settings among patients with lumbar disc herniation. Material and Method: It was a retrospective study conducted at the Medical Trust Hospital, Kochi, India. The present study was conducted on patients who underwent micro lumbar discectomy for single level lumbar disc herniation, and those with the same diagnosis but who refused surgery or were still waiting for the surgery to be scheduled. The patients were divided into two groups that is, Group A—treated surgically and Group B—awaiting for surgery and managed nonsurgically. Cases between 20 and 60 years of age, male or female, with low back pain and lower limb radiculopathy, positive signs of root tension (SLRT between 30–70 degrees or severe femoral root stress), associated neurological dysfunction (with respect to corresponding abnormal reflexes, reduced sensation in dermatomal distribution or weakness in myotomal distribution) and multiple disc herniation cases if only one of the level was symptomatic, were included in the study. The study excluded patients with scoliosis of more than 15 degrees, segmental instability, spondylolisthesis, spine or tumor infection, psychiatric disease, refusal of patients and age < 20 years and > 60 years. All patients recruited had to fill the consent and a clinical evaluation by means of established questionnaires which included the Short Form 36 (SF-36), the Oswestry Disability Index (ODI), and the Visual Analog Scale for pain (VAS). Then the patients were categorized into two groups—Group A, those who had already undergone surgical treatment and Group B, those who were awaiting surgery. Results: A total of 60 patients fulfilling the inclusion criteria were included in the present study. Mean age of the patients in Group A and Group B was 36.7 ± 5.8 years and 37.01 ± 5.56 years, respectively. Male preponderance was observed in our study with male to female ratio of 1.7:1. At the time of admission, patients in both the groups suffered similar scale of pain and agony. The VAS and ODI did not show significant difference in the pain and disability among both the group of patients. During follow-up of six month and two years, surgically treated patients showed a significant improvement in the scores of VAS and ODI. Also, the SF-36 showed a similar result and was better in patients treated by surgery contrary with conservative treatment. Conclusion: The study concluded with positive benefits from surgery with a reduction in pain reported in the lower limbs (VAS leg with p<0.05) and improved function (ODI with p<0.05); however, it did not show any much significant change in the quality of life according to the SF-36 scale.

Keywords: Lower back pain, lumbar disc herniation, Oswestry disability index (ODI), Short form-36 (SF-36), sciatica, visual analog scale (VAS)

Cite this Article

Shashank Sangoli. Comparative Effectiveness of Surgical and Nonsurgical Management for Patients with Single Level Lumbar Disc Herniation in terms of Symptom Severity and Quality of Life. Research & Reviews: A Journal of Neuroscience. 2020; 10(1): 25–29p.