Technique Update: Size Doesn’t Matter, for Patients with Lumbar Disc Herniation
By Dr. David Graber, Council on Technique and Clinical Excellence Chair
Does the size of a lumbar disc herniation (LDH) matter in predicting which patients will do poorly with conservative non-operative care? Not according the latest research by Harvard Medical School researchers, and published in this month’s Global Spine Journal.[1]
The study, “Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment,” followed 368 patients over a two-year period with lumbar radicular pain and an LDH on MRI. These patients underwent six weeks of conservative care (physical therapy and/or steroid injections).
The main finding was that the size of the disc herniation did not predict whether non-operative treatment would not be successful. The results also suggest that there is “no correlation between the size of an LDH and the likelihood that a patient will require surgery after six weeks of non-operative management.”
Previous studies have demonstrated that many LDH often resolve on their own, or with conservative care.[2][3][4][5] This study reinforces that surgical options should not be rushed into for patients with even a large LDH.
References:
1 Gupta, A., Upadhyaya, S., Yeung, C. M., Ostergaard, P. J., Fogel, H. A., Cha, T., … Hershman, S. (2019). Does Size Matter? An Analysis of the Effect of Lumbar Disc Herniation Size on the Success of Nonoperative Treatment. Global Spine Journal. https://doi.org/10.1177/2192568219880822
2 Benson, R. T., Tavares, S. P., Robertson, S. C., Sharp, R., & Marshall, R. W. (2010). Conservatively treated massive prolapsed discs: a 7-year follow-up. Annals of the Royal College of Surgeons of England, 92(2), 147–153. doi:10.1308/003588410X12518836438840
3 Lurie, J. D., Tosteson, T. D., Tosteson, A. N., Zhao, W., Morgan, T. S., Abdu, W. A., … Weinstein, J. N. (2014). Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine, 39(1), 3–16. doi:10.1097/BRS.0000000000000088
4 Shaiq, M.W., & Shamim, M.S. (2017). Spontaneous disc resolution: Illustrative Cases with supportive argument for a more conservative approach.
5 Chiu, C., Chuang, T., Chang, K., Wu, C., Lin, P., & Hsu, W. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical rehabilitation, 29 2, 184-95 .
Originally published in the ANJC Back Channel, Oct. 30, 2019
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