Abstract
4,000 patients with discogenic lumbosacral radiculitis were treated. 2,000 patients were managed conservatively, 1,000 patients underwent microdiscectomy and 1,000 patients underwent endoscopic discectomy. The authors of the paper compared indications for different types of treatment, effectiveness of treatment, and duration of rehabilitation. The age of patients in both groups ranged 18 to 78 years. Treatment outcomes were evaluated using the Macnab scale, including the need for additional treatment, duration of rehabilitation treatment, and terms of return to work. Currently, the results of conservative treatment of lumbar hernias are being discussed in the literature. In general, according to authors, the result of conservative treatment is inversely proportional to the size of hernias: the smaller the hernia, the more successful the treatment results. Moreover, there is no clear correlation with the conservative treatment methods. At the same time, the results of surgical intervention directly correlate with the size of hernias or sequesters: the larger the hernia, the better the outcome. Alternatively, microsurgical and endoscopic interventions were used with similar outcomes and relapse rates. The long-term outcomes were tracked using the Macnab scale. Relapses of hernias in the endoscopic discectomy group were found in 18 patients, which was 1.8%. Relapses of hernias in the microdiscectomy group were found in 11 patients, which was 1.1%. Modern conservative methods of treatment allow good outcomes for treatment of hernias even up to 8 mm. In patients with hernias 8 mm to 10 mm the results of conservative treatment were generally not satisfactory and relapses occurred quickly. In patients with hernias of more than 10 mm, conservative treatment is not recommended; positive outcomes are possible only with the use of surgical methods.
Highlights
Discogenic lumbosacral radiculitis in 99% of cases is caused by compression of the lumbar segmental roots by protrusions, hernias, or stenosis of the vertebral canal or intervertebral foramina [1].Most often, the pathology of intervertebral discs occurs in the lumbosacral region, in 90% of cases – at L4–L5, L5–S1 disc levels, since these are characterized by greater mobility and loading as compared to other discs
The results of conservative treatment of lumbar hernias are being discussed in the literature
According to authors, the result of conservative treatment is inversely proportional to the size of hernias: the smaller the hernia, the more successful the treatment results
Summary
Discogenic lumbosacral radiculitis in 99% of cases is caused by compression of the lumbar segmental roots by protrusions, hernias, or stenosis of the vertebral canal or intervertebral foramina [1]. The pathology of intervertebral discs occurs in the lumbosacral region, in 90% of cases – at L4–L5, L5–S1 disc levels, since these are characterized by greater mobility and loading as compared to other discs. The roots at L5 and S1 levels are compressed most often [2]. We analyzed management and outcomes in patients with discogenic lumbosacral radiculitis
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