Non-surgical treatment with XSHHD for ruptured lumbar disc herniation: a 3-year prospective observational study

Feng Dai,Jin Tao Liu,Hong Jiang,Yu Xiang Dai,Peng Fei Yu

doi:10.1186/s12891-020-03723-2

Feng Dai, Jin Tao Liu + Show 3 more

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https://doi.org/10.1186/s12891-020-03723-2

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Abstract

BackgroundLumbar disc herniation (LDH) is mainly caused by annular fiber disruption with a discrete leakage of nucleus pulposus pressing on a nerve, resulting in back pain and radiating pain. Most patients with LDH can be treated conservatively, but there are many different conservative treatments. Furthermore, most previous studies did not evaluate the long-term efficacy of these treatments and the prognosis. Therefore, an effective and safe therapeutic strategy is lacking for patients with LDH. In this study, we evaluated Xiao Sui Hua He decoction (XSHHD) in the treatment of LDH.MethodsThis was a rigorous prospective observational 3-year follow-up study. We recruited 69 participants with ruptured lumbar disc herniation (RLDH) between February 2014 and February 2016. Patients took XSHHD orally twice a day for 6 months. The primary outcome measurements were visual analogue scale (VAS) pain score, Oswestry disability index (ODI) and straight leg raising test (SLRT). The secondary outcome measurements was nucleus pulposus protrusion volume on magnetic resonance imaging (MRI). Clinical outcomes were measured at baseline (Visit 1), and at 3, 6, 12, and 36 months (Visit 2, 3, 4, and 5, respectively)..ResultsSixty-three patients were followed-up for 3 years after treatment. SLRT and ODI after non-surgical treatment improved significantly compared with baseline (P < .001). There were no statistically significant differences at 6 months vs 36 months for SLRT and ODI. VAS scores (leg, back) after 3 years of treatment were statistically significantly different compared with baseline (P < .001; Z = − 6.93, − 6.637). The baseline protrusion volume was 2018.61 ± 601.16 mm3, and the volume decreased significantly to 996.51 ± 387.42 mm3 at 36 months (t = 12.863; P < .001). The volume of protrusion resorption rate (VPRR) at 36 months was 47.24 ± 23.99%, with significant resorption in 23 cases, partial resorption in 23 cases, no resorption in 15 cases, and increased volume in 2 cases.ConclusionsThis study showed that non-surgical treatment with XSHHD was effective, and the study clarified the natural outcomes in LDH.

Highlights

Lumbar disc herniation (LDH) is mainly caused by annular fiber disruption with a discrete leakage of nucleus pulposus pressing on a nerve, resulting in back pain and radiating pain
If Ruptured lumbar disc herniation (RLDH) can be controlled by drugs in the acute stage, resorption of the protrusions may occur after a period of time, and the clinical symptoms will be alleviated
After 3 years’ treatment, most patients reported no pain and had obvious improvement in their symptoms. These findings indicate that non-surgical treatment of RLDH with Xiao Sui Hua He decoction (XSHHD) is effective

Summary

Introduction

Lumbar disc herniation (LDH) is mainly caused by annular fiber disruption with a discrete leakage of nucleus pulposus pressing on a nerve, resulting in back pain and radiating pain. Lumbar disc herniation (LDH) is mainly caused by annular fibers disruption with a discrete leakage of nucleus pulposus pressing on a nerve, resulting in back pain, radiating pain in the lower extremities, and paresthesia as the main manifestations of the disease. Many clinical guidelines, including the Prognosis Research Trial and meta-analyses, acknowledge the effectiveness of conservative treatment for patients with LD H[1,2,3,4]. Ruptured lumbar disc herniation (RLDH) is one of the most commonly accepted surgical indications due to the large-sized and dissociative protrusions and patients’ severe clinical symptoms.

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