Management Of Lumbar Disc Herniation Research Articles

Endoscopic Transforaminal versus Interlaminar Discectomy in Management of Lumbar Disc Herniation: A Systematic Review of Outcomes and Complications

Abstract Background Lumbar herniated discs are common manifestations of degenerative spine diseases, being the main cause of radiated lower back pain. Aim of the Work The aim of this study is to compare between the transforaminal approach and the interlaminar approach in the incidence of complications and clinical prognosis scores in patients with lumbar disc herniation. Patients and Methods Literature searches was conducted using the following databases:” PubMed, Web of Science, ScienceDirect, Scopus, Cochrane Library, Google Scholar, Medline” using the following key words: “percutaneous transforaminal endoscopic discectomy, percutaneous interlaminar endoscopic discectomy, operative complications, minimally invasive, discectomy, endoscopic” from studies published after 2010. Results Although there is no significant difference between the two groups of comparison regarding percentage of postoperative complications, VAS scores, or ODI scores, However, PEID was superior to PETD regarding fluoroscopy times and operative time. The increased radiation exposure might be caused by the higher iliac crest, narrower foramina, or larger facet joints, which increased the difficulty of percutaneous puncture. Repeated fluoroscopy must be used to guide the puncture. In addition, the hypertrophy of ligamenta flava might also contribute to the difficulty of puncture and further increase radiation exposure in the PETD group. Conclusion This review provides evidence that both PEID and PETD are safe, effective, and minimally invasive surgical methods for the treatment of lumbar disc herniation, under the conditions that the surgical techniques required have been mastered and the indications for surgery are observed.

An evidence-based guideline on treating lumbar disc herniation with traditional Chinese medicine.

Lumbar disc herniation (LDH), as one of the most common causes of lower back pain, imposes a heavy economic burden on patients and society. Conservative management is the first-line choice for the majority of LDH patients. Traditional Chinese medicine (TCM) is an important part of conservative treatment and has attracted more and more international attention. Evidence-based guideline. We formed a guideline panel of multidisciplinary experts. The clinical questions were identified on the basis of a systematic literature search and a consensus meeting. We searched the literature for direct evidence on the management of LDH and assessed its certainty-generated recommendations using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The guideline panel made 20 recommendations, which covered the use of Shentong Zhuyu decoction, Shenzhuo decoction, Simiao San decoction, Duhuo Jisheng decoction, Yaobitong capsule, Yaotongning capsule, Osteoking, manual therapy, needle knife, manual acupuncture, electroacupuncture, Chinese exercise techniques (Tai Chi, Baduanjin, or Yijinjing), and integrative medicine, such as combined non-steroidal anti-inflammatory drugs, neural nutrition, and traction. Recommendations were either strong or weak, or in the form of ungraded consensus-based statement. This is the first LDH treatment guideline for TCM and integrative medicine with a systematic search, synthesis of evidence, and using the GRADE method to rate the quality of evidence. We hope these recommendations can help support healthcare workers caring for LDH patients.

Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review.

Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags. The methodology employed in this review involves an extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR. By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections. Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling. Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy.

Open Microdiscectomy or Tubular Discectomy: What Is Better for Lumbar Disc Herniation

Introduction: Many different minimally invasive procedures can be used to treat lumbar disc herniation. In the management of lumbar disc herniation, Open microdiscectomy MD is the gold standard and is used as a benchmark for comparison with more recent techniques like tubular discectomy. The purpose of this study was to assess the complication rates of tubular discectomy and to compare the postoperative outcomes of individuals undergoing tubular discectomy with those undergoing MD. Material & Methods: A retrospective analysis of 250 patients who underwent single-level lumbar discectomy either by tubular TD or MD between JULY 2018- JUNE 2023 was performed. The differences in the 2 groups' demographics, surgical length, intraoperative blood loss, overall hospital stay, pain score on the visual analogue scale (VAS), Oswestry Disability Index (ODI) score both before and after the procedure, and complications were assessed. Results: Out of the 250 patients, 130 patients were treated with MD and 120 by tubular discectomy TD. The mean age in MD and tubular TD group was 45.5 and 45.8 years. There was a improvement in VAS and ODI scores at 4 weeks in both the groups. There was a greater reduction of back pain in the TD group at 2 weeks compared to MD group but at 1 month both are comparable. Average surgical time was shorter in MD (71.6 min) as compared to TD group (80.2 min). the Average blood loss was higher (90.2 mL) in MD group as compared to TD group (35.8 mL) (Table 3 ). Length of incision as measured from the surgical scar was 1.7 cm in TD while it was 3.0 cm in MD group. Average hospital length of stay in TD (1.2 days) which was less than MD group (2.1 days). Likewise, MD group patients took 5.9 weeks to return to activity which was higher than the TD group (4.1 weeks). There were 9 cases (6.9%) of dural tear in MD and 10 cases (8.3%) in TD group. Conclusion: Sciatica caused by disc herniation can be effectively and safely treated with lumbar discectomy, whether it is TD or MD. In comparison to MD, the TD method for treating symptomatic lumbar radiculopathy is superior in that it causes less postoperative back pain, less blood loss, a shorter hospital stay, and a quicker return to work. Despite the learning curve, TD has been demonstrated to be a viable choice for treating lumbar disc herniation in patients who are carefully chosen.

Prevalence of Low Back Pain and Its Related Risk Factors and Disability Following Lumbar Discectomy: A Single-Center Study.

Background Lumbar disc herniation is considered the most common cause of sciatica, which is a contributing factor to disability. Surgical management of lumbar disc herniation in the form of discectomy is superior to conservative management in terms of better recovery and pain relief. However, recurrence, residual back pain, and disability are common expected complications following surgery. Therefore, this study aims to determine the prevalence of low back pain and its related risk factors and disability following discectomy at King Fahad Hospital in the Al-Ahsa region. Methodology A cross-sectional study was conducted at King Fahad Hofuf Hospital in the Al-Ahsa region among patients who were admitted and underwent lumbar spine discectomy in the last six years either due to traumatic or degenerative causes. The study used an anonymous questionnaire consisting of the patient's sociodemographic data, medical and surgical history, spine disease history, and surgical history. The preoperative Glasgow Coma Scale score, neurological status, and American Spinal Cord Impairment Scale score were noted. In addition, immediate postoperative neurological status and minor complications were recorded. Moreover, more than six months postoperatively, the Numeric Analogue Scale and the Oswestry low back pain disability index questionnaire were administered. Results A total of 201 patients were included in the study. The majority of the patients were male (59.7%), with ages ranging from 41 to 60 years (51.7). Most patients underwent one surgery (83.6%) in the form of discectomy alone (90.5%) at L3-L4 (58.7%), for which the intervertebral disc was the most common degenerative indication for surgery. All patients (100%) had low back pain preoperatively, and most patients (50.7%) had no back pain six months postoperatively. Preoperatively, 58.2% had diminished neurological status, while only 29.9% showed a deficit postoperatively. Postoperative low back pain was significantly associated with office-based jobs (p = 0.021, 60.5%) and a high number of surgeries (p = 0.004, 74.1%). The following factors were observed to be risk factors for having lower back pain: six months postoperatively, being unemployed (p = 0.024, odds ratio = 4.38, 338% increased risk), having an office-based job (p = 0.012, odds ratio = 3.98, 298% increased risk), and the underlying cause of the problem being degenerative (p = 0.003, odds ratio = 3.34, 234% increased risk). Low back pain-related severe disability postoperatively was significantly associated with increased age >40 (28-50%; p = 0.045), female gender (p = 0.012, 44.4%), and being unemployed (p = 0.002, 51.4%). The level of disability six months postoperatively was moderate in 40.4% of the patients. Conclusions Lumbar discectomy is a successful procedure for relieving low back pain among patients with degenerative spine disease, with an improvement that involves neurological status. However, residual back pain may still occur in less than half of the patients despite appropriate management, such as being unemployed or office-based employees and having multiple spine surgeries. However, low back pain-related disability is often moderate, with increasing severity seen with increased age, being female, and being unemployed.

Interventional Therapy and Surgical Management of Lumbar Disc Herniation in Spine Surgery: A Narrative Review.

Significant advancements in lumbar disc herniation (LDH) management have been made in interventional pain therapy, operative therapy, peri-operative management, and cost analysis of various procedures. The present review aims to provide a concise narrative of all these topics, current trends, and possible future directions in the management of LDH. Interventional pain management using intradiscal injections often serves as a minimally invasive non-surgical approach. Surgical modalities vary, including traditional open laminectomy, microdiscectomy, endoscopic discectomy, tubular discectomy, percutaneous laser disc decompression, and transforaminal foraminotomy. Prevention of infections during surgery is paramount and is often done via a single-dose preoperative antibiotic prophylaxis. Recurrence of LDH post-surgery is commonly observed and thus mitigative strategies for prevention have been proposed including the use of annular closure devices. Finally, all treatments are well-associated with clear as well as hidden costs to the health system and society as described by billing codes and loss of patients' quality-adjusted life-years. Our summary of recent literature regarding LDH may allow physicians to employ up-to-date evidence-based practice in clinical settings and can help drive future advancements in LDH management. Future longitudinal and comprehensive studies elucidating how each type of treatments fare against different types of herniations are warranted.

Management of Lumbar Disc Herniation: A Systematic Review.

A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. It is a common cause of back pain. The patients who experience pain related to a herniated disc often remember an inciting event that caused their pain. This activity reviews the evaluation and management of lumbar disc herniation and discusses the role of the healthcare team in evaluating and improving care for patients with this condition. Data sources were PubMed/Medline and Embase. Our review investigated English-language articles (from 2010 to 2023) according to the PRISMA guidelines.Overall, there were seven articles. Surveys and analyses of national databases were the most widely used methods (n=7). The search identified 777 studies; 7 were eligible for inclusion in the analysis. Further understanding of spinal disc herniationand treatment protocols may help improve evaluation and management in the future. Our research covered a range of management options. Disc herniation is a frequent problem for internists, emergency department doctors, nurse practitioners, and primary care physicians. To manage efficiently, an interprofessional team is needed. The first course of treatment is conservative, with paracetamol and anti-inflammatories being frequently used to relieve pain. A chemist must supervise the use of opioid analgesics in certain situations. Although surgery is sometimes the final option, patients frequently have neurological damage and lingering discomfort. In circumstances where physical treatment is not working, MRI interpretation becomes necessary. Primary care physicians or mental health professionals should handle back pain as it is frequently linked to mental health issues. Results can be enhanced by regular exercise and preserving a healthy body weight.

Guidance of Nerve Stimulator and Ultrasound for Transforaminal Epidural Steroid Injection in Lumbosacral Radicular Pain : A Single Institution Experience in Vietnam.

This study aimed to evaluate the clinical feasibility of the combination of ultrasound and nerve stimulator guidance in transforaminal epidural steroid injections (TESIs) to manage lumbosacral chronic radicular pain. Using the combination of nerve stimulator and ultrasound guidance, TESIs were performed in 125 segments of 78 patients who presented with chronic lumbar radicular pain. Demographic characteristics and surgical outcomes were recorded on admission, pre-procedural and post-procedural for 1-week, 1-month, 3-month, and 6-month follow-ups. The result was measured using the Numeric rating scale (NRS) and Oswestry disability index (ODI). Patients who received TESIs showed significant improvements on two evaluation tools (NRS, ODI), compared to that before procedure (p<0.001). No significant complications were observed for 6 months' follow-up. The result suggests that a combination of ultrasound and nerve stimulator guidance in transforaminal epidural injections is safe, reliable and effective for short-term management of lumbar disc herniation. It is a promising technique and has shown good results in providing intermediate pain relief.

Biportal endoscopic surgery for lumbar spine herniated discs: a narrative review of its clinical application and outcomes.

Lumbar disk herniation (LDH) is a common condition affecting millions worldwide. The management of LDH has evolved over the years, with the development of newer surgical techniques that aim to provide better outcomes with minimal invasiveness. One promising emerging technique is biportal endoscopic spinal surgery (BESS), which utilizes specialized endoscopic equipment to treat LDH through two small incisions. This review aims to assess the effectiveness of BESS as a management option for LDH by analyzing the available literature on surgical outcomes and potential complications associated with the technique. Our review shows that BESS is associated with favorable postoperative results as judged by clinical scoring systems, such as visual analog scale, Oswestry disability index, and MacNab criteria. BESS has several advantages over traditional open surgery, including minimized blood loss, a shorter duration of hospitalization, and an expedited healing process. However, the technique has limitations, such as a steep learning curve and practical challenges for surgeons. Our review offers recommendations for the optimal use of BESS in clinical practice, and provides a foundation for future research and development in this field, aiming to improve patient outcomes and quality of life.

Effects of the administration of Shinbaro 2 in a rat lumbar disk herniation model.

The current standard for the pharmacological management of lumbar disk herniation (LDH), involving non-steroidal anti-inflammatory drugs, muscle relaxants, and opioid analgesics, often carries a risk of adverse events. The search for alternative therapeutic options remains a vital objective, given the high prevalence of LDH and the critical impact on the quality of life. Shinbaro 2 is a clinically effective herbal acupuncture against inflammation and various musculoskeletal disorders. Therefore, we explored whether Shinbaro 2 exerts protective effects in an LDH rat model. The results showed that Shinbaro 2 suppressed pro-inflammatory cytokines, interleukin-1 beta, tumor necrosis factor-alpha, disk degeneration-related factors, matrix metalloproteinase-1,-3,-9, and ADAMTS-5 in LDH rats. Shinbaro 2 administration reinstated a behavioral activity to a normal level in the windmill test. The results indicated that Shinbaro 2 administration restored spinal cord morphology and functions in the LDH model. Therefore, Shinbaro 2 exerted a protective effect in LDH via actions on inflammatory responses and disk degeneration, indicating that future research is warranted to assess the action mechanisms further and validate its effects.

The importance of "time to surgery" in the management of lumbar disc herniation in patients without progressive neurological deficits.

Prolonged sciatica symptoms may result in disability and consequently, absence from work for a longer period. Up to 10% of patients may need surgery but it is difficult to predict and determine which of these patients would improve spontaneously in comparison to those who might benefit from discectomy surgery. We aimed to determine if delay in the "time to surgery" (TTS) has any adverse effects on the patient reported outcome measures (PROMs). Eighty-seven patients after exclusions were selected consecutively. PROMs were comprised of pre-operative, six weeks and six months post-operative back and leg pain visual analogue scores (VAS) and Oswestry disability index (ODI). The differences between these scores were correlated with TTS. Minimal clinically important difference (MCID) of 30% improvement for ODI scores and 33% for VAS scores from baseline were considered as significant improvement. Patients were grouped into TTS less than 6 months and TTS greater than 6 months from referral to TTS. The longest TTS was 18 months. Statistical analysis was done using JASP (Version 0.14.0) [computer software]. The TTS was on average 22.5 weeks. MCID for the leg pain VAS was achieved in 90.2% patients with TTS <6 months and in 80.8% with TTS ≥6 months. The MCID for ODI was achieved in 60.7% with TTS <6 months and in 42.0% with TTS ≥6 months. The MCID for back pain VAS was achieved in 73.8% with TTS <6 months and in 50.0% of patients with TTS ≥6 months. Those who achieved the MCID in ODI score between the two groups were analysed using chi-square test with P=0.115. Those who achieved the MCID in VAS leg pain score between the two groups were analysed using chi-square test with P=0.227. No statistical difference was found in ODI and VAS for leg for patients with TTS before or after 6 months. Lumbar discectomies had a positive impact on patient's pain and function in our local district hospital. Delayed surgery of ≥6 months did not cause statistically significant worse outcomes. In the absence of worsening neurological deficit, it may be the wrong approach to define a value for the TTS.

Effect of caudal epidural adhesiolysis plus steroid injections on pain and daily activities among chronic lumbar disc herniation patients; an observational study

Background &amp; Objective: The management of lumbar disc herniation (LDH) remains a big challenge as it may involve the surrounding tissues, and attract neovascularization facilitated macrophage aggregates. Epidural triamcinolone might have a half-life action ranging from 10 to 31 days, whereas 80 mg methylprednisolone might improve the pain up to 1 week. The higher doses of steroids will lead to adrenal cortex suppression and osteopenia. We evaluated the effect of treatment with 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at 2 weeks, and 3 and 6 months follow-up.&#x0D; Methodology: We enrolled seven males (38.9%) and 11 females (61.1%) with mean age 44 ± 23 y in the study. Eight (44.44%) subjects were younger than 51 y old, whereas the 10 (55.56%) subjects were ≥ 51 y old. Twelve (66.7%) subjects had had a bulged disc, and 6 (33.3%) subjects had disc protrusion. We injected 1500 international unit (IU) hyaluronidase followed by 20 mg triamcinolone at the site of disc lesion. Pain scores were measured with NRS scale and Oswestry Disability Index (ODI) scores at 2 weeks, and 3- and 6-months follow-up.&#x0D; Results: The NRS score improved at 2 weeks, 40% to 71.43%, at 3 months 60% to 100%, and 6 months 80% to 100%. And the Oswestry Disability Index (ODI) score was improved at 2 weeks from 23.5% to 68.18%), at 3 months from 39.13% to 100%, and at 6 months 82.35% to 100%. A significant association was observed between age older than 50 y old and ODI scores at 2 weeks followed up.&#x0D; Conclusions: The intra-epidural 1500 IU hyaluronidase before triamcinolone brings better results even though using a lower dose of triamcinolone. This approach showed the lower-cost better pain scores as compared to the routine use of heavy doses of triamcinolone for managing bulged and protruding LDH.

Transforaminal injection of autologous platelet-rich plasma for lumbar disc herniation: A single-center prospective study in Vietnam

ObjectiveLumbar radiculopathy is a major health problem, which often treated by neurosurgery or guided lumbar epidural steroids for pain relief. We used autologous Platelet Rich Plasma (PRP) as a novel pharmaceutical agent that has strongly emerged in recent years to treat patients of lumbar disc herniation. From that, we evaluated the efficacy of PRP via transforaminal route in treatment of radicular pain in patients with lumbar disc herniation. MethodsTwenty-five patients were enrolled and injected with 4 ml of autologous platelet rich plasma under fluoroscopic guidance via transforaminal epidural injection into area of affected nerve root. They were followed using Visual Analogue Scale (VAS), Modified Oswestry Disability Index (ODI) and Straight Leg Raising Test (SLRT) for clinical assessment. ResultsPatients who received transforaminal injections with autologous PRP showed statistically significant improvements on all three evaluation tools (VAS, ODI, SLRT). The improvements were sustained over twelve-month follow-up and there were no associated complications. ConclusionTransforaminal injection with autologous PRP helps patients relieve chronic pains and be able return to work. Besides, autologous PRP can be considered as a good alternative to epidural steroids in management of lumbar disc herniation.

Guideline for diagnosis, treatment and rehabilitation of lumbar disc herniation

Recent years,the incidence of lumbar disc herniation is increasing annually,trending to younger age.There is a lack of clinical guideline for the management of lumbar disc herniation.Considering various problems in the management of lumbar disc herniation under different occasions,based on a systematic literature review,Basic Research and Transformation Society,Professional Committee of Spine and Spinal Cord organized experts to make this consensus jointly.This guideline aims to provide a standardized management of lumbar disc herniation with scientific principle and practical feasibility.Evidence-based medicine,and scientific suggestions are put forward specially for the management of lumbar disc herniation to standardize the diagnosis and treatment,promote the prognosis as well as improve the quality of life of patients.

What's New in Spine Surgery.

What's New in Spine Surgery.

Temporal Pattern of Pain and Disability Following the Administration of a Selective Nerve Root Block in Lumbar Disc Herniation With Radiculopathy

Lumbar disc herniation with radiculopathy has a favorable natural history, and a selective nerve root block (SNRB) is an accepted treatment modality. This study aims to ascertain the temporal pattern of pain and disability following the administration of an SNRB in the management of lumbar disc herniation with radiculopathy because there is limited evidence regarding this issue in the published literature. This prospective study included 50 patients who underwent an SNRB and were followed for 3 months. Numerical Rating Scale (NRS) for back and leg pain and Oswestry Disability Index (ODI) and Depression Anxiety Stress Scales-21 (DASS-21) scores were collected. At the final follow-up at 3 months, the number of patients who underwent surgery was ascertained. Forty-two of 50 (84%) patients avoided the surgery with a reduction in mean preinjection NRS for back and leg pain from 7.5 (SD 1.33) and 7.7 (SD 1.35) to 3.1 (SD 1.69) and 2.3 (SD 1.14) (P < 0.001), respectively, within the 30 minutes after injection. The pain relief was sustained until the last follow-up. The ODI score also decreased from a mean preinjection level of 59.4 (SD 14.69) to 26.3 (SD 9.43) (P < 0.001) at 3 months. The mean preinjection depression score was higher in patients who had recurrence of pain and eventually underwent surgery. Early administration of an SNRB in the course of lumbar radiculopathy is recommended as it provides instantaneous and sustained relief of back and leg pain and disability in a majority of patients. SNRB should be administered early in the course of management of lumbar radiculopathy and should not be delayed until after other non-surgical modalities have failed. 2.

Application of teach-back method combined with mind mapping training in health education of functional exercise for patients after surgery management of lumbar disc herniation

Application of teach-back method combined with mind mapping training in health education of functional exercise for patients after surgery management of lumbar disc herniation

Application of teach-back method combined with mind mapping training in health education of functional exercise for patients after surgery management of lumbar disc herniation

Application of teach-back method combined with mind mapping training in health education of functional exercise for patients after surgery management of lumbar disc herniation

Evaluation of asymptomatic lumbar disc herniation and endplate failure in general population and their significance in development of low backache

Introduction: Despite being the most common cause of low back pain, there are wide variations in the pathogenesis and management of lumbar disc herniation (LDH). Previously the nucleus pulposus was being implicated for most of the symptoms, but recent papers propose the endplate failure (EPF) as the most important component of symptomatic LDH. However considering the abundance of the asymptomatic LDH in normal population, it is important to study the association of endplate failure in general population to understand it’s contribution in symptomatic LDH.Aim: To evaluate the incidence of asymptomatic LDH and EPF in normal population and note development of any low back pain in them. Material and Methods: Adult patients presenting outdoor with complains other than present or past history of low backache were evaluated clinically and radiologically [x-ray, CT scan, MRI scan including the fat suppressed 3D fast spoiled gradient sequences (3DFSPGR)] to note status of lumbar disc and endplate. They were then, prospectively followed up for 3 years for any occurrence of backache.Results: Twenty volunteers (13 males, 7 females) were studies from age 19-50 years (mean 33.6±10.3). Six volunteers (30%) had desiccation of one or more lumbar disc and 8 volunteers (40%) had LDH at one or more levels. However all of the LDH were broad based disc bulge. Three volunteers had cartilaginous EPF and 1 had bony EPF. None of the EPFs were associated with disc desiccation, but 2 were associated with LDH. The presence of disc desiccations and LDH were significantly correlated to the increasing age but the EPF had no such age correlation. Subsequently 2 volunteers developed low backache.Conclusion: Asymptomatic disc desiccation and lumbar disc bulge is fairly common. Their mere presence may not be the cause of the low backache and should be carefully considered for any surgical planning. However presence bony EPF is rare and may have some significance in development of symptomatic LDH

Establishing a critical pathway for Korean medical management of lumbar disc herniation: A modified Delphi consensus process.

A modified Delphi method was used to establish a consensus. Stakeholders and experts were invited to participate in the expert panel. Best practice statements and decision-making questionnaires were distributed to the panel. Panel members were asked to mark “Strongly disagree” to “Strongly agree” after a series of statements over several rounds until either a consensus was reached or the decision-making method was deemed unsuitable for reaching a consensus.The most common cause of lumbar pain is intervertebral degeneration, which leads to degenerative disc disease and lumbar disc herniation. There is a lack of unanimity regarding appropriate patient protocols and rehabilitation expectations for Korean medical care. The long-term viability of Korean medical treatment, further adoption in the institutional setting, and specific patient outcomes are contingent on the existence of appropriate Korean medical programs.A Korean medical expert panel of 17 practitioners employed a modified Delphi method to achieve consensus on Korean medical care for lumbar disc herniation. The panel first reviewed the literature and guidelines relevant to Korean medical treatment for lumbar disc herniation. The panel members considered questionnaires intended to determine “standardized” Korean medical care recommendations for patients with a wide range of symptoms of lumbar disc herniation. Each panel member participated in a round of voting, which was followed by an opinion-collecting session online. Consensus was defined as a ≥75% agreement among the respondents.In the first round, 144 questionnaires across 5 domains were administered to the expert panels. After reviewing the responses and open-ended comments collected in the first round, the authors modified the questionnaires to 53 items and proceeded. In round 2, consensus was achieved in all 53 survey questions. The final treatment pathway comprised a standardized and comprehensive care approach for lumbar disc herniations in 4 types of medical institutions.This study identified a core set of evidence- and consensus-based principles that are essential to a comprehensive model of care, incorporating identification, referral, and management of patients with lumbar disc herniation.