• World Neurosurg · Feb 2023

    Conservative Treatments for Lumbar Disc Herniation at L3-4 or L4-5 Were More Likely to Fail When Ipsilateral Foraminal Stenosis Was Present at the Caudally Adjacent Segment.

    • Shuchen Ding, Xiaotian Du, Chudi Fu, Xinhua Zhao, Yunlin Ge, and Yue Wang.
    • Center of Orthopedics, The 903rd Hospital of People's Liberation Army, Hangzhou, Zhejiang, China.
    • World Neurosurg. 2023 Feb 1; 170: e577e583e577-e583.

    BackgroundConservative treatments are important in lumbar disc herniation (LDH), but predictors for poor outcomes are unclear.MethodsConsecutive patients with unilateral single-level LDH at L3-4 or L4-5 were enrolled. Baseline clinical data were collected, and lumbar spine magnetic resonance imaging was evaluated. Foraminal stenosis was evaluated using Lee's approach and further categorized as absence (grade 0 and 1) or presence (grade 2 or 3). Each patient underwent conservative treatments (oral meloxicam and dexamethasone, corset, back extension exercise, physiotherapy, and manual therapy) for 6 weeks. Conservative treatments were defined as failed if a patient underwent surgery within 6 weeks or reported poor recovery at 6-week follow-up. Multivariate logistic regressions were used to examine the associations of failed conservative treatments with baseline characteristics and magnetic resonance imaging findings.ResultsThe study included 222 patients (mean age 45.5 ± 9.8 years). Of patients, 48 (21.6%) had concurrent ipsilateral foraminal stenosis at the caudal segment, and conservative treatments failed in 39 (17.6%). At baseline, patients with LDH and caudal foraminal stenosis were older (50.79 ± 6.14 years vs. 44.10 ± 10.13 years, P < 0.001), had greater leg pain (7.06 ± 1.17 vs. 6.39 ± 1.40, P = 0.003), and had a higher rate of positive straight leg raising test (54.2% vs. 33.3%, P = 0.008) than patients without caudal foraminal stenosis. In multivariate regression, failure of conservative treatments was associated with positive straight leg raising test (odds ratio 2.26, P = 0.046), and caudal foraminal stenosis (odds ratio 3.20, P = 0.007).ConclusionsIn the presence of caudal foraminal stenosis and positive SLR test, conservative treatments were more likely to fail in patients with LDH.Copyright © 2022 Elsevier Inc. All rights reserved.

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