Jung Hwan Lee1, Kyoung Hyo Choi2, Seok Kang3, Dong Hwan Kim4, Du Hwan Kim5, Bo Ryun Kim6, Won Kim7, Jung Hwan Kim8, Kyung Hee Do9, Jong Geol Do10, Ju Seok Ryu11, Kyunghoon Min12, Sung Gin Bahk13, Yun Hee Park14, Heui Je Bang15, Kyoung-Ho Shin16, Seoyon Yang17, Hee Seung Yang18, Seung Don Yoo19, Ji Sung Yoo20, Kyung Jae Yoon10, Se Jin Yoon21, Goo Joo Lee22, Sang Yoon Lee23, Sang Chul Lee24, Seung Yeol Lee25, In-Sik Lee26, Jung-Soo Lee27, Chang-Hyung Lee28, Jae-Young Lim29, Jae-Young Han30, Seung Hoon Han31, Duk Hyun Sung32, Kang Hee Cho33, Soo Young Kim34, Hyun Jung Kim35, Woong Ju36. 1. Namdarun Rehabilitation Clinic, Yongin-si, Gyeongg-do, South korea. 2. Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: kyounghyochoi@gmail.com. 3. Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea. 4. Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University Hospital, South Korea. 5. Department of Physical and Rehabilitation Medicine, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, South Korea. 6. Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju, South Korea. 7. Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 8. Rehabilitation Hospital and Research Institute, National Rehabilitation Center, Seoul, South Korea. 9. Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, South Korea. 10. Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. 11. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundnang Hospital, Seoul, South Korea. 12. Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. 13. Department of Physical Medicine & Rehabilitation, Seocho Se Barun Hospital, Seoul, South Korea. 14. Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. 15. Department of Rehabilitation Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea. 16. Heal & Tun Rehabilitation Medicine Clinic, Seongnam-si, Gyeonggi-do, South Korea. 17. Department of Physical and Rehabilitation Medicine, Seoul Hyundai Hospital, Seoul, South Korea. 18. Department of Physical and Rehabilitation Medicine, Veterans medical center, Seoul, South Korea. 19. Department of Physical and Rehabilitation Medicine, Kyung Hee university, College of Medicine, Seoul, South Korea. 20. Department of Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, South Korea. 21. Department of Physical and Rehabilitation Medicine, Danam Rehabilitation Hospital, South Korea. 22. Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, South Korea. 23. Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. 24. Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea. 25. Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Seoul, South Korea. 26. Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, South Korea. 27. Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. 28. Department of Physical and Rehabilitation Medicine, Pusan National University Yangsan Hospital, School of Medicine, Pusan National University, Busan, South Korea. 29. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. 30. Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea. 31. Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Seoul, South Korea. 32. Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 33. Department of Physical and Rehabilitation Medicine, Chungnam National University, Daejeon, South Korea. 34. Department of Family Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea. 35. Department of Preventive Medicine, Institute for Evidence-based Medicine, Cochrane Korea, College of Medicine, Korea University, Seoul, South Korea. 36. Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, South Korea.
Abstract
BACKGROUND CONTEXT: Lumbosacral disc herniation (LDH) is one of the most frequent musculoskeletal diseases causative of sick leave in the workplace and morbidity in daily activities. Nonsurgical managements are considered as first line treatment before surgical treatment. PURPOSE: This clinical practice guideline (CPG) is intended to provide physicians who treat patients diagnosed with LDH with a guideline supported by scientific evidence to assist in decision-making for appropriate and reasonable treatments. STUDY DESIGN/ SETTING: A systematic review. PATIENT SAMPLE: Studies of human subjects written in Korean or English that met the following criteria were selected: patients aged ≥18 years, clinical presentation of low back and radicular leg pain, diagnosis of LDH on radiological evaluation including computed tomography or magnetic resonance imaging. OUTCOMES MEASURES: Pain and functional evaluation scales such as visual analogue scale, numeric rating scale, and Oswestry disability index METHODS: The MEDLINE (PubMed), EMBASE, Cochrane Review, and KoreaMed databases were searched for articles regarding non-surgical treatments for LDH published up to July 2017. Of the studies fulfilling these criteria, those investigating clinical results after non-surgical treatment including physical and behavioral therapy, medication, and interventional treatment in terms of pain control and functional improvements were chosen for this study. RESULTS: Nonsurgical treatments were determined to be clinically effective with regards to pain reduction and functional improvement in patients with LDH. Nevertheless, the evidence level was generally not evaluated as high degree, which might be attributed to the paucity of well-designed randomized controlled trials. Exercise and traction were strongly recommended despite moderate level of evidence. Epidural injection was strongly recommended with high degree of evidence and transforaminal approach was more strongly recommended than caudal approach. CONCLUSIONS: This CPG provides new and updated evidence-based recommendations for treatment of the patients with LDH, which suggested that, despite an absence of high degrees of evidence level, non-surgical treatments were clinically effective.
BACKGROUND CONTEXT: Lumbosacral disc herniation (LDH) is one of the most frequent musculoskeletal diseases causative of sick leave in the workplace and morbidity in daily activities. Nonsurgical managements are considered as first line treatment before surgical treatment. PURPOSE: This clinical practice guideline (CPG) is intended to provide physicians who treat patients diagnosed with LDH with a guideline supported by scientific evidence to assist in decision-making for appropriate and reasonable treatments. STUDY DESIGN/ SETTING: A systematic review. PATIENT SAMPLE: Studies of human subjects written in Korean or English that met the following criteria were selected: patients aged ≥18 years, clinical presentation of low back and radicular leg pain, diagnosis of LDH on radiological evaluation including computed tomography or magnetic resonance imaging. OUTCOMES MEASURES: Pain and functional evaluation scales such as visual analogue scale, numeric rating scale, and Oswestry disability index METHODS: The MEDLINE (PubMed), EMBASE, Cochrane Review, and KoreaMed databases were searched for articles regarding non-surgical treatments for LDH published up to July 2017. Of the studies fulfilling these criteria, those investigating clinical results after non-surgical treatment including physical and behavioral therapy, medication, and interventional treatment in terms of pain control and functional improvements were chosen for this study. RESULTS: Nonsurgical treatments were determined to be clinically effective with regards to pain reduction and functional improvement in patients with LDH. Nevertheless, the evidence level was generally not evaluated as high degree, which might be attributed to the paucity of well-designed randomized controlled trials. Exercise and traction were strongly recommended despite moderate level of evidence. Epidural injection was strongly recommended with high degree of evidence and transforaminal approach was more strongly recommended than caudal approach. CONCLUSIONS: This CPG provides new and updated evidence-based recommendations for treatment of the patients with LDH, which suggested that, despite an absence of high degrees of evidence level, non-surgical treatments were clinically effective.