Soleimani et al., J Spine 2013, 2:3 DOI: 10.4172/2165-7939.1000134 Research Article Open Access Volume 2 • Issue 3 • 1000134 J Spine, an open access journal ISSN: 2165-7939 Conservative Management of Acute Lumbar Disc Herniation Soleimani H 1 , Owlia MB 1 *, Dahaj AA 2 , Lotf M 3 , Dehghan A 1 and Mehrpoor G 4 1 Rheumatologist, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2 Resident of surgery Mashhad University of Medical Sciences, Mashhad, Iran 3 Shahid Sadoughi University of Medical Sciences, Yazd, Iran 4 Internist, Alborz University of Medical Sciences, Karaj, Iran Abstract Background: Low back pain (LBP) due to acute disc herniation is a common disease bellow the age 45 years of age. Nowadays several types of treatment modalities used to manage these patients. The economic burden of LBP is heavy. LBP rank ffth among category of diseases in cost of hospital care. LBP has higher indirect costs due to absenteeism from work and disability than any other disease. This study was performed to assess the clinical outcomes of non-surgically treatment of LBP patients after six months follow up. Material & methods: Present prospective study was performed among 50 lumbar radicular patients with clinical signs and symptoms of acute lumbar disc herniation (less than three months). Their diagnosis was confrmed by Magnetic Resonance Imaging (MRI) study. The patties were treated conservatively during six months. Study outcome variables were pain and disability that were assessed by Visual Analog Scale (VAS) and Oswestry Disability Questionnaire (ODQ). Results: Twenty (40%) female and 30 (60%) male were participated in the study. During the follow up period, fve (10%) patients (four male) were referred to neurosurgeon due to poor response to conservative treatment and motor weakness. Pain of patients according to VAS after six months conservative treatment signifcantly improved than initial evaluation of patients (3.11 ± 1.83, 7.1 ± 1.43 P = 0.00). Disability score of patients signifcantly improved with conservative treatment in follow up period (25.82 ± 16.92, 53.66 ± 17.66; P = 0.00). Conclusion: Results of our study showed that conservative treatment in patients with acute lumbar disc herniation causes signifcant pain relief and disability improvement without any notable side effect. *Corresponding author: Dr. Mohammad Bagher Owlia, M.D, Rheumatologist, Shahid Sadoughi University of Medical Sciences, Shahid Sadoughi hospital, Rheumatology Department, Yazd, Iran, Tel: +98 351 8224001; Fax: +98 351 8224100; E-mail: bagherowlia@gmail.com Received December 11, 2012; Accepted March 22, 2013; Published March 22, 2013 Citation: Soleimani H, Owlia MB, Dahaj AA, Lotf M, Dehghan A, et al. (2013) Conservative Management of Acute Lumbar Disc Herniation. J Spine 2: 134. doi:10.4172/2165-7939.1000134 Copyright: © 2013 Soleimani H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Low back pain; Lumbar radicular pain; Disc herniation; Conservative treatment Introduction Low Back Pain (LBP) is a common-condition younger than the 45 years of age. Te estimated annual LBP incidence in Western countries is fve cases per 1000 adults [1]. Te economic burden of lumbar-spine disorders is heavy. Tis disorder ranks ffh among category of diseases for hospital care cost and has higher costs due to absenteeism from work and disability than any other disease [2]. LBP due to acute lumbar disc herniation is a common disorder at the ages of 44-50 years. It is characterized by radiating pain in the area of the leg typically served by one nerve root in the lumbar or sacral spine [1,2]. Several conservative and surgical modalities were applied for these patients. Cauda equina syndrome was considered as the single absolute indication for surgery in a LBP patient [3-5]. Ninthly and ninthly fve percents of acute disc herniation patients were improved during two months with conservative treatment such as bed rest, life style modifcation, medication, back support, exercise, manipulation, physical therapy And epidural steroid injection [3-7]. Previous studies reported that conservative treatment such as non- steroidal anti-infammatory drugs cause pain relief in patients with disc herniation [8,9]. Other drugs such as muscle relaxant might be useful in acute low back pain [9]. Some reports showed that oral steroid did not have useful impacts on acute lumbar disc herniation [8,9]. Epidural injection is one of the alternative treatment modalities for patients who did not respond to conservative treatment or have contraindication for surgery [9-12]. Tis study was performed to assess the clinical outcomes of non-surgically treated LBP patients afer six months follow up. Material and Methods Present prospective study was performed among 50 patients with clinical signs and symptoms of acute lumbar disc herniation(less than three months symptoms) who confrmed by MRI. Our subjects then were referred to rheumatology clinic of Shahid Sadoughi hospital, Yazd, Iran. Tis study was approved by ethical board and fully supported by Shahid Sadoughi University of Medical Sciences. Study samples Our sampling method was consecutive sampling and also written informed consent was obtained from all patients. Patients who had symptoms and signs of radicular pain in L5 or S1 territory level were assessed by neurologic and lumbar movement examination, detection of muscle force and Straight Leg Raising test (SLR). MRI was done for all patients and if they had disc herniation without exclusion criteria were included in this study. Te exclusion criteria were: degenerative or spinal canal stenosis, tumor, trauma, infection, spondilolysthesis or signs and symptoms of neurologic defcit. Study design All patients were visited by rheumatologist; and MRI imaging studies were used for diagnosis confrmation. An independent Journal of Spine J o u r n a l o f S p i n e ISSN: 2165-7939