Effectiveness of Non-Surgical Treatment of Lumbar Disc Herniation: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Xinyong , WANG Zhenfei ,  LIANG Yu

Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine/ Shanghai Institute of Traumatology and Orthopaedics, Shanghai 200025, China;

Corresponding author：

LIANG Yu, Email: liangyu@sh163.net

Keywords：

Systematic review; Lumbar disc herniation; Non-surgical treatment; Treatment outcome; Randomized controlled trial

DOI：

10.7507/1672-2531.20120132

Video：

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Lumbar disc herniation is one of the most common causes of low back and leg pain in clinic. There are a lot of non-surgical therapeutic methods widely used in clinic for treating lumbar disc herniation. The author assessed the available systematic reviews of non-surgical methods in treating lumbar disc herniation which had been published in these years, and finally a total of 13 systematic reviews were retrieved including 1 about conservative treatments, 8 Chinese medicine treatments, and 4 percutaneous treatments, such as chemonucleolysis and epidural steroid injection. The results showed that the conservative treatments included injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture. But no evidence was found to show that any of the above treatments was clearly superior to others including no treatment for patients with lumbar disc herniation. The outcomes from some reviews showed that Chinese medicine treatments were safer and comprehensive treatment of traditional Chinese medicine was relatively effective compared with single treatment. Electro-acupuncture, compared with conventional therapy (bed rest, waist protection, pelvic traction, manual or physical therapy) and oral medications as well, was safe and effective in alleviating pain and improving overall function. Chinese medicinal fumigation combined with traction was more effective than single treatment. Percutaneous treatment of chemonucleolysis had much better short-term effectiveness. Percutaneous epidural steroid injection also had certain effects. To summarize, Chinese medicine and percutaneous treatments may be effective in treating lumbar disc herniation. However, more clinical trials are needed, since current evidence is of low quality.

Citation： CHEN Xinyong,WANG Zhenfei,LIANG Yu. Effectiveness of Non-Surgical Treatment of Lumbar Disc Herniation: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(7): 861-866. doi: 10.7507/1672-2531.20120132 Copy

1.	Kostelianetz M, Espersen JO, Halaburt H, et al. Predictive value of clinical and surgical findings in patients with lumbago-sciatica. A prospective study (Part I). Acta Neurochir (Wien), 1984, 73(3-4): 67-76.
2.	Markwalder TM, Battaglia M. Failed back surgery syndrome. Part II: Surgical techniques, implant choice, and operative results in 171 patients with instability of the lumbar spine. Acta Neurochir (Wien), 1993, 123(3-4): 129-134.
3.	Luijsterburg PA, Verhagen AP, Ostelo RW, et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J, 2007, 16(7): 881-899.
4.	黄锦军, 彭文琦, 雷龙鸣, 等. 中医综合疗法治疗腰椎间盘突出症的系统评价. 中医药信息, 2009, 26(5): 65-69.
5.	王林华, 卢敏. 中药熏蒸配合牵引治疗腰椎间盘突出症的系统评价与Meta分析. 中国中医骨伤科杂志, 2009, 17(8): 13-15.
6.	李林, 詹红生, 张明才, 等. 手法治疗腰椎间盘突出症临床随机对照试验系统评价. 中国骨伤, 2010, 23(9): 696-700.
7.	李林, 詹红生, 高宁阳, 等. 电针治疗腰间盘突出症临床随机对照试验系统评价. 中华中医药杂志, 2010, 25(12): 1949-1952.
8.	罗胜, 罗思文. 针灸治疗腰椎间盘突出症的系统分析. 针灸临床杂志, 2005, 21(6): 10-14.
9.	熊俊, 陈日新, 付勇, 等. 热敏灸治疗腰椎间盘突出症随机对照试验的系统评价. 江西中医药, 2011, 42(339): 48-51.
10.	穆敬平, 刘莉, 方伟, 等. 针刀治疗腰椎间盘突出症的系统评价. 中国中医药信息杂志, 2010, 17(7): 31-35.
11.	黄叶, 杨拯, 田芸, 等. 小针刀治疗腰椎间盘突出症的系统评价. 时珍国医国药, 2010, 21(9): 2420-2422.
12.	Couto JMC, Castilho EA de, Menezes PR. Chemonucleolysis in lumbar disc herniation: a meta-analysis. Clinics(Sao Paulo), 2007, 62(2): 175-180.
13.	毛秀, 王莉, 孟月, 等. 不同部位和途径注射胶原酶治疗腰椎间盘突出症有效性与安全性的系统评价. 中国循证医学杂志, 2006, 7(1): 53-60.
14.	孟月, 王莉, 毛秀, 等. 胶原酶治疗腰椎间盘突出症疗效的系统评价. 中国循证医学杂志, 2006, 6(12): 885-892.
15.	熊键, 杨万同, 廖维靖, 等. 硬膜外激素注射治疗腰椎间盘突出症的Meta分析. 中国康复医学杂志, 2004, 19(9): 684-686.
16.	Vroomen PC, de Krom MC, Knottnerus JA. Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract, 2002, 52(475): 119-123.
17.	Atlas SJ, Keller RB, Wu YA, et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study. Spine, 2005, 30(8): 927-935.
18.	Vroomen PC, de Krom MC, Slofstra PD, et al. Conservative treatment of sciatica: a systematic review. J Spinal Disord, 2000, 13(6): 463-469.

1. Kostelianetz M, Espersen JO, Halaburt H, et al. Predictive value of clinical and surgical findings in patients with lumbago-sciatica. A prospective study (Part I). Acta Neurochir (Wien), 1984, 73(3-4): 67-76.
2. Markwalder TM, Battaglia M. Failed back surgery syndrome. Part II: Surgical techniques, implant choice, and operative results in 171 patients with instability of the lumbar spine. Acta Neurochir (Wien), 1993, 123(3-4): 129-134.
3. Luijsterburg PA, Verhagen AP, Ostelo RW, et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J, 2007, 16(7): 881-899.
4. 黄锦军, 彭文琦, 雷龙鸣, 等. 中医综合疗法治疗腰椎间盘突出症的系统评价. 中医药信息, 2009, 26(5): 65-69.
5. 王林华, 卢敏. 中药熏蒸配合牵引治疗腰椎间盘突出症的系统评价与Meta分析. 中国中医骨伤科杂志, 2009, 17(8): 13-15.
6. 李林, 詹红生, 张明才, 等. 手法治疗腰椎间盘突出症临床随机对照试验系统评价. 中国骨伤, 2010, 23(9): 696-700.
7. 李林, 詹红生, 高宁阳, 等. 电针治疗腰间盘突出症临床随机对照试验系统评价. 中华中医药杂志, 2010, 25(12): 1949-1952.
8. 罗胜, 罗思文. 针灸治疗腰椎间盘突出症的系统分析. 针灸临床杂志, 2005, 21(6): 10-14.
9. 熊俊, 陈日新, 付勇, 等. 热敏灸治疗腰椎间盘突出症随机对照试验的系统评价. 江西中医药, 2011, 42(339): 48-51.
10. 穆敬平, 刘莉, 方伟, 等. 针刀治疗腰椎间盘突出症的系统评价. 中国中医药信息杂志, 2010, 17(7): 31-35.
11. 黄叶, 杨拯, 田芸, 等. 小针刀治疗腰椎间盘突出症的系统评价. 时珍国医国药, 2010, 21(9): 2420-2422.
12. Couto JMC, Castilho EA de, Menezes PR. Chemonucleolysis in lumbar disc herniation: a meta-analysis. Clinics(Sao Paulo), 2007, 62(2): 175-180.
13. 毛秀, 王莉, 孟月, 等. 不同部位和途径注射胶原酶治疗腰椎间盘突出症有效性与安全性的系统评价. 中国循证医学杂志, 2006, 7(1): 53-60.
14. 孟月, 王莉, 毛秀, 等. 胶原酶治疗腰椎间盘突出症疗效的系统评价. 中国循证医学杂志, 2006, 6(12): 885-892.
15. 熊键, 杨万同, 廖维靖, 等. 硬膜外激素注射治疗腰椎间盘突出症的Meta分析. 中国康复医学杂志, 2004, 19(9): 684-686.
16. Vroomen PC, de Krom MC, Knottnerus JA. Predicting the outcome of sciatica at short-term follow-up. Br J Gen Pract, 2002, 52(475): 119-123.
17. Atlas SJ, Keller RB, Wu YA, et al. Long-term outcomes of surgical and nonsurgical management of sciatica secondary to a lumbar disc herniation: 10 year results from the Maine Lumbar Spine Study. Spine, 2005, 30(8): 927-935.
18. Vroomen PC, de Krom MC, Slofstra PD, et al. Conservative treatment of sciatica: a systematic review. J Spinal Disord, 2000, 13(6): 463-469.

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