Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up

Full Text:


Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal antiinflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

About the Authors

M. A. Ivanova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine

V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine

A. I. Isaikin
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow
Russian Federation
Department of Nervous System Diseases and Neurosurgery, Faculty of General Medicine


1. Driscoll T, Jacklyn G, Orchard J, et al. The global burden of occupationally related low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014 Jun;73(6):975-81. doi: 10.1136/annrheumdis-2013-204631. Epub 2014 Mar 24.

2. Подчуфарова ЕВ, Яхно НН. Боль в спине. Москва: Гэотар-Медиа; 2010. 368 с. [Podchufarova EV, Yakhno NN. Bol' v spine [Back pain]. Moscow: Geotar-Media; 2010. 368 p.]

3. Manchikanti L, Singh V, Falco FJ, et al. Epidemiology of low back pain in Adults. Neuromodulation. 2014 Oct;17 Suppl 2:3-10. doi: 10.1111/ner.12018.

4. Парфенов ВА, Исайкин АИ. Боли в поясничной области. Москва; 2018. 200 с. [Parfenov VA, Isaikin AI. Boli v poyasnichnoi oblasti [Lumbar pain]. Moskva; 2018. 200 p.]

5. Bardin LD, King P, Maher CG. Diagnostic triage for low back pain: A practical approach for primary care. Med J Aust. 2017 Apr 3; 206(6):268-273. doi:10.5694/mja16.00828.

6. Cook CE, Taylor J, Wright A, et al. Risk factors for first time incidence sciatica: A systematic review. Physiother Res Int. 2014 Jun;19(2): 65-78. doi: 10.1002/pri.1572. Epub 2013 Dec 11.

7. Ashworth J, Konstantinou K, Dunn KM. Prognostic factors in non-surgically treated sciatica: A systematic review. BMC Musculoskelet Disord. 2011 Sep 25;12:208. doi: 10.1186/1471-2474-12-208.

8. North American Spine Society. Diagnosis and Treatment of Lumbar Disc Herniation with Radiculopathy. Documents/ResearchClinicalCare/Guidelines/ LumbarDiscHerniation.pdf

9. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014 Jan; 14(1):180-91. doi: 10.1016/j.spinee. 2013.08.003. Epub 2013 Nov 14.

10. NICE. Low back pain and sciatica in over 16s: assessment and management (NG59). ces/low-back-pain-and-sciatica-in-over-16sassessment-and-management-1837521693637

11. Парфенов ВА, Яхно НН, Кукушкин МЛ и др. Острая неспецифическая (скелетномышечная) поясничная боль. Рекомендации Российского общества по изучению боли (РОИБ). Неврология, нейропсихиатрия, психосоматика. 2018;10(2):4-11. [Parfenov VA, Yakhno NN, Kukushkin ML, et al. Acute nonspecific (musculoskeletal) low back pain Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(2): 4-11. (In Russ.)]. doi:10.14412/2074-2711-2018-2-4-11.

12. Shah JP, Thaker N, Heimur J, et al. Myofascial trigger point then and now: A historical and scientific prespective. PM R. 2015 Jul;7(7):746-61. doi: 10.1016/j.pmrj.2015.01.024. Epub 2015 Feb 24.

13. Исайкин АИ, Шевцова ГЕ, Рожков ДО и др. Роль мышечного фактора в развитии поясничной боли. Неврология, нейропсихиатрия, психосоматика. 2017;9(2):95-101. [Isaikin AI, Shevtsova GE, Rozhkov DO, et al. Role of a muscle factor in the development of low back pain. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2017;9(2):95-101. (In Russ.)]. doi:10.14412/2074-2711-2017-2-95-101.

14. Adelmanesh F, Jalali A, Jazayeri Shooshtari SM, et al. Is there an association between lumbosacral radiculopathy and painful gluteal trigger points? A cross-sectional study. Am J Phys Med Rehabil. 2015 Oct;94(10): 784-91. doi: 10.1097/PHM.0000000000000261.

15. Saeidian SR, Pipelzadeh MR, Rasras S, Zeinali M. Effect of trigger point injection on lumbosacral radiculopathy source. Anesth Pain Med. 2014 Sep 8;4(4):e15500. eCollection 2014 Oct.

16. Kawakami M, Weinstein JN, Chatani KI, et al. Experimental lumbar radiculopathy behavioral and histologic changes in a model of radicular pain after spinal nerve root irritation with chromic gut ligatures in the rat. Spine (Phila Pa 1976). 1994 Aug 15;19(16):1795-802. doi:10.1097/00007632-199408150-00002.

17. Kawakami M, Tamaki T, Hayashi N, et al. Possible mechanism of painful radiculopathy in lumbar disc herniation. Clin Orthop Relat Res. 1998 Jun;(351):241-51.

18. Kawakami M. Pathophysiology of radicular pain. Clin Calcium. 2005 Mar;15(3):57-62.

19. Chou R, Qaseem A, Snow V, et al. Clinical Guidelines Diagnosis and Treatment of Low Back Pain?: A Joint Clinical Practice Guideline from the American College of Physicians and the American. Ann Intern Med. 2007 Oct 2; 147(7):478-91. doi:10.7326/0003-4819-147-7-200710020-00006.

20. McGuirk B, King W, Govind J, et al. Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine (Phila Pa 1976). 2001 Dec 1;26(23):2615-22.

21. Kuritzky L, Samraj GP. Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. J Pain Res. 2012;5:579-90.

22. doi: 10.2147/JPR.S6775. Epub 2012 Nov 28.

23. Rasmussen-Barr E, Held U, Grooten WJ, et al. Non-steroidal anti-inflammatory drugs for sciatica. Cochrane Database Syst Rev. 2016 Oct 15;10:CD012382.

24. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr 4; 166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14.

25. Герасимова ОН, Парфенов ВА. Ведение пациентов с болью в спине в амбулаторной практике. Неврология, нейропсихиатрия, психосоматика. 2010;2(4):65-71. [Gerasimova ON, Parfenov VA. Management of patients with back pain in outpatient practice. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;2(4):65-71. (In Russ.)]. doi: 10.14412/2074-2711-2010-120

26. Парфенов ВА, Герасимова ОН. Использование ацеклофенака (аэртал ) при неспецифической боли в спине и других заболеваниях. Неврология, нейропсихиатрия, психосоматика. 2011;3(4):90-4. [Parfenov VA, Gerasimova ON. Use of aceclofenac (airtal) in nonspecific back pain and other diseases. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2011;3(4):90-4. (In Russ.)]. doi: 10.14412/ 2074-2711-2011-353

27. Парфенов ВА, Герасимова ОН. Неспецифическая боль в спине в амбулаторной практике, применение аэртала и мидокалма. Справочник поликлинического врача. 2013;(1):34-7. [Parfenov VA, Gerasimova ON. Nonspecific back pain in outpatient practice, the use of airtal and midokalm. Spravochnik poliklinicheskogo vracha. 2013; (1):34-7. (In Russ.)].

28. Кукушкин М, Брылев Л, Ласков В, Макаров Н. Результаты рандомизированного двойного слепого параллельного исследования эффективности и безопасности применения толперизона у пациентов с острой неспецифической болью в нижней части спины. Журнал неврологии и психиатрии им. С.С. Корсакова. 2017;117(11):69-78. [Kukushkin M, Brylev L, Laskov V, Makarov N. The results of a randomized double-blind parallel study of the efficacy and safety of tolperisone in patients with acute non-specific pain in the lower back. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2017;117(11): 69-78. (In Russ.)]. doi:10.17116/jnevro 201711711169-78.

29. Dincer U, Kiralp MZ, Cakar E, et al. Caudal epidural injection versus non-steroidal anti-inflammatory drugs in the treatment of low back pain accompanied with radicular pain. Joint Bone Spine. 2007 Oct;74(5):467-71. Epub 2007 May 30.

30. Thomas KC, Fisher CG, Boyd M, et al. Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathy. Spine (Phila Pa 1976). 2007 Jun 1;32(13):1414-22. doi:10.1097/BRS. 0b013e318060a5d1.

31. Jacobs WC, Van Tulder M, Arts M, et al. Surgery versus conservative management of sciatica due to a lumbar herniated disc: A systematic review. Eur Spine J. 2011 Apr; 20(4):513-22. doi: 10.1007/s00586-010-1603-7. Epub 2010 Oct 15.

32. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus Prolonged Conservative Treatment for Sciatica. N Engl J Med. 2007 May 31;356(22):2245-56. doi:10.1056/NEJMoa1414264.

33. Lequin MB, Verbaan D, Jacobs WC, et al. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial. BMJ Open. 2013 May 28;3(5). pii: e002534. doi: 10.1136/bmjopen-2012-002534.

34. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs Nonoperative Treatment for Lumbar Disk Herniation. The Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA. 2006 Nov 22;296(20):2441-50. doi:10.1001/ jama.296.20.2441.

35. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus Non-Operative Treatment for Lumbar Disc Herniation?: Four-Year Results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2008 Dec 1;33(25):2789-800. doi: 10.1097/BRS.0b013e3 1818ed8f4.

36. Lurie J, Tosteson T, Tosteson A, et al. Surgical versus Non-Operative Treatment for Lumbar Disc Herniation: Eight-Year Results for the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2014 Jan 1; 39(1):3-16. doi: 10.1097/BRS.0000000000000088.

37. Sun Z, Zhang M, Zhao XH, et al. Immune cascades in human intervertebral disc: The pros and cons. Int J Clin Exp Pathol. 2013 May 15;6(6): 1009-14. Print 2013.

38. Risbud MV, Shapiro IM. Role of Cytokines in Intervertebral Disc Degeneration: Pain and Disc-content. Nat Rev Rheumatol. 2014 Jan;10(1): 44-56. doi: 10.1038/nrrheum.2013.160. Epub 2013 Oct 29.

39. Kato T, Haro H, Komori H, Shinomiya K. Sequential dynamics of inflammatory cytokine, angiogenesis inducing factor and matrix degrading enzymes during spontaneous resorption of the herniated disc. J Orthop Res. 2004 Jul;22(4): 895-900. doi:10.1016/j.orthres.2003.11.008.

40. Macki M, Hernandez-Hermann M, Bydon M, et al. Spontaneous regression of sequestrated lumbar disc herniations: Literature review. Clin Neurol Neurosurg. 2014 May;120: 136-41. doi: 10.1016/j.clineuro.2014.02.013. Epub 2014 Feb 25.

41. Chiu CC, Chuang TY, Chang KH, et al. The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clin Rehabil. 2015 Feb;29(2):184-95. doi: 10.1177/0269215514540919. Epub 2014 Jul 9.


For citations:

Ivanova M.A., Parfenov V.A., Isaikin A.I. Conservative treatment for patients with discogenic lumbosacral radiculopathy: results of a prospective follow-up. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(3):59-65. (In Russ.)

Views: 605

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)