Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation.
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.
['Lee|Jung Hwan|JH|', 'Choi|Kyoung Hyo|KH|', 'Kang|Seok|S|', 'Kim|Dong Hwan|DH|', 'Kim|Du Hwan|DH|', 'Kim|Bo Ryun|BR|', 'Kim|Won|W|', 'Kim|Jung Hwan|JH|', 'Do|Kyung Hee|KH|', 'Do|Jong Geol|JG|', 'Ryu|Ju Seok|JS|', 'Min|Kyunghoon|K|', 'Bahk|Sung Gin|SG|', 'Park|Yun Hee|YH|', 'Bang|Heui Je|HJ|', 'Shin|Kyoung-Ho|KH|', 'Yang|Seoyon|S|', 'Yang|Hee Seung|HS|', 'Yoo|Seung Don|SD|', 'Yoo|Ji Sung|JS|', 'Yoon|Kyung Jae|KJ|', 'Yoon|Se Jin|SJ|', 'Lee|Goo Joo|GJ|', 'Lee|Sang Yoon|SY|', 'Lee|Sang Chul|SC|', 'Lee|Seung Yeol|SY|', 'Lee|In-Sik|IS|', 'Lee|Jung-Soo|JS|', 'Lee|Chang-Hyung|CH|', 'Lim|Jae-Young|JY|', 'Han|Jae-Young|JY|', 'Han|Seung Hoon|SH|', 'Sung|Duk Hyun|DH|', 'Cho|Kang Hee|KH|', 'Kim|Soo Young|SY|', 'Kim|Hyun Jung|HJ|', 'Ju|Woong|W|']
D006801:Humans D007268:Injections, Epidural D007403:Intervertebral Disc D007405:Intervertebral Disc Displacement D017116:Low Back Pain D059408:Pain Management D026741:Physical Therapy Modalities D017410:Practice Guidelines as Topic D016032:Randomized Controlled Trials as Topic D016896:Treatment Outcome
Nonsurgical Treatment Pain Lumbosacral Disc herniation Function