Radicular pain, weak extremities predict poor outcomes in lumbar disc herniation

In patients with lumbar disc herniation, type of pain and weak lower extremities correlate with failure of conservative management, a recent Indonesia study has found.

Researchers conducted a prospective analysis of 171 patients with lumbar herniated nucleus pulposus who underwent conservative management involving back rest, physical therapy, diathermy therapy, education, and pharmacological medications. Neurologic examinations such as the passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were evaluated at baseline and at 2, 4, 8, 12, and 24 weeks after initiation.

Overall, 61 participants (35.7 percent) achieved good outcome, defined as a marked reduction in pain intensity, not requiring unscheduled clinic visitations and uptitrations in medicine dose, undisturbed social activity, and no absenteeism. In the remaining 110 patients, conservative treatment was deemed to have failed.

Multivariate logistic regression analysis revealed that having dominant radicular pain was a significant risk factor for poor conservative management outcome, increasing its odds by more than 10-fold relative to dominant back pain (adjusted odds ratio [OR], 10.57, 96 percent confidence interval [CI], 1.15–96.93; p=0.037).

Similarly, having weak vs normal motor power of the lower extremities significantly and strongly increased the likelihood of poor outcome (adjusted OR, 354.78, 95 percent CI, 12.5–10,092.2).

“Observation [of] type of pain and assessment [of] the motor power of lower extremities therefore are critical to predict the success of conservative treatment and these assessments could help to plan further management [for] the patient including to consider operative management,” the researchers said. “However, we encourage further studies using larger sample size to validate our results.”