Surgical and medical treatments for discogenic low back radiculopathy
Objective: to compare the efficiency of medical and surgical treatments for discogenic low back radiculopathy. Patients and methods. 32 patients (including 13 men; mean age, 39.1+11.8 years) received inpatient medical treatment with epidural glucocorticoids; 32 patients (including 19 men; mean age. 42.3+12.1 years) had surgical treatment (removal of a herniated disk). A questionnaire [numerical pain rating scale (NPRS), Oswestry disability index, and quality of life questionnaire (QOL), SF-12] survey was carried out on admission to the clinic, after 7-14 days during treatment (pain intensity and functional status), and after 3, 6, and 12 months. Results and discussion. There were no clinical differences between the patient groups at baseline. Both groups showed a significant decrease in pain intensity and reduced disability after 7-14 days of treatment, with a persistent positive effect over 12 months (p < 0.01). During a year, both groups exhibited better quality of life (p < 0.01). In the surgical treatment group, leg pain intensity was noted to become lower in the early stages (NPRS scores were 0.97 vs 2.41 after 7-14 days and 0.84 vs 1.56 scores after 3 months; p < 0.05); however, this advantage did not persist in the long-term. No significant differences were found between the groups in back pain intensity, disability, and QOL indicators throughout the follow-up period. Conclusion. There were no significant clinical differences between patients with discogenic low back radiculopathy who are referred to hospital for surgical or medical treatment. Surgery makes it possible to reduce more rapidly the intensity of leg pain; however, no benefits of surgical treatment in terms of back pain intensity, disability, and QOL are noted. It is advisable to inform patients about the favorable course of the disease and the possibility of natural regression of disc herniation.