Surgical versus conservative management in lumbar disc herniation with neurological deficit

Shah M. S. Hoque; M. Anowarul Islam; M. Kamrul Ahsan; K. M. Rofiqul I. Setu; M. Shahidul I. Khan; Shagor K. Sarker; M. Moniruzzaman Monir

doi:10.18203/issn.2455-4510.IntJResOrthop20252621

Authors

Shah M. S. Hoque Department of Ortho Surgery, M. H. Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
M. Anowarul Islam Department of Ortho Surgery, Bangladesh Medical University, Dhaka, Bangladesh
M. Kamrul Ahsan Department of Spine Surgery, Bangladesh Medical University, Dhaka, Bangladesh
K. M. Rofiqul I. Setu Department of Spine Surgery, Bangladesh Medical University, Dhaka, Bangladesh
M. Shahidul I. Khan Department of Spine Surgery, Bangladesh Medical University, Dhaka, Bangladesh
Shagor K. Sarker Department of Spine Surgery, Bangladesh Medical University, Dhaka, Bangladesh
M. Moniruzzaman Monir National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252621

Keywords:

Lumbar disc herniation, Conservative treatment, Operative treatment, VAS, ODI

Abstract

Background: Lumbar disc herniation (LDH) with neurological deficit is a universal problem. Decision making between conservative or surgical treatment for LDH with neurological deficit remains still controversial. The objective of this study was to assess neurological outcomes for LDH with neurological deficit treated with surgical or conservative treatment.

Methods: Total 40 patients, 20 (50%) treated surgically and 20 (50%) conservatively, 18 to 55 years with neurological deficit due to LDH, irrespective of sex, established clinical symptoms, signs and radiologically evidenced (X-ray L/S spine and magnetic resonance imaging (MRI) of lumbar spine) were included and prospectively studied in Bangladesh medical University from August 2024 to June 2025. Outcomes were measured by visual analog scale (VAS) for back and leg pain and disability by Oswestry disability index (ODI) and satisfaction by modified Macnab criteria.

Results: 21 (52.5%) male and 19 (47.5%) female, 65% patients had right sided neurological deficit. At final follow up, VAS score for back and leg pain were significantly decline in both operative and conservative management and were 0.85±0.66, 1.00±0.63 and 1.85±.55, 1.65±0.67 respectively. Initially the ODI score for operative and conservatively treated patients were 62±4.92 and 61.6±2.86 and 6 months after these were 14.5±6.30 and 20±4.80 (p=0.0036). At final follow up, 90% of patients were satisfied with surgical treatment versus 55% treated conservatively (p=0.035).

Conclusions: Management of LDH with neurological deficit shows better outcome by surgically than conservatively treated patients at final follow up.

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