The relationship between pain and herniation radiology in giant lumbar disc herniation causing severe sciatica: 15 cases

Abstract

Objective

To evaluate conservative treatment of giant lumbar disc herniation in patients with extreme pain and to assess temporal changes in pain levels and radiological findings with short-term follow-up.

Methods

A total of 15 patients with severe pain (as measured by visual analog scale [VAS]) due to giant lumbar disc herniation and without neurological deficits were included. All patients received conservative treatment and were followed weekly for pain and medication assessment. MRI was performed at baseline, second month and fourth month to calculate disc herniation volume. The changes in disc herniation and pain were evaluated.

Results

There was no relationship between pain and the regression of disc herniation in these five females and ten males with a mean age of 41.4 years. MRI results showed an average of 20.3% and 20.4% regression of disc herniation from baseline to second month, and second month to fourth month, respectively. Whereas, pain levels had reduced from an average of 90.8–13.53 by the second month, and to 3.13 by the fourth month, indicating significant success with conservative treatment.

Conclusions

Regardless of the size of the herniation and the severity of the pain, patients with giant lumbar disc herniation should be encouraged to undergo conservative treatment, given that the patient does not have urinary-fecal incontinence, foot drop or progressive neurodeficit.

Keywords:

• Giant lumbar disc herniation
• radiological imaging
• pain
• conservative treatment
• disc herniation volume

Acknowledgments

The authors would like to thank the patients and their families.

Ethical approval

Ethical approval for this study was obtained from by the Ethics Committee of Ankara Training and Research Hospital with a study approval number of 213/20.02.2020.

Disclosure statement

No potential conflict of interest was reported by the authors. Conceptualization: [Tuncer Tascioglu]; Methodology: [Tuncer Tascioglu], [Omer Sahin]; Formal analysis and investigation: [Omer Sahin]; Writing - original draft preparation: [Tuncer Tascioglu, Omer Sahin]; Writing - review and editing: [Tuncer Tascioglu]; Funding acquisition: [Omer Sahin]; Resources: [Omer Sahin]; Supervision: [Tuncer Tascioglu]. All authors read and approved the final manuscript.

*The Manuscript submitted does not contain information about medical device(s)/drug(s).[AQ]

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.