[Comparative analysis of the neurological status in patients with lumbar discopathy receiving conservative or operative therapies].
Neurological examination is one of basic assessment methods of the patients with discopathy of the lumbar spine. Neurological status of the patients can significantly change depending on progression of the disease of the intervertebral disc. It often determines a selection of the treatment method; it is also important criterion for assessment of efficacy of the accepted procedure. The aim of this study was to retrospectively evaluate neurological status in the patients with lumbar discopathy receiving only conservative therapy as well as undergoing surgical procedures.


METHODS
665 patients aged between 16 and 76 years with discopathy at L4-L5 and L5-S1 levels have been enrolled to the study. In estimated group 348 patients received only a conservative therapy whereas 317 patients undergone an operative procedure. Study included hospitalization period and more than ten year period after discharge from the Clinic. Collected material has been analyzed in tree age groups: young persons (up to 30), mid age persons (31-50 years) and older persons (at the age of above 50). Neurological examination included analysis of the following parameters: cough symptom, Laségue's sign, stretch reflexes (patellar, ankle), superficial perception and vibration, function of sphincters, muscular power).


RESULTS
No significant progression of the neurological symptoms up to the fifth year of treatment has been seen in group of patients receiving conservative therapy. In group of operated patients starting the second year after surgical procedure, number of diagnosed pathological neurological symptoms systematically was increasing. Patients at the age above 50 presented significantly higher level of neurological disturbances than young and patients in mid age. In the baseline study, level of diagnosed neurological disturbances in group of patients referred to surgical procedure was significantly higher than in group of patients receiving only conservative therapy.


CONCLUSIONS
Conservative treatment and operative procedure yield improvement of the neurological status of the patients. Improvement ratio, within immediate period following operative therapy, takes higher values than in analogous period of the conservative therapy. In distant investigation, the average quantity of neurological pathological symptom is higher in the group of patients treated surgically. Individualized plan of treatment within patients with lumbar discopathy is needed in every example.
Radziszewski
Krzysztof Roch
KR
Uniwersytet Mikołaja Kopernika w Toruniu, Collegium Medicum w Bydgoszczy, Zakład Klinicznych Podstaw Fizjoterapii. radziszewski@wp.pl
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D008161:Lumbosacral Region / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012018:Reflex; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome