title: Factors predicting failure of conservative treatment in lumbar-disc herniation.
abstract: OBJECTIVE
  To explore factors predicting failure of conservative treatment in lumbar-disc herniation.
  
  
  BACKGROUND
  Sciatica due to lumbar-disc herniation is a common complaint of spine patients. Even though the natural course is favorable, surgery is necessary in at least 10% of cases. Current trends show surgery to be more cost-effective than prolonged conservative care. However; there is limited information about the usefulness of clinical and radiographic parameters to classify patients who are likely to fail conservative treatment.
  
  
  METHODS
  Medical records of patients diagnosed with lumbar-disc herniation between January 1, 2007 and December 31, 2009 were studied. The records of patients in conservative and surgery groups were compared, for clinical features, MRI results and treatment modalities.
  
  
  RESULTS
  Fifty cases (discectomy) and 50 controls (successful conservative treatment) were enrolled. Demographic data, presenting symptoms and physical examination did not differ apart from duration of symptoms. Logistic regression analysis did not find a significant association between percentage of canal compromised after controlling for disc-fragment size, duration of symptoms and types of disc herniation. However disc fragment size was strongly associated with surgical outcome (OR = 2.6). Duration of symptoms (OR = 1.2) and sequestered type of lesion (OR = 12.3) were associated with surgery in this model. The use of physiotherapy and epidural steroid injections was lower but the failure rate was higher.
  
  
  CONCLUSIONS
  Long-duration, sequestered herniation and large fragment are predictive of failure in the conservative treatment of lumbar-disc herniation.
authors.affiliation: Bumrungrad Spine Institute, Bumrungrad International Hospital, Bangkok, Thailand. schaiyuth34@hotmail.com
authors.forename: Chaiyuth
authors.initials: C
authors.lastname: Sutheerayongprasert
authors.forename: Sompoch
authors.initials: S
authors.lastname: Paiboonsirijit
authors.forename: Verapan
authors.initials: V
authors.lastname: Kuansongtham
authors.forename: Surapong
authors.initials: S
authors.lastname: Anuraklekha
authors.forename: Nanthadej
authors.initials: N
authors.lastname: Hiranyasthiti
authors.forename: Sumroeng
authors.initials: S
authors.lastname: Neti
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D007405:Intervertebral Disc Displacement / Q000628:therapy*; D008159:Lumbar Vertebrae; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities
chemical_list: D000305:Adrenal Cortex Hormones