Types of Lumbar Herniated Disc and Clinical Course

STUDY DESIGN: A retrospective study of different types of herniated discs and duration of symptoms in patients with lumbar disc herniation, and a trial of longer conservative treatment to reduce the number of operations. OBJECTIVE: To determine whether noncontained and contained herniated discs have different clinical courses and to evaluate the results of the clinical trial of longer and vigorous conservative treatment. SUMMARY OF BACKGROUND DATA: The possibility of a difference in clinical features between contained and noncontained disc herniation has been suggested previously. METHODS: In the first study, the medical history and intraoperative findings of 156 patients who had undergone herniotomy were reviewed. In the second study, conservative treatment of at least 2 months' duration was recommended for all patients with lumbar disc herniation. RESULTS: In the first study, patients with noncontained disc herniation had a shorter preoperative clinical course than those with contained disc herniation. It was rare for noncontained herniation to require surgery 4 months or more after the onset of symptoms. In the second study, the authors' protocol reduced the number of herniotomies required, especially the number of operations for the patients with noncontained disc herniation. CONCLUSIONS: The authors believe that patients with noncontained lumbar disc herniation can be treated without surgery, if these patients can tolerate the symptoms for the first 2 months.