Lumbar disc herniation: a controlled, prospective study with 10 years of observation
One article on PainSci cites Weber 1983: The Complete Guide to Low Back Pain
PainSci commentary on Weber 1983: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
This paper is old enough and good enough to be considered a bit of a classic. In addition to a good sample size and very long follow-up, it was noteworthy in at least two even more significant ways:
An extremely rare example of a direct comparison of a common surgery to conservative care. Although not placebo controlled (there was no sham surgery involved), the spirit of a head-to-head test was quite unusual, and it remains scarce well into the 21st Century. The results favoured surgery slightly at one year, and barely at four.
And was also one of the earliest papers to clearly show that there's only a sloppy correlation at best between symptoms and the status of disc herniation — much like later studies (see Fraser, Barth 2008, Barzouhi 2013).
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Two hundred eighty patients with herniated lumbar discs, verified by radiculography, were divided into three groups. One group, which mainly will be dealt with in this paper, consisted of 126 patients with uncertain indication for surgical treatment, who had their therapy decided by randomization which permitted comparison between the results of surgical and conservative treatment. Another group comprising 67 patients had symptoms and signs that beyond doubt, required surgical therapy. The third group of 87 patients was treated conservatively because there was no indication for operative intervention. Follow-up examinations in the first group were performed after one, four, and ten years. The controlled trial showed a statistically significant better result in the surgically treated group at the one-year follow-up examination. After four years the operated patients still showed better results, but the difference was no longer statistically significant. Only minor changes took place during the last six years of observation.
- “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis,” Zhong et al, Pain Physician, 2017.
- “Resolution of Lumbar Disk Herniation without Surgery,” Jennifer Hong and Perry A Ball, NEJM.org.
- “Progression of lumbar disc herniations over an eight-year period in a group of adult Danes from the general population: a longitudinal MRI study using quantitative measures,” Kjaer et al, BMC Musculoskeletal Disorders, 2016.
- “Magnetic resonance imaging in follow-up assessment of sciatica,” Barzouhi et al, New England Journal of Medicine, 2013.
- “Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome,” Barth et al, Spine (Phila Pa 1976), 2008.
- “Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation,” Fraser et al, Spine (Phila Pa 1976), 1995.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- Is there a relationship between throbbing pain and arterial pulsations? Mirza 2012 J Neurosci.