Nonsurgical treatments for patients with radicular pain from lumbosacral disc herniation

Jung Hwan Lee, Kyoung Hyo Choi, Seok Kang, Dong Hwan Kim, Du Hwan Kim, Bo Ryun Kim, Won Kim, Jung Hwan Kim, Kyung Hee Do, Jong Geol Do, Ju Seok Ryu, Kyunghoon Min, Sung Gin Bahk, Yun Hee Park, Heui Je Bang, Kyoung ho Shin, Seoyon Yang, Hee Seung Yang, Seung Don Yoo, Ji Sung YooKyung Jae Yoon, Se Jin Yoon, Goo Joo Lee, Sang Yoon Lee, Sang Chul Lee, Seung Yeol Lee, In Sik Lee, Jung Soo Lee, Chang Hyung Lee, Jae Young Lim, Jae Young Han, Seung Hoon Han, Duk Hyun Sung, Kang Hee Cho, Soo Young Kim, Hyun Jung Kim, W. Ju

Research output: Contribution to journalReview articlepeer-review

23 Scopus citations


BACKGROUND CONTEXT: Lumbosacral disc herniation (LDH) is one of the most frequent musculoskeletal diseases causative of sick leave in the workplace and morbidity in daily activities. Nonsurgical managements are considered as first line treatment before surgical treatment. PURPOSE: This clinical practice guideline (CPG) is intended to provide physicians who treat patients diagnosed with LDH with a guideline supported by scientific evidence to assist in decision-making for appropriate and reasonable treatments. STUDY DESIGN/SETTING: A systematic review. PATIENT SAMPLE: Studies of human subjects written in Korean or English that met the following criteria were selected: patients aged ≥18 years, clinical presentation of low back and radicular leg pain, diagnosis of LDH on radiological evaluation including computed tomography or magnetic resonance imaging. OUTCOMES MEASURES: Pain and functional evaluation scales such as visual analogue scale, numeric rating scale, and Oswestry disability index METHODS: The MEDLINE (PubMed), EMBASE, Cochrane Review, and KoreaMed databases were searched for articles regarding non-surgical treatments for LDH published up to July 2017. Of the studies fulfilling these criteria, those investigating clinical results after non-surgical treatment including physical and behavioral therapy, medication, and interventional treatment in terms of pain control and functional improvements were chosen for this study. RESULTS: Nonsurgical treatments were determined to be clinically effective with regards to pain reduction and functional improvement in patients with LDH. Nevertheless, the evidence level was generally not evaluated as high degree, which might be attributed to the paucity of well-designed randomized controlled trials. Exercise and traction were strongly recommended despite moderate level of evidence. Epidural injection was strongly recommended with high degree of evidence and transforaminal approach was more strongly recommended than caudal approach. CONCLUSIONS: This CPG provides new and updated evidence-based recommendations for treatment of the patients with LDH, which suggested that, despite an absence of high degrees of evidence level, non-surgical treatments were clinically effective.

Original languageEnglish
Pages (from-to)1478-1489
Number of pages12
JournalSpine Journal
Issue number9
StatePublished - Sep 2019

Bibliographical note

Publisher Copyright:
© 2019 Elsevier Inc.


  • Disc herniation
  • Function
  • Lumbosacral
  • Nonsurgical
  • Pain
  • Treatment


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