Issues of optimization of management of patients with discogenic lumbosacral radiculopathy

Background. Discogenic lumbosacral radiculopathy (DLSR) is less common than lumbar musculoskeletal pain, but more often accompanied by a long disabilities. To improve patient management with DLSR, the study of conservative and surgical management of patients in real clinical practice is required.

Aim. Optimization of patient management aimed at surgical treatment.

Materials and methods. Surgical treatment (microdiskectomy) due to the ineffectiveness of conservative DLSR was suffered by 90 patients (33 men, 57 women, average age – 59.78±12 years). The duration of the disease to operation ranged from 2 to 14 weeks and was an average of 6±3 weeks. The intensity of pain was evaluated on a visual analog scale (VAS), disability on Oswestry Disability Index (ODI) and Roland–Morris Disability Questionnaire (RMDQ) before the operation, after 10 days, 1, 3 and 6 months after surgery.

Results. Patients were not informed about the favorable course of the DLSR, the possibilities of natural (without surgical intervention) of the regression of the disk hernia, as well as expediency to maintain all types of activity, avoid a long bed mode. After microdiskectomy after 10 days, significant reliable (p≤0.01) decrease in pain with 7 (95% confidence interval – CI 7–8) to 4 (95% CI 3–4) points for VAS and reduction of disability with 13 (95% CI 12–16) to 9 (95% CI 7–11) RMDQ points, from 63 (95% CI 61–65) to 32 (95% CI 30–34) % by ODI. After 1, 3 and 6 months, a further decrease in pain was observed [6 months to 3 (95% CI 2–3) points for VAS] and a decrease in disability [6 months to 5 (95% CI 4–7) points for RMDQ and up to 18 (95% CI 17–19) % on ODI]. To reduce the intensity of pain 6 months after the operation, it was significantly (p≤0.05) influenced the initial intensity of pain according to VAS and conducting kinesitherapy after the operation. To reduce the disability in RMDQ after 6 months, the initial disability in RMDQ and the conduct of kinesitherapy after surgery was significantly (p≤0.05) influenced.

Conclusion. Patients with DLSR should be informed about the favorable course of the disease, the possibilities of natural (without surgical intervention) of the regression of the disc hernia; after performing surgical treatment, it is advisable to the kinesitherapy, capable of improving the functional recovery of patients.