Comparison of the effects of conservative and operative treatment of lumbar intervertebral disc herniation - literature review

Uvod: Bolečina v ledvenem predelu hrbtenice je najpogostejša bolečina v gibalih pri človeku. Enkrat ali večkrat v življenju jo začuti kar 90 % odraslih oseb. V aktivnem življenjskem obdobju ima kar 50 % ljudi vsaj enkrat na leto tovrstne bolečine. Zaradi neznačilnosti posameznih znakov je diferencialno diagnozo težko postaviti, zdravljenje pa je pogosto zahtevno. Najbolj pogost dejavnik tveganja za degeneracijo medvretenčnih ploščic je naraščanje starosti. Med dejavnike tveganja uvrščamo slabo ergonomijo na delovnem mestu, kajenje, prekomerno telesno težo, psihosocialne dejavnike in nosečnost. Športna aktivnost pripomore k boljši telesni pripravljenosti posameznika in s tem zmanjšuje verjetnost prve epizode bolečine v križu. Namen: Namen diplomskega dela je na podlagi literature primerjati učinke konzervativnega in operativnega zdravljenja hernije ledvene medvretenčne ploščice. Metode dela: Kot metoda dela je uporabljen pregled literature, v katerega so bila vključena objavljena poročila o raziskavah. Rezultati: V pregled literature je bilo vključenih devet raziskav. Za ocenjevanje bolečine in stopnje nezmožnosti so bile uporabljene različne ocenjevalne lestvice pred začetkom zdravljenja, med samim zdravljenjem in po končanem zdravljenju. V vseh raziskavah je prišlo do statistično pomembnega zmanjšanja bolečine in stopnje nezmožnosti ne glede na vrsto obravnave. V petih raziskavah so ugotovili, da kirurško zdravljenje ni imelo prednosti pred konzervativnim zdravljenjem na srednji in dolgi rok. Razprava in sklep: Rezultati pregledanih raziskav so heterogeni, zato je nujno potrebno nadaljnje raziskovanje na tem področju. Noben od pristopov nima zagotove prednosti, saj je izbira le-tega odvisna od več različnih dejavnikov. Pri izbiri ustreznega postopka za posameznega pacienta je potrebno upoštevati čas trajanja simptomov, intenziteto, nevrološke izpade, vrsto in nivo hernije medvretenčne ploščice, funkcijo, kvaliteto življenja in stopnjo nezmožnosti.Introduction: Pain in the lumbar region of the spine is the most common type of pain in the human muscular system. 90% of adults experience it once or more times in a lifetime. In an active life span, 50% of people endure this kind of pain at least once a year. The distinctive character of individual symptoms makes a differential diagnosis hard and the pain is often difficult to treat. The most common risk factor for intervertebral disc degeneration is increasing age. Risk factors moreover include poor ergonomics in the workplace, smoking, excess body weight, psychosocial factors, and pregnancy. Physical activity contributes to a better physical fitness of the individual and thereby reduces the probability of the first episode of lower back pain. Purpose: The purpose of this diploma thesis was to compare the effects of conservative and operative treatment of lumbar intervertebral disc herniation based on literature. Methods: A systematic literature review was used, which included published research reports. Results: The literature review included nine studies. With the help of different rating scales, pain and incapacity were assessed three times: before treatment started, during treatment and after treatment was completed. In all studies, the result was a statistically significant reduction of pain and incapacity, regardless of the type of treatment. Five of the studies found that operative treatment was not superior to conservative treatment over short and longer periods. Discussion and conclusion: The results of these nine reviewed studies were very diverse, therefore further research is urgently needed. None of procedure has a definitive advantage, because the choice depends on multiple factors. When selecting an individual patient, the duration and intensity of the symptoms, neurological dysfunction, type and level of hernia on the spinal cord, function, life quality and degree of disability should be considered