Progress on rehabilitation treatment of lumbar disc herniation_West China Medical Journal

Authors：

HUAI Juan ,  YUE Shouwei

Department of Rehabilitation Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P. R. China;

Corresponding author：

YUE Shouwei, Email: shouweiyql@163.com

Keywords：

Lumbar disc herniation; Pain; Rehabilitation treatment

DOI：

10.7507/1002-0179.201805172

Video：

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Lumbar disc herniation (LDH) is very prevalent in clinical practice. It manifests as low back pain and pain radiating to the leg, followed by disfunction and large family and social cost. Risk factors for LDH include biomechanical stress on the lumbar spine, specifically torsion and hyperflexion, poor posture, obesity, and occupational hazards including heavy manual labor or prolonged driving. Rehabilitation therapy mainly includes bed rest, drug therapy, physical therapy, exercise, manipulation therapy, acupuncture treatment, epidural injection treatment and so on. This review summarizes the current status of epidemiology, clinical features and rehabilitation treatment of LDH so as to improve our understanding of it and to provide a reference for clinical treatment.

Citation： HUAI Juan, YUE Shouwei. Progress on rehabilitation treatment of lumbar disc herniation. West China Medical Journal, 2018, 33(10): 1311-1315. doi: 10.7507/1002-0179.201805172 Copy

1.	岳寿伟. 腰椎间盘突出症的非手术治疗. 北京: 人民军医出版社, 2009.
2.	Jöud A, Petersson IF, Englund M. Low back pain: epidemiology of consultations. Arthritis Care Res (Hoboken), 2012, 64(7): 1084-1088.
3.	Deyo RA, Mirza SK. Clinical practice. Herniated lumbar intervertebral disk. N Engl J Med, 2016, 374(18): 1763-1772.
4.	Ropper AH, Zafonte RD. Sciatica. N Engl J Med, 2015, 372(13): 1240-1248.
5.	Delgado-López PD, Rodríguez-Salazar A, Martin-Alonso J, et al. Lumbar disc herniation: natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests. Neurocirugia (Astur), 2017, 28(3): 124-134.
6.	Akmal M, Kesani A, Anand B, et al. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine (Phila Pa 1976), 2004, 29(5): 568-575.
7.	Hamberg-van Reenen HH, Ariëns GA, Blatter BM, et al. A systematic review of the relation between physical capacity and future low back and neck/shoulder pain. Pain, 2007, 130(1/2): 93-107.
8.	Shahbandar L, Press J. Diagnosis and nonoperative management of lumbar disk herniation. Operat Tech Sports Med, 2005, 13(2): 114-121.
9.	Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J, 2003, 3(6): 460-465.
10.	Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and Meta-analysis. AJNR Am J Neuroradiol, 2015, 36(12): 2394-2399.
11.	Schroeder JE, Barzilay Y, Kaplan L, et al. Value of repeat CT scans in low back pain and radiculopathy. J Clin Neurosci, 2016, 24: 74-77.
12.	Ract I, Meadeb JM, Mercy G, et al. A review of the value of MRI signs in low back pain. Diagn Interv Imaging, 2015, 96(3): 239-249.
13.	Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J, 2014, 14(1): 180-191.
14.	Fritz JM, Irrgang JJ. A comparison of a modified oswestry low back pain disability questionnaire and the quebec back pain disability scale. Phys Ther, 2001, 81(2): 776-788.
15.	Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil, 2003, 84(12): 1858-1864.
16.	齐宗华, 西永明, 胡有谷. 腰椎间盘突出症神经根损害的肌电图检查分析. 中国骨与关节外科, 2009, 2(1): 9-11.
17.	Linsiński P. Surface EMG in chronic low back pain. Eur Spine J, 2000, 9(6): 559-562.
18.	Zhang B, Xu H, Wang J, et al. A narrative review of non-operative treatment, especially traditional Chinese medicine therapy, for lumbar intervertebral disc herniation. Biosci Trends, 2017, 11(4): 406-417.
19.	Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet, 2014, 384(9954): 1586-1596.
20.	Roelofs PD, Deyo RA, Koes BW, et al. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev, 2008(1): CD000396.
21.	Holve RL, Barkan H. Oral steroids in initial treatment of acute sciatica. J Am Board Fam Med, 2008, 21(5): 469-474.
22.	Khoromi S, Cui L, Nackers L, et al. Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain. Pain, 2017, 130(1/2): 66-75.
23.	Dernek B, Adiyeke L, Duymus TM, et al. Efficacy of trigger point injections in patients with lumbar disc hernia without indication for surgery. Asian Spine J, 2018, 12(2): 232-237.
24.	Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J, 2015, 15(6): 1461-1477.
25.	Simon CB, Riley JL 3rd, Fillingim RB, et al. Age group comparisons of TENS response among individuals with chronic axial low back pain. J Pain, 2015, 16(12): 1268-1279.
26.	Ghoname EA, White PF, Ahmed HE, et al. Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica. Pain, 1999, 83(2): 193-199.
27.	周谋望, 岳寿伟, 何成奇, 等. " 腰椎间盘突出症的康复治疗”中国专家共识. 中国康复医学杂志, 2017, 32(2): 129-135.
28.	Unlu Z, Tasci S, Tarhan S, et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther, 2008, 31(3): 191-198.
29.	Seco J, Kovacs FM, Urrutia G. The efficacy, safety, effectiveness, and cost-effectiveness of ultrasound and shock wave therapies for low back pain: a systematic review. Spine J, 2011, 11(10): 966-977.
30.	杨少华. 腰椎间盘突出症牵引疗法的技术发展及其量化标准. 中国临床康复, 2005, 9(38): 143-145.
31.	张杨, 岳寿伟, 王艳琴. 腰椎多方位快速牵引与腰椎纵向牵引临床疗效的对比研究. 中国康复医学杂志, 2011, 26(7): 638-643.
32.	Snook SH, Webster BS, McGorry RW. The reduction of chronic, nonspecific low back pain through the control of early morning lumbar flexion: 3-year follow-up. J Occup Rehabil, 2002, 12(1): 13-19.
33.	Simon J, Conliffe T, Kitei P. Non-operative management: an evidence-based approach. Simin Spine Surg, 2016, 28: 8-13.
34.	宋红梅, 谢娜, 张坤木, 等. 整脊手法治疗腰椎间盘突出症的临床研究. 现代中西医结合杂志, 2015, 24(1): 5-7.
35.	Clare HA, Adams R, Maher CG. A systematic review of efficacy of McKenzie therapy for spinal pain. Aust J Physiother, 2004, 50(4): 209-216.
36.	May S, Aina A. Centralization and directional preference: a systematic review. Man Ther, 2012, 17(6): 497-506.
37.	Berman BM, Langevin HM, Witt CM, et al. Acupuncture for chronic low back pain. N Engl J Med, 2010, 363(5): 454-461.
38.	Parr AT, Manchikanti L, Hameed H, et al. Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician, 2012, 15(3): E159-E198.
39.	Manchikanti L, Cash KA, McManus CD, et al. One-year results of a randomized, double-blind, active controlled trial of fluoroscopic caudal epidural injections with or without steroids in managing chronic discogenic low back pain without disc herniation or radiculitis. Pain Physician, 2011, 14(1): 25-36.
40.	Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am, 2004, 86-A(4): 670-679.
41.	Schaufele MK, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician, 2006, 9(4): 361-366.
42.	梁航, 邓享誉, 邵增务. 干细胞技术用于椎间盘再生的研究进展及挑战. 中国组织工程研究, 2017, 21(19): 3063-3071.
43.	马良彧, 王善正, 郭玉冬, 等. 富血小板血浆治疗椎间盘退变: 从基础研究到临床应用. 中国组织工程研究, 2017, 21(32): 5215-5220.
44.	Bunzli S, Gillham D, Esterman A. Physiotherapy-provided operant conditioning in the management of low back pain disability: a systematic review. Physiother Res Int, 2011, 16(1): 4-19.

1. 岳寿伟. 腰椎间盘突出症的非手术治疗. 北京: 人民军医出版社, 2009.
2. Jöud A, Petersson IF, Englund M. Low back pain: epidemiology of consultations. Arthritis Care Res (Hoboken), 2012, 64(7): 1084-1088.
3. Deyo RA, Mirza SK. Clinical practice. Herniated lumbar intervertebral disk. N Engl J Med, 2016, 374(18): 1763-1772.
4. Ropper AH, Zafonte RD. Sciatica. N Engl J Med, 2015, 372(13): 1240-1248.
5. Delgado-López PD, Rodríguez-Salazar A, Martin-Alonso J, et al. Lumbar disc herniation: natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests. Neurocirugia (Astur), 2017, 28(3): 124-134.
6. Akmal M, Kesani A, Anand B, et al. Effect of nicotine on spinal disc cells: a cellular mechanism for disc degeneration. Spine (Phila Pa 1976), 2004, 29(5): 568-575.
7. Hamberg-van Reenen HH, Ariëns GA, Blatter BM, et al. A systematic review of the relation between physical capacity and future low back and neck/shoulder pain. Pain, 2007, 130(1/2): 93-107.
8. Shahbandar L, Press J. Diagnosis and nonoperative management of lumbar disk herniation. Operat Tech Sports Med, 2005, 13(2): 114-121.
9. Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J, 2003, 3(6): 460-465.
10. Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and Meta-analysis. AJNR Am J Neuroradiol, 2015, 36(12): 2394-2399.
11. Schroeder JE, Barzilay Y, Kaplan L, et al. Value of repeat CT scans in low back pain and radiculopathy. J Clin Neurosci, 2016, 24: 74-77.
12. Ract I, Meadeb JM, Mercy G, et al. A review of the value of MRI signs in low back pain. Diagn Interv Imaging, 2015, 96(3): 239-249.
13. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J, 2014, 14(1): 180-191.
14. Fritz JM, Irrgang JJ. A comparison of a modified oswestry low back pain disability questionnaire and the quebec back pain disability scale. Phys Ther, 2001, 81(2): 776-788.
15. Hicks GE, Fritz JM, Delitto A, et al. Interrater reliability of clinical examination measures for identification of lumbar segmental instability. Arch Phys Med Rehabil, 2003, 84(12): 1858-1864.
16. 齐宗华, 西永明, 胡有谷. 腰椎间盘突出症神经根损害的肌电图检查分析. 中国骨与关节外科, 2009, 2(1): 9-11.
17. Linsiński P. Surface EMG in chronic low back pain. Eur Spine J, 2000, 9(6): 559-562.
18. Zhang B, Xu H, Wang J, et al. A narrative review of non-operative treatment, especially traditional Chinese medicine therapy, for lumbar intervertebral disc herniation. Biosci Trends, 2017, 11(4): 406-417.
19. Williams CM, Maher CG, Latimer J, et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet, 2014, 384(9954): 1586-1596.
20. Roelofs PD, Deyo RA, Koes BW, et al. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev, 2008(1): CD000396.
21. Holve RL, Barkan H. Oral steroids in initial treatment of acute sciatica. J Am Board Fam Med, 2008, 21(5): 469-474.
22. Khoromi S, Cui L, Nackers L, et al. Morphine, nortriptyline and their combination vs. placebo in patients with chronic lumbar root pain. Pain, 2017, 130(1/2): 66-75.
23. Dernek B, Adiyeke L, Duymus TM, et al. Efficacy of trigger point injections in patients with lumbar disc hernia without indication for surgery. Asian Spine J, 2018, 12(2): 232-237.
24. Lewis RA, Williams NH, Sutton AJ, et al. Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine J, 2015, 15(6): 1461-1477.
25. Simon CB, Riley JL 3rd, Fillingim RB, et al. Age group comparisons of TENS response among individuals with chronic axial low back pain. J Pain, 2015, 16(12): 1268-1279.
26. Ghoname EA, White PF, Ahmed HE, et al. Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica. Pain, 1999, 83(2): 193-199.
27. 周谋望, 岳寿伟, 何成奇, 等. " 腰椎间盘突出症的康复治疗”中国专家共识. 中国康复医学杂志, 2017, 32(2): 129-135.
28. Unlu Z, Tasci S, Tarhan S, et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther, 2008, 31(3): 191-198.
29. Seco J, Kovacs FM, Urrutia G. The efficacy, safety, effectiveness, and cost-effectiveness of ultrasound and shock wave therapies for low back pain: a systematic review. Spine J, 2011, 11(10): 966-977.
30. 杨少华. 腰椎间盘突出症牵引疗法的技术发展及其量化标准. 中国临床康复, 2005, 9(38): 143-145.
31. 张杨, 岳寿伟, 王艳琴. 腰椎多方位快速牵引与腰椎纵向牵引临床疗效的对比研究. 中国康复医学杂志, 2011, 26(7): 638-643.
32. Snook SH, Webster BS, McGorry RW. The reduction of chronic, nonspecific low back pain through the control of early morning lumbar flexion: 3-year follow-up. J Occup Rehabil, 2002, 12(1): 13-19.
33. Simon J, Conliffe T, Kitei P. Non-operative management: an evidence-based approach. Simin Spine Surg, 2016, 28: 8-13.
34. 宋红梅, 谢娜, 张坤木, 等. 整脊手法治疗腰椎间盘突出症的临床研究. 现代中西医结合杂志, 2015, 24(1): 5-7.
35. Clare HA, Adams R, Maher CG. A systematic review of efficacy of McKenzie therapy for spinal pain. Aust J Physiother, 2004, 50(4): 209-216.
36. May S, Aina A. Centralization and directional preference: a systematic review. Man Ther, 2012, 17(6): 497-506.
37. Berman BM, Langevin HM, Witt CM, et al. Acupuncture for chronic low back pain. N Engl J Med, 2010, 363(5): 454-461.
38. Parr AT, Manchikanti L, Hameed H, et al. Caudal epidural injections in the management of chronic low back pain: a systematic appraisal of the literature. Pain Physician, 2012, 15(3): E159-E198.
39. Manchikanti L, Cash KA, McManus CD, et al. One-year results of a randomized, double-blind, active controlled trial of fluoroscopic caudal epidural injections with or without steroids in managing chronic discogenic low back pain without disc herniation or radiculitis. Pain Physician, 2011, 14(1): 25-36.
40. Buttermann GR. Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy. A prospective, randomized study. J Bone Joint Surg Am, 2004, 86-A(4): 670-679.
41. Schaufele MK, Hatch L, Jones W. Interlaminar versus transforaminal epidural injections for the treatment of symptomatic lumbar intervertebral disc herniations. Pain Physician, 2006, 9(4): 361-366.
42. 梁航, 邓享誉, 邵增务. 干细胞技术用于椎间盘再生的研究进展及挑战. 中国组织工程研究, 2017, 21(19): 3063-3071.
43. 马良彧, 王善正, 郭玉冬, 等. 富血小板血浆治疗椎间盘退变: 从基础研究到临床应用. 中国组织工程研究, 2017, 21(32): 5215-5220.
44. Bunzli S, Gillham D, Esterman A. Physiotherapy-provided operant conditioning in the management of low back pain disability: a systematic review. Physiother Res Int, 2011, 16(1): 4-19.

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