Prolonged Physiotherapy versus Early Surgical Intervention in Patients with Lumbar Disk Herniation: Short-term Outcomes of Clinical Randomized Trial

Study Design: Randomized controlled trial. Purpose: We compared the disability and functional outcome after conservative treatment with prolonged physiotherapy versus early surgical intervention in patients with lumbar disk herniation. Overview of Literature: Lumbar disk herniation is one of the most common causes of job-related disability in individuals less than 45 years old. Conservative treatment is the initial pathway for the majority of patients but the duration of conservative treatment remains debatable and the adverse effects of prolonged conservative treatment are still unclear. Prolonged duration of symptoms before surgical intervention is associated with worse outcomes than a short period of symptoms. Methods: From June 2011 to July 2013, 60 patients with lumbar disk herniation at our institute were randomized into two groups. Group I was treated with prolonged physiotherapy and rehabilitation for 6 months, while group II was treated with early surgical discectomy. Oswestry disability index was used to assess disability, while the Prolo economic outcome rating scale was used to assess the work status. Results: Most patients were males between 21 and 45 years old (mean age, $35.88{\pm}7.15$). There was significant improvement in the disability and work status in both groups without statistically significant differences in the disability score at the second or third assessment. However, the Prolo scale became significantly better in group I than in group II patients during the second and third assessments. Conclusions: A prolonged physiotherapy and rehabilitation program is a beneficial and successful treatment in patients with recently diagnosed lumbar disk herniation.