Clinical prognosis of posterior longitudinal ligament ruptured lumbar disc herniation after conservative treatment

English Keywords:Lumbar disc herniation  Posterior longitudinal ligament ruptured  Conservative treatment  Resorption

English Abstract:

  【Abstract】 Objectives: To explore the clinical prognosis of posterior longitudinal ligament(PLL) ruptured lumbar disc herniation(LDH) via conservative treatment. Methods: From June 2008 to June 2011, 107 cases with PLL-ruptured LDH were studied prospectively. Among them, 60 were male and 47 were female, aged 16~60 years old, with an average age of 39.9±14.3. The disease course was 3 days to 10 years, averaging 16.9±21.0 months, 52 cases were shorter than 1 year and the other 55 cases were longer than 1 year. And the diseased level located at: L3/4 in 6 cases, L4/5 in 46 cases, L5/S1 in 55 cases. JOA score was 5-21 with an average of 11.87±5.62. The Iwabuchi type of the protrusion: 51 cases in type 1, 12 cases in type 2, 10 cases in type 3, 8 cases in type 4, and 26 cases in type 5. 31 cases accompanied with Modic changes in adjacent endplate. All patients accepted conservative treatment. Surgery was considered only if no responsible to conservative treatment after 3~6 months, or suffering from exacerbated and progressive radicular symptom or cauda equina signs during treatment period. The JOA score and improvement rate at the 1st, 3rd, 6th month and the 1st, 3rd year after first visit were recorded respectively, and the resorption rate of the protrusion was calculated on MR image. Results: 86 cases underwent conservative treatment. The JOA score at the 1st, 3rd, 6th months and the 1st, 3rd years after conservative treatment was 19.65±2.77, 21.77±2.81, 23.55±2.78, 24.02±3.01, 23.99±3.15 respectively, significantly statistical differences were found at every time point copared with the time point before treatment(P＜0.01). The excellent and good rate at each time point was 40.69%, 80.23%, 82.56%, 83.72% and 82.56% respectively. In the patients who accepted non-operative therapy: 20 cases(18.7%) presented with obvious resorption of herniated nuclea pulpsus, the excellent and good rate was 100% at the 3-year follow-up. The other 66 cases showed no obvious resorption, the excellent and good rate was 81.82%. The resorption rate and the improvement rate of JOA scores at 3 years after treatment showed a significant linear positive correlation(r=0.488, P＜0.001). 21 cases finally suffered from exacerbated progressive radicular symptom or cauda equina neurological signs during any term in the treatment period and had operation, the operation rate was 19.63%. Among them, 12 cases′s disease course were longer than 1 year, 14 cases′s Iwabuchi type were type 2, 3, 4, 14 cases accompanied with Modic change in adjacent endplate. Conclusions: After conserva-tive treatment, symptoms of PLL-ruptured LDH can be alleviated and herniation resorption can be found in some cases with the following characteristics: the disease course shorter than 1 year, Iwabuchi type 1 or type 5, no Modic change in adjacent endplate.