| Popis: |
In a time frame of 30 months, 21 patients with radiographically confirmed lumbar disc prolapse and prominent referred leg pain (n = 21) and neurological deficits (n = 16) were managed nonsurgically using medication and physiotherapy in a prospective, single-arm phase II trial. The 21 patients were selected for nonsurgical therapy from a group of 69 patients based on specific changes in pain perception during mechanical assessment. The strategy of physiotherapy involved repetitive active and passive movements of the vertebral column. Therapeutic movements were selected according to the change of symptoms induced by these movements. The mechanical assessment was repeated in each therapy session to reassess symptom-relieving movements. Response to therapy was monitored by the shortest achieved distance from fingers to ground upon bending forward, signs of nerve and root tension, pain, sensory loss, muscular strength, intake of analgesics, subjective feeling of well-being, and the patient's ability to work. After a median in-patient treatment of 12 days, all 21 patients were discharged in clinically improved condition. At the first follow-up assessment after a median of 42 days, the condition of 19 of 20 patients had further improved compared with the end of the in-patient treatment. At the second follow-up assessment after an average period of 262 days, 16 of 18 patients still felt better than at the time of hospital discharge and the time of the first follow-up visit. This study shows that physiotherapy, according to the concepts of McKenzie and Maitland, is an effective therapy for lumbar disc prolapses, and indicates that a reliable prediction of response to conservative treatment can be obtained from the mechanical assessment and the changes of symptoms during five physiotherapy sessions. |
