Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study
- Authors
- Kim, C.H.; Choi, Y.; Chung, C.K.; Kim, K.-J.; Shin, D.A.; Park, Youn Kwan; Kwon, Woo Keun; Yang, S.H.; Lee, C.H.; Park, S.B.; Kim, E.S.; Hong, H.; Cho, Y.
- Issue Date
- 16-Feb-2021
- Publisher
- Nature Research
- Citation
- Scientific Reports, v.11, no.1
- Indexed
- SCIE
SCOPUS
- Journal Title
- Scientific Reports
- Volume
- 11
- Number
- 1
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52065
- DOI
- 10.1038/s41598-021-83471-y
- ISSN
- 2045-2322
- Abstract
- Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process. © 2021, The Author(s).
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Collections - 2. Clinical Science > Department of Neurosurgery > 1. Journal Articles
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