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Lumbar disc prolapse with myelopathy — Clinical Guidelines

Overview

Lumbar disc prolapse with myelopathy involves herniation of intervertebral discs leading to compression of spinal nerves and potentially spinal cord, causing radiculopathy and neurological deficits. 2

Diagnosis

Clinical Presentation: Lower limb radiculopathy, back pain, and varying degrees of neurological deficits.

Imaging: MRI is essential for confirming disc prolapse and assessing myelopathy involvement.

Functional Assessment: Use of Oswestry Disability Index (ODI) to quantify functional impairment. 1 2 3

Management

Physical Therapy: Patient-specific three-dimensional lumbar traction may reduce pain and improve function (3 sessions/week for 1 month). (Evidence: Moderate) 1

Surgical Interventions:

- Percutaneous Endoscopic Lumbar Discectomy (PELD): Effective for disc prolapse, with favorable outcomes measured by VAS, ODI, and Macnab criteria. - Posterior Lumbar Interbody Fusion (PLIF): Considered for complex cases involving adjacent segment disease and retrolisthesis, though associated with longer operative times and rehabilitation. 3

Special Populations

Elderly: Surgical options like PELD may be preferred over fusion due to reduced invasiveness and quicker recovery, though individualized assessment is crucial. 3

Key Recommendations

Consider patient-specific three-dimensional lumbar traction as an adjunctive therapy to reduce pain and improve functional outcomes in lumbar disc prolapse patients. (Evidence: Moderate) 1

For patients with persistent radiculopathy or progressive myelopathy, percutaneous endoscopic lumbar discectomy (PELD) can be an effective surgical approach with favorable short-term outcomes. (Evidence: Moderate) 2 3

In cases involving adjacent segment disease with stable retrolisthesis post-previous fusion, evaluate the benefits of PELD over internal fixation methods like PLIF, considering factors such as operative time and rehabilitation needs. (Evidence: Moderate) 3

References

1 Asiri F, Tedla JS, D Alshahrani MS, Ahmed I, Reddy RS, Gular K. Effects of patient-specific three-dimensional lumbar traction on pain and functional disability in patients with lumbar intervertebral disc prolapse. Nigerian journal of clinical practice 2020. link 2 Kim HS, Adsul N, Kapoor A, Choi SH, Kim JH, Kim KJ et al.. A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations. Journal of visualized experiments : JoVE 2018. link 3 Sun Y, Zhang W, Qie S, Zhang N, Ding W, Shen Y. Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis: A retrospective case-control study. Medicine 2017. link

Lumbar disc prolapse with myelopathy