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ROE JAL PUBC ; 6: 5-0

The effctivens of treatment forhe prlapd lumbar inrvrbral d

A review of the literature

MERYL DEANE, ANNE). MOORE, NDREW F. LOG STEPHEN HARRISON *

Literature relating o he management of prolapsed lumbar inteertebral discs was reviewed in oreectiveness of current medical care. Five aspects of care were addressed: he effectiveness of alteconseative treatment, he length of ime necessry for a satisfactory rial of conseative musefulness or otherwise of outine lumbar spine X-rays he ype of investigation best suited o coand level of he lesion in cases where surgical inteenion is considered and he form of ineent

he best otome o h paient. Pain mba spine -ays we found o e unnecessay as a out

Al conseative reatment options were found o ofer a most short-term enefit only and did not affoutcome. Compuerized omographic scans or magnetic esonance imagin are mos suitabconfiration of he level of he esion. Myelograms should not be used routinely. Minimally invasive

o have he best outcomes and o be he most acceptable to the patient.

Key words: prolapsed lumbar intervertebral discs computerized tomographic scans lumbar sp

minimlly invasive surgery

Low back pain is reported to occur at some time in% of the adult poplation. 1,2 Lumbar disc prolapsesare estimated to account for approxiately % of cases ofback pai)The aageet of prolapsed lumbar intervertebral dscs(PIDs as changed over time wth developments indagostic techology (computerized tomographic scasad magetic resonace imagg, newer miimallyivasive surgical approaches and the contued use ofcomplementay terapy Desite the range of ewtechologies, no systeatic review of the evidence of theeectveess ad approprateness of dierent foms ofmaaget for PIDs exists in the literature, although arevew of spial disorders in general, publshed in 987does exist4 Such a overvew is essental to eable practitioers to eep up it current evidence for eectivepracticeThi d f j

Tis artcle draws out the themes ad coom a systematic review of the publsheeectiveess of te maagement of PID

MTHDA systeatic search of the clinical litertake sig a iitial Medlie search ocatd terms, supplemeted by hand selected articles A umber of key questowere identified Tese were te beefittreatmet, the investigations tat sholrm the nature and level of the leson, of a plai X-ray, te legth of tie te allowed to recover with conservative trfor of interventio whic should be oEach study was te systematically revilished checklists56 Greater wegt wa

d i d ll d di (RCT

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