腰部椎間板ヘルニアの保存的療法

抄録

Conservative versus surgical treatment of herniated intervertebral disk has been a controversial subject for many scholars. We should like to discuss this problem from the standpoint of conservative treatment. The common means of conservative treatment are manipulation, continuous lumbar traction, application of heat on the hip, medication, and the use of brace. As to manipulation there are both pro and con. We fell, however, it should be tried once, at least in the early stage of the herniation, althogh we are not too optimistic about the result.
Conservative treatment should be continued, if radicular symptoms disappear after three weeks of lumbar traction, or, even when mild radicular symptoms persist, if it is the first herniation and the myelogram is negative, or the non-laborer patient decline surgery.
The latest four year result of our treatment is as follows: of the total 119 cases of herniated lumbar disk 63 cases (52.9 per cent) had conservative treatment and 56 cases (47.1 per cent) had surgery. The follow-up study of 52 of 63 conservatively treated cases revealed 19 nearly cured (36.5 per cent), 15 unchanged or slightly improvd (23.8 per cent), and 18 relapsed or operated cases (34.6 per cent).
Hitherto reported incidence of cure under conservative treatment is approximately 30 per cent. This means 30 per cent of the patients with herniated intervertebral disk have good chance of cure by conservative treatment. Surgical intervention on the mild case often leaves post-operative complaint as hazardous as the preoperative lumbar pain. We believe, therefore, that the surgical treatment of herniated disk should be weighed seriously only after long observation under conservative treatment.