A Nonsurgical Approach to the Management of Patients with Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study with Follow-up

Donald R. Murphy, DC

Clinical Director
Rhode Island Spine Center
Pawtucket, RI
Clinical Assistant Professor
Department of Community Health
Warren Alpert Medical School of Brown University
Providence, Rhode Island

Lumbar radiculopathy secondary to a herniated disk is a prevalent problem, affecting as many as 1 in 3 men and almost 1 in 2 women at some point in their lifetimes. Although surgical interventions are not appropriate for the vast majority of patients, little data has been reported to support the relative merits of various nonsurgical recommendations. The diagnosis-based clinical decision rule (DBCDR) was developed as a strategy for diagnostic and treatment decision making when nonsurgically managing patients with spinal pain. In this study, a cohort of 49 patients with lumbar radiculopathy secondary to an MRI-confirmed herniated disk were examined and treated based on the DBCDR approach. Clinically meaningful improvements in pain and disability were seen for the majority of patients after cessation of an individualized treatment plan, which may have included distraction and/or joint manipulation, neural mobilization, educational interventions, and exercise programs. Importantly, these improvements were maintained over the long-term (average follow-up, 14.5 months). Moreover, “good” or “excellent” improvement was self-reported by 80% of patients and the treatment approaches were safe in this patient population.

References

Murphy DR, Hurwitz EL, McGovern EE. A nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. J Manipulative Physiol Ther. 2009;32:723-733.
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Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain. BMC Musculoskelet Disord. 2007;8:75.
Murphy DR, Hurwitz EL, Nelson CF. A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature. Chiropr Osteopat. 2008;16:7.

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