1. Background and purpose
Lumbar herniated intervertebral disc is a common disease affecting many of patients visiting Korean medicine hospitals and clinics, and causes substantial medical expenses and social-economical loss. Compared to surgical therapy, recently, the ratio and role of conservative treatment have increased. Related research and supporting evidence are very important for Korean medicine treatment with high patient preference.
this clinical guideline was developed to help make a more reasonable medical decision in the clinical field by analyzing the maximum evidence that can be accessed at the time of development for the treatment of lumbar disc herniation. However, the contents should not be applied uniformly to all patients, and the user must make the final medical decision considering the patient’s situation.
this clinical guideline was developed by reviewing various clinical guidelines, including ‘Korean medicine clinical practice guideline for lumbar herniated intervertebral disc’ developed in 2017. To complement the existing guidelines, it was developed with the aim of providing objective and highly available medical guidelines by applying the hybrid adaptation method. An extended literature retrieval strategy was established and the GRADE methodology was newly applied in developing the guideline and drawing recommendations.
2. Overview of disease
the lumbar intervertebral disc herniation covered by this clinical guideline shows of clinical symptoms of low back pain and radiating pain in the lower extremities, and the physical and imaging findings are consistent with the clinical symptoms. this study is aimed at adult patients diagnosed with lumbar disc herniation. In the case of the Korean Standard Disease Classification (KCD), the disease corresponds to M51 (other intervertebral disc disorder). Diseases that can cause back pain other than lumbar disc herniation are not within the scope of this clinical practice guideline.
Intervertebral disc herniation refers to a disease in which the nucleus pulposus ruptures and breaks out due to the rupture of the annulus. the main symptoms of lumbar disc herniation include low back pain and radiating pain in the lower extremities. Weakness of the muscle that is controlled by the nerve root related to the lesion may be accompanied.
Intervertebral disc herniation is first classified according to the extent of nucleus pulposus escaping and whether the annulus ruptures. Depending on the stage, it is classi ed as bulging, protrusion, extrusion, and sequestration. In some cases, two or more shapes may appear in combination. When lumbar intervertebral disc herniation is classified according to the protruding region, it is generally classified based on the axial plane. Based on the centerline of the lumbar spine, it is divided into central, lateral recess, paracentral, or subarticular, foraminal, far lateral, extraforaminal, and anterior.
In order to diagnose lumbar disc herniation, neurological evaluation and physical examination of lumbar nerve roots should be performed first. Muscle strength and sensory tests for each nerve root, SLRT, and Lasegue’s test are recommended.
Imaging medical examination is required for final diagnosis. Simple radiographs cannot distinguish other diseases that cause lumbar intervertebral disc herniation other than reduction of normal lumbar curvature. therefore, in order to confirm lumbar disc herniation, computed tomography (CT) or magnetic resonance imaging (MRI) is necessary. MRI can be used to determine if there is a spinal tumor or infection, and it is known to be the more suitable method for diagnosing intervertebral disc prolapse than CT.
Acupuncture, moxibustion, herbal medicine, pharmacopuncture, chuna, thread-embedding acupuncture, and cupping can be used as Korean medical treatment for lumbar disc herniation. Each treatment method can be used alone or in combination depending on the severity of the patient. In addition, comprehensive treatment strategies should be established according to Korean medicinal pattern identification such as kidney deficiency lumbago, congested fluids lumbago, food accumulation lumbago, strain and contusion lumbago, blood stagnation lumbago, wind lumbago, cold lumbago, dampness lumbago, dampness heat lumbago, Qi lumbago.
Since the prognosis of lumbar disc herniation differs according to age, duration of symptoms and severity, a comprehensive evaluation should be made based on clinical symptoms and radiological findings. For management of lumbar disc herniation, bed rest is essential in acute stage, and after acute stage, education for good posture and exercise training for muscle strength and flexibility are also necessary.
