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J Acupunct Res > Volume 33(1); 2016 > Article
Kim, Bae, Kim, Suh, Kim, Lee, and Yang: Effects of Conservative Korean Traditional Medical Treatment on Lumbar Intervertebral Disc Herniation in 12 Adolescents: A Retrospective Study

Abstract

Objectives:

This study was performed to assess the effectiveness of conservative Korean traditional medical treatment on lumbar intervertebral disc herniation in 12 adolescents.

Methods:

Data were collected from adolescent patients diagnosed with lumbar intervertebral herniation by MRI, hospitalized at Jaseng Korean Medicine Hospital from January 1, 2014 to December 31, 2015. A total of 12 patients were included in the study. Patients were treated by acupuncture, pharmacopuncture, electroacupuncture, herbal medicine, chuna manual therapy, physical therapy during hospitalization period. To measure treatment outcomes, a verbal numerical rating scale (VNRS), Oswestry disability index (ODI), range of motion (ROM), Straight leg raising test (SLR), and EQ-5D were used.

Results:

The average age of the participants was 16.05±1.62 The average of duration of symptom was 19.25±26.83 (weeks) and the average length of hospitalization was 23.8±16.4 (days). 2 patients (17 %) suffered from only lumbar pain, while 10 patients (83 %) suffered from lumbar and leg pain. No participant suffered from only leg pain. 8 patients (67 %) were diagnosed with disc herniation in one segment, and 4 patients (33 %) were diagnosed with disc herniation in multiple segments. A total of 17 disc segments (28 %) were herniated. The most herniated lumbar level was L4-5. 3 segments were diagnosed with bulging (17 %), 6 with protrusion (35 %), and 8 with extrusion (47 %). Extrusion was the most frequent herniated type. After treatment, the average VNRS of lumbar pain significantly decreased from 5.58±1.62 to 2.91±1.56 (p<0.001) and the average VNRS of leg pain significantly decreased from 5.16±2.51 to 3.08±1.8 (p<0.001). ODI significantly decreased from 48.87±18.72 to 28.57±15.05 (p<0.05) and EQ-5D significantly increased 0.58±0.31 to 0.80±0.12 (p<0.05). Range of flexion significantly improved from 61.25±32.62 to 68.33±26.22 (p<0.05).

Conclusion:

Conservative Korean Traditional Medical Treatment may be effective in the treatment of lumbar intervertebral disc herniation in adolescence. However, more case reports and clinical research are needed

Fig. 1
Box plot showing the changes of NRS(lumbar) between admission and discharge
The line in the box represents median.
p-value for paired t–test.
acup-33-1-103f1.gif
Fig. 2
Box plot showing the changes of NRS(leg) between admission and discharge
The line in the box represents median.
p-value for paired t–test.
acup-33-1-103f2.gif
Fig. 3
Box plot showing the changes of ODI between admission and discharge
The line in the box represents median.
p-value for paired t–test.
acup-33-1-103f3.gif
Fig. 4
Box plot showing the changes of EQ-5D between admission and discharge
The line in the box represents median.
p-value for wilcoxon signed rank test.
acup-33-1-103f4.gif
Fig. 5
Box plot showing the changes of range of flexion between admission and discharge
The line in the box represents median.
p-value for wilcoxon signed rank test.
acup-33-1-103f5.gif
Table 1
Characteristics of Subjects
Number of Patient Mean±SD
Age 16.05±1.62

Sex
 Female 2(17 %)
 Male 10(83 %)

Duration
 Hospitalization Period 23.8±16.4(days)
 Duration of Symptom 19.25±26.83(weeks)
  Acute 6(50 %)
  Subacute 1(8 %)
  Chronic 5(42 %)
Table 2
Distribution of Symptom
Symptom Number of Patient
Lumbar pain 2(17 %)
Leg pain 0(0 %)
Lumbar with leg pain 10(83 %)
Neurologic symptom 0(0 %)
Table 3
The Number of Involved Segment and Involved Level and Type of intervertebral disc Herniation in Adolescence
Involved segment Number of case
1 segment 8(67 %)

Multiple segments 4(33 %)

Involved level 17(28 %)
 L1/2 0(0 %)
 L2/3 0(0 %)
 L3/4 1(6 %)
 L4/5 10(59 %)
 L5/S1 6(35 %)

Type
 Bulging 3(17 %)
 Protrusion 6(35 %)
 Extrusion 8(47 %)
Table 4
Disc Herniation Type of Involved Level
Level Type of Disc Herniation Total
Bulging Protrusion Extrusion
L3/4 1(100 %) 0 0 1(100 %)
L4/5 1(10 %) 4(40 %) 5(50 %) 10(100 %)
L5/S1 1(17 %) 2(33 %) 3(50 %) 6(100 %)
Table 5
Comparison Between Admission and Discharge of NRS
VNRS(Lumbar pain) VNRS(Leg pain)
AD* DC AD* DC
Patient 1 6 5 6 5
Patient 2 6 4 6 4
Patient 3 6 2 6 2
Patient 4 5 4 5 4
Patient 5 1 1 7 5
Patient 6 7 5 7 5
Patient 7 6 2 0 0
Patient 8 6 4 0 0
Patient 9 5 2 7 4
Patient 10 5 1 5 1
Patient 11 7 1 7 4
Patient 12 7 4 6 3
Mean±SD 5.58±1.62 2.91 ±1.56 5.16±2.51 3.08±1.8
p-value 0.000177 0.000280

* AD: Admission

DC: Discharge

p-value for paired t–test

Table 6
Comparison Between Admission and Discharge of ODI, EQ–5D
ODI EQ-5D
AD* DC AD* DC
Patient 1 33.33 35.56 0.771 0.771
Patient 2 37.78 37.78 0.867 0.867
Patient 3 28.89 15.56 0.773 0.826
Patient 4 48.89 35.55 0.766 0.862
Patient 5 60 48.89 0.452 0.816
Patient 6 80 30 −0.056 0.677
Patient 7 34 10 0.817 0.913
Patient 8 17.78 8.89 0.913 0.913
Patient 9 60 44.44 0.034 0.513
Patient 10 51.11 11.11 0.422 1
Patient 11 68 18 0.677 0.816
Patient 12 66.67 46.67 0.556 0.72
Mean±SD 48.87±18.72 28.57±15.05 0.58±0.31 0.80±0.12
p-value 0.002 0.008§

* p-value for wilcoxon signed rank test.

p-value for wilcoxon signed rank test.

p-value for wilcoxon signed rank test.

§ p-value for wilcoxon signed rank test.

Table 7
Comparison Between Admission and Discharge of SLRT, ROM
Admission Discharge p-value*
Mean±SD Mean±SD
SLRT Right side 57.5±26 60.83±21.5 0.18
Left side 49.58±27.9 55.00±25 0.10
Affected side 47.08±27.67 51.66±24 0.10
ROM Flexion 61.25±32.62 68.33±26.22 0.042
Extension 15.83±6.68 17.50±4.52 0.157
Lat. bending Right side 27.50±6.21 28.33±3.89 0.317
Left side 28.33±5.77 30 0.157
Affected side 26.66±6.51 28.33±5.77 0.157
Rotation Right side 43.33±4.43 43.75±4.33 0.317
Left side 43.75±4.33 45 0.317
Affected side 42.5±5.83 43.75±4.33 0.317

* p-value for wilcoxon signed rank test.

VI.
VI.

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