The incidence of regression after the non-surgical treatment of symptomatic lumbar disc herniation: a systematic review and meta-analysis

摘要

Background: Although the regression of symptomatic lumbar disc herniation (SLDH) has been widely reported,little data exist regarding the generalized incidence of regression (IR). We aimed to review the varying IRs and tosynthesize the pooled IR of non-surgically-treated SLDH.Methods: Four electronic databases were searched for relevant studies pertaining to the regression of SLDH afternon-surgical treatment and for potential studies that may have reported morphological changes in lumbar discherniation in the follow-up results of SLDH patients treated non-surgically. The main outcome was the regression ofSLDH. A random effects model was used to determine the pooled IR of SLDH.Results: We identified 13,672 articles, 38 of which were eligible for analysis. Our analysis included 2219 nonsurgicallytreated SLDH patients, 1425 of whom presented regression. The pooled IR was 63% (95% CI 0.49–0.77). Insubgroup analyses, studies that quantitatively measured the regression of SLDH yielded statistically higher pooledIRs than those that used qualitative methods. The pooled IRs gradually increased in randomized controlled trialsand prospective and retrospective studies. The pooled IR varied from 62 to 66% after the sequential omission ofany single study. Meta-regression showed that study types, herniation levels and regression measurements causedheterogeneity.Conclusions: We report an overall IR of 63% among non-surgically treated SLDH patients, thus providing clinicaldecision makers with quantitative evidence of IR. Based on our systematic review, we suggest a follow-up timelinewith time points 4 and 10.5 months after onset when deciding whether to perform surgery for SLDH.