CHAPTER I: INTRODUCTION
1.1 Introduction
Lumbar disk herniation (LDH) is characterized by the displacement of the contents of the intervertebral disc (the pulpous nucleus) through its exterior membrane (the fibrous ring), most commonly in its posterolateral region. Depending on the extent of herniated material, compression and inflammation of the lumber nerve roots and the dural sac, clinically known as sciatica, may ensue. Sciatica is one of the most incapacitating types of pain that comes from below. It is a disorder brought on by nerve root pressure or pain (Brayda-Bruno et al., 2014). The most common symptoms are lower back discomfort, pain that spreads past the knee, decreased muscular strength, and sensory loss. Mechanical nerve end stimulation of the outer section of the fibrous band, direct nerve root compression (with or without ischemia), and a series of inflammatory abnormalities generated by the extruded nucleus are all possible causes of sciatic pain (Colombier et al., 2014). The procedure for lumbar disc herniation progresses from transdural excision to a conventional approach, followed by microsurgery and endoscopic and percutaneous operation. The first care should be conservative, regulated by medication and physiotherapy, and frequently associated with a percutaneous nerve root block (Vaille LR et al., 2015). Discectomy is an operation used to treat lumbar disc herniation. Conservative medicine, which includes physical therapy, pharmaceutical care, and penetration, is a beneficial technique for symptomatic patients; conservative intervention is used in 90% of instances of sciatica caused by lumbar disc herniation. Most patients chose conservative therapy for lumbar disc herniation since it has a lower risk of consequences than surgery (Lama et al., 2013).
1.2 Background of the study
Back pain and sciatica have been recognized since the beginning of time. Everything was attributed to nature's evil forces by ancient civilizations. Hippocrates (460-370 B.C.) was the first to create this technique, with nature facts and logical thought as the foundation for therapy. Little new science was generated until the 18th century when the intellectual attitude of the Enlightenment Age started the modern movement that brought us to where we are now (Paul et al., 2017). Modern medicine is said to have originated about 1850 when a more conventional scientific approach re-entered medical progress. Statistics and mathematical studies were employed, and evolution started a century of unprecedented progress in all human professions. The mind and body met again' in this description are considered two different aspects of the same individual. Given the lack of an 'anti-ageing pill' and the fact that disc degeneration/herniation is frequently viewed as a symptom of an ageing spine, there is a higher prevalence of disc herniated patients in various age groups (Capoor et al., 2016).
Disc herniation is most common between the fourth and fifth decades of life (mean age 37), while it has been observed in all age groups (Vaille LR et al., 2015). It is anticipated that 2 to 3% of the population may be afflicted, with a frequency of 4.8 % among males over 35 and 2.5% among women over this age (EL Shazly A.A. et al., 2013). (Aghazadeh et al., 2017). Disk herniation symptoms are readily treated. If left untreated, it will result in a medical emergency (Aghazadeh et al., 2017).
Excess body weight, deep core muscular weakness, and age-related degenerative-dystrophic spine alterations have occurred from the working population's increasing longevity, lack of physical activity, and poor food. As a result, the number of instances of herniated intervertebral discs has grown. However, because of its extensive prevalence and the harm it causes, it has been designated a global health concern (Cuesta et al., 2014; Petersen et al., 2017).
Disc herniation is now the most prevalent cause of lumbar spine degenerative diseases and the most common reason for spinal surgery. Factors such as greater access to medical care, early demand for imaging testing, and surgical procedure safety have resulted in high surgical treatment rates, a situation that is generally self-limiting (Amin R et al., 2017). Surgery or conservative therapy is typically used to treat lumbar disc herniation. There are several significant discectomy consequences for LDH. The prevalence of LDH dural tears ranges from 1% to 17% and increases with advanced age, obesity, and revision surgeries. The consequences of inadvertent durotomy include increased hospitalization expenditures and a 2.4-fold increase in the chance of wound dehiscence. Many problems include post-operative infection (1-5%), loss of functional status (4%), and nerve root injury (Vialle et al., 2010; Arts et al., 2019).
In most situations, the therapy of choice for symptomatic LDH is operative management. Non-operational treatment entails a multimodal strategy that includes anti-inflammatory medications, education, and physical therapy. Conservative treatment to remove the offending herniated disk material can be indicated for symptoms that do not respond to first conservative therapies, albeit whether the approach is best has sparked heated discussion. For a long, disputes have raged between operational and non-operative therapy approaches. Although the issue of superior treatment remains unexplored (Gugliotta et al., 2016a; Wong et al., 2017), no recent literature review has been generated to compare operative and non-operative management of lumbar disc herniation. MRI findings alone cannot decide the type of treatment to undergo, and we need to understand all the pros and cons of treatment modalities for lumbar disc herniation (Gugliotta et al., 2016a; Wong et al., 2017).
1.3 Statement of the Problem
The herniation of the lumbar disc is a harmless disorder. Conservative therapies aim to alleviate pain and encourage neurological repair, with an early return to everyday life and work (Alexander M Dydyk et al., 2020). Young patients with sequestrated hernias and modest neurological abnormalities, with common hernias and little disc degeneration, benefit the most from conservative therapy (Schoenfeld A J et al., 2010). In most situations, spontaneous regression of herniated disc tissue can occur, so operational therapy might be beneficial. As a result, the patient's choice of therapy should not be ignored and should be acknowledged. However, there is no agreement on the best treatment method for individuals with lumbar disc herniation.
1.4 Aim and objective of the study
The primary goal of this study is to evaluate non-operative and surgical therapy options for lumbar disc herniation. The secondary objective is determining which treatment approach provides the most significant benefit in pain and symptom relief.
1.5 Hypothesis of the study
To examine the surgical and non-surgical therapy options for lumbar disc herniation.
1.6 Scope and Significance of the study
Lumbar disk herniation (LDH) is a significant cause of low back pain, affecting around 9% of the global population and carrying a considerable economic cost that is expected to grow as the population ages. LDH has been linked to annulus fibrosus (A.F.), nucleus pulposus extrusion (N.P.), and nerve fibre activation, all of which contribute to discomfort. Low back pain has been a growing health concern for over a century. After headaches, it is the most commonly reported discomfort. Back discomfort was ranked top among the most prevalent causes of disability (Truumees, 2015). A sedentary lifestyle also reduces the spinal disc's capacity to sustain natural water concentration (Plomp et al., 2015).
The hydration level of the nucleus pulposus influences the formation of degenerative and surcharge lesions (Inoue N et al., 2011). Sedentism has also been linked to an increased risk of spinal disc herniation (Amin R et al., 2017). Even nurses and paramedics are at a greater risk of getting back discomfort in the lumbar area of the spine. Operating on patients also includes unnecessary strain on the low back due to the necessity to maintain a stressed body position (called postural stress) (Sparrey et al., 2014; Cunha et al., 2018). To develop viable preventative techniques, examining characteristics connected not only with the working environment but also with aspects of lifestyle such as routine physical activity, cigarette smoking, excessive coffee consumption, and poor diet appears reasonable. There is a confirmed link between the affluent living and the occurrence of so-called affluent illnesses (Appaduray & Lo, 2013). It is also worth noting the involvement of obesity and overweight as risk factors for low back pain. Overweight and obesity all contribute to paraspinal tissue mechanical loading and may even encourage the formation of disc herniations. Other metabolic illnesses (hyperlipidaemia, hypertension, and type 2 diabetes) have been linked to low back discomfort. Fewer studies have found a relationship between lower back discomfort and smoking (Adib-Hajbaghery & Zohrehea, 2013; Shemory et al., 2016; Tsuboi et al., 2018). As the frequency of low back pain rises, a research effort based on knowledge of non-operative treatment of lumbar disc herniation appears to be appropriate.
Factors related to the work environment, as well as lifestyle behaviours such as regular physical activity, nicotine consumption, excessive caffeine consumption, and an unhealthy diet, should be considered as causative factors for disc herniation (Appaduray & Lo, 2013). Obesity and being overweight are other risk factors for low back pain. Overweight and obesity both cause mechanical depletion of the paraspinal tissue and may even promote the development of disc herniations. There have been reports on the impact of various metabolic diseases such as hyperlipidaemia, hypertension, and type 2 diabetes on low back pain. Fewer studies have found a relationship between lower back discomfort and smoking (Adib-Hajbaghery & Zohrehea, 2013; Shemory et al., 2016; Tsuboi et al., 2018). As the prevalence of low back pain rises, it appears that a research study focusing on non-operative therapy of lumbar disc herniation is appropriate.
