Multidisciplinary stepwise treatments for lumbar disc herniation: a retrospective study

AbstractO_ST_ABSObjectiveC_ST_ABSThe study was aimed to compare the efficacy of the treatment for lumbar disc herniation (LDH) in the pain management department, orthopedics department and rehabilitation department, and to explore the multidisciplinary stepwise treatments style. MethodsThis single-center retrospective study analyzed the clinical data from 1397 patients with LDH between June 2015 and July 2019 in the hospital. The patients were divided into three groups: Pain Management Department (P), Orthopedics Department (O), and Rehabilitation Department (R). Propensity score matching (PSM) was used to adjust for imbalanced confounding variables among the three groups. Patients general information, different style of treatments, visual analogue scale (VAS), duration of hospitalization, and hospitalization costs were recorded. Follow-up information of patients was obtained through the telephone, including: Oswestry dysfunction index (ODI), remission rate at discharge, the rate of three months revisit after the discharge. The independent students t test and chi-square test were applied to compare the differences among groups. ResultsAfter PSM, 144 patients from each group were included in the study and all covariates were well balanced among the three groups. In the matched patients, the order of remission rate at discharge was O>P>R(P<0.05), the rate of three months revisit after discharge was R (17.36%)> P (6.94%)>R (4.86%) (P <0.05). There was no significant difference in ODI index at discharge and follow-up between group O and group P(P> 0.05), while group R was higher than the other two groups (P <0.05). Patients in Group R had a longer length of hospital stay (P <0.05), while the hospitalization costs were ranked as O>P>R (P <0.05). ConclusionsIn the treatment of LDH, orthopedics department, pain management department and rehabilitation department could all achieve the relief of clinical symptoms, and the long-term efficacy was not stable. Patients presenting to the orthopedic department had the highest pain relief rate at discharge, low rate of the revisit at three months after discharge, followed by the pain management department and third by the rehabilitation department. We proposed that the treatment of LDH should be based on stepwise treatment and multidisciplinary treatment (MDT) model.