The relationship between pain and herniation radiology in giant lumbar disc herniation causing severe sciatica: 15 cases

Objective To evaluate conservative treatment of giant lumbar disc herniation in patients with extreme pain and to assess temporal changes in pain levels and radiological findings with short-term follow-up. Methods A total of 15 patients with severe pain (as measured by visual analog scale [VAS]) due to giant lumbar disc herniation and without neurological deficits were included. All patients received conservative treatment and were followed weekly for pain and medication assessment. MRI was performed at baseline, second month and fourth month to calculate disc herniation volume. The changes in disc herniation and pain were evaluated. Results There was no relationship between pain and the regression of disc herniation in these five females and ten males with a mean age of 41.4 years. MRI results showed an average of 20.3% and 20.4% regression of disc herniation from baseline to second month, and second month to fourth month, respectively. Whereas, pain levels had reduced from an average of 90.8-13.53 by the second month, and to 3.13 by the fourth month, indicating significant success with conservative treatment. Conclusions Regardless of the size of the herniation and the severity of the pain, patients with giant lumbar disc herniation should be encouraged to undergo conservative treatment, given that the patient does not have urinary-fecal incontinence, foot drop or progressive neurodeficit.