Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags. The methodology employed in this review involves an extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR. By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections. Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling. Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy.

Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review

A multicenter, prospective cohort study conducted in 5 physiotherapy clinics in the UAE from January 2021 to March 2023 to assess coronal lumbar spine radiographic parameters as a predictor of conservative therapy outcomes in patients suffering from low back and leg pain due to lumbar disc herniation (HNP). Ninety patients (mean age 44 yrs., 54% male) with lumbar HNP underwent conservative therapy. All participants received lumbar spine MRI and radiography to assess spine alignment. Interventions included specific exercises, diathermy, traction, education, a home-based exercise pro-gram, and medications. Detailed demographic data was collected. Follow-up was 6-months after discharge. A successful outcome was based on a minimum of the following four outcomes: (1) reduction of pain by 17.5 points (0–100 NRS); (2) fatigue reduction by 7.5 points; (3) distress reduction by 5 points; and (4) interference reduction by 9.5 points. At 6-month follow-up it was found that patient age, education, and radio-graphic determined lumbosacral angle measures significantly affected the odds of a successful outcome. Increasing age 1-year significantly decreased the odds of success of improving pain, fatigue (OR = 0.85, p = 0.016) and interference scores (OR = 0.89, p = 0.042) by 15%, 15%, and 11% respectively. Lower education significantly increased the odds of success for improving pain, fatigue, and interference by 26.18, 26.18, and 7.5 (p = 0.006, = 0.006, and = 0.029 respectively). Increasing (worsening) the radiographic lumbosacral angle by each 1° significantly reduced the odds of success for improving pain, fatigue, distress, and interference by 3.52, 3.52, 27.99, and 2.55, respectively (p &amp;lt; 0.001, &amp;lt; 0.001, = 0.003, = 0.001). Our findings indicate that younger age, less education, and better coronal radiological lumbar spine alignment all had a substantial impact on the likelihood of success of 6-month outcomes in patients suffering from chronic lower back pain and radiculopathy due to HNP. 

Lumbar Spine Coronal Balance Parameters as a Predictor of the Rehabilitation Management Outcomes in Patients With Radiculopathy Due to Lumbar Disc Herniation: A Multicenter Prospective Cohort Study

Back pain is one of the most urgent healthcare problems in many countries of the world. The high prevalence of the disease among persons of working age, the high disability indices and the high economic losses determine the relevance of this problem and its epidemiological and socio-economic significance.


OBJECTIVE
To analyze sources of scientific and technical literature and study materials of meta-analyses, systematic reviews on the issues of evaluation of the spinal traction effectiveness (dry and underwater, horizontal and vertical) in the treatment of patients with degenerative spine diseases.


MATERIAL AND METHODS
An analysis of 67 sources, including 54 periodical articles, 5 meta-analyses and 8 systematic reviews was conducted. The search depth was 20 years.


RESULTS
The ability of the spinal traction method to influence on the pain intensity, functional state, general improvement or return to work in patients with degenerative spine diseases has been identified. There has been a statistically significant regression of lumbar and radicular pain under the influence of «dry» horizontal tractions of the spine (13389 patients with degenerative spine diseases received them), including in combination with physiotherapy (vibration, impulse currents, laser therapy), and there has been an improvement in the motor function of the spine, a decrease in the disability rate in patients with herniated disks. These results were also obvious in short-term observation (up to 3 months after intervention). Underwater traction (5533 patients received it) had a positive impact on pain syndrome at rest and during activity, increased the activity of patients. All registered effects were related to short-term effect for up to 3 months after the intervention.


CONCLUSION
The evidence, based on the materials of meta-analyses and systematic reviews of medium and low quality, that «dry» and underwater spinal traction can be considered as a therapeutic tool for short-term (within 3 months) reducing pain and disability in patients with lumbar pain and lumbar radiculopathy, is presented.

[Effectiveness of spinal traction in degenerative spine diseases. (A literature review)].

Abstract Background Low back pain (LBP) resides as a most common type of symptom pointing towards lumber radiculopathy. It is defined as burning sharp leg pain that originates from the back and goes all the way down your legs and extends into the toes and foot. Lumbosacral radiculopathy is caused by pathology of the intervertebral disk or associated structures. Different dimensional traction has been used to treat lumbar radiculopathy. This study aimed to compare the effects of 3-dimensional and 2-dimensional lumbar traction on pain and functional disability in patients with lumbar radiculopathy. The randomized clinical trial study of 4 weeks was carried out at the Lifeline Health Care Imaging and Pain Center and the Hamza Hospital Lahore. Twenty-six subjects were included in the clinical trial and divided into two groups after randomization. Group A received three-dimensional lumbar traction with traction force 50% of total body weight on Spine MT 3D traction machine, and group B received two-dimensional lumbar traction with traction force 50% of total body weight. Pre- and post-values of NPRS and ODI were noted. Results Parametric tests were used during statistical analysis because data was normally distributed. NPRS pre- and posttreatment values showed significant results with p -value &lt; 0.05. ODI pre- and post-values were also obvious with p -value &lt; 0.05. Independent sample T -test was used to assess across the group comparison, suggesting that both groups showed significant improvements of NPRS and ODI post-treatment with p -value (&lt; 0.001). Conclusion The study concluded that 3D traction significantly reduced pain levels and improved functional impairment more effectively than 2D traction in patients with lumbar radiculopathy. Trial registration Trial was registered with ClinicalTrials.gov: NCT05356689 . 

Comparative effects of patient-specific 3-dimensional and 2-dimensional lumbar traction on pain and functional disability in patients with lumbar radiculopathy

Lumbar spine coronal balance parameters as a predictor of rehabilitation management outcomes in patients with radiculopathy due to lumbar disc herniation: A multicenter prospective case series study

P2.14-67 Metastatic RET-Rearranged Lung Adenocarcinomas Treated with Alectinib: Retrospective Analysis of a Single Institution

The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis

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P2.14-67 Metastatic RET-Rearranged Lung Adenocarcinomas Treated with Alectinib: Retrospective Analysis of a Single Institution

The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis