Clinical Profile and Outcomes of Patients with Lumbar Disc Prolapse Undergoing Conservative versus Surgical Management in a Tertiary Hospital of Bangladesh

Abstract

Background: Lumbar disc prolapse is one of the most common causes of low back pain and sciatica, affecting individuals in their most productive years. It occurs when the intervertebral disc herniates and compresses adjacent nerve roots, leading to varying degrees of pain, sensory disturbances, and functional impairment. This study aims to evaluate and compare the clinical presentation and treatment outcomes of patients with lumbar disc prolapse who underwent either conservative or surgical management. Methods: This comparative observational study was conducted at National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR) and the Orthopedic Department of Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh from January to December 2022. It included 100 patients with MRI-confirmed lumbar disc prolapse, divided into two equal groups: 50 received conservative treatment (rest, analgesics, physiotherapy) and 50 underwent surgical intervention (discectomy or decompression). Statistical analysis was performed using SPSS version 25, with a p-value <0.05 considered statistically significant. Result: In this study of 100 patients with lumbar disc prolapse, both conservative and surgical groups showed significant improvement in pain, but surgical patients experienced greater and faster relief (VAS reduction: 6.7 vs 4.4; p=0.001). Disc extrusion and neurological deficits were more common in the surgical group. While conservative management had a higher symptom recurrence (10% vs 4%), surgical patients experienced minor complications like wound infection (6%) and transient nerve irritation (8%). Overall, surgical treatment provided better short-term outcomes in selected patients. Conclusion: This study demonstrates that both conservative and surgical treatments are effective for lumbar disc prolapse, but surgery provides faster and greater pain relief, especially in cases with prolonged symptoms, neurological deficits, or disc extrusion on MRI. Conservative management remains suitable for milder cases, emphasizing the need for individualized treatment based on clinical severity and imaging findings.