Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study

Chi Heon Kim, Yunhee Choi, Chun Kee Chung, Ki Jeong Kim, Dong Ah Shin, Youn Kwan Park, Woo Keun Kwon, Seung Heon Yang, Chang Hyun Lee, Sung Bae Park, Eun Sang Kim, Hyunsook Hong, Yongeun Cho

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.

Original languageEnglish
Article number3931
JournalScientific reports
Issue number1
Publication statusPublished - 2021 Dec

Bibliographical note

Funding Information:
A grant from the Korea Health Technology Research & Development Project supported this study through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (HC15C1320). This study was supported by grants from Basic Research Laboratory program (2018R1A4A1025616), Republic of Korea. This work was supported by the New Faculty Startup Fund from Seoul National University.

Publisher Copyright:
© 2021, The Author(s).

All Science Journal Classification (ASJC) codes

  • General


Dive into the research topics of 'Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study'. Together they form a unique fingerprint.

Cite this