Efficacy of complex physiotherapeutic approach to stimulate the resorption of lumbar disc herniation
Patients and Methods: 101 patients (50 women and 51 men) with acute leg pain (≥ 6 points by VAS scale) resulting from LDH were enrolled. Initial LDH size and its changes were measured by MRI. All patients received gabapentin (300-2400 mg daily, dose adjustment after 3 and 8 weeks. At baseline, all patients underwent 12 consecutive daily acupuncture and laser therapy (MLS M6, Beka, Russian Federation). 12 weeks after finishing physiotherapy, all patients underwent re-MRI. Further management strategy was based on MRI results and clinical presentation, i.e., to proceed to treatment (persistent pain or no pain but persistent LDH) or to stop treatment (the lack of pain and reduced LDH sizes). Patients who proceeded to treatment were prescribed with repeated complex physiotherapy. This protocol was followed until pain relief and LDH resorption. Results: after the first, second, and third courses of physiotherapy, 26 patients (25.7%), 47 patients (46.5%), and 22 patients (21.8%), respectively, stopped the treatment. 6 patients (5.9%) required the fourth course of physiotherapy. The rate and level of LDH resorption were directly proportional to LDH size at baseline. The mean LDH resorption period was 4.4 months. In the first 12 weeks, mean gabapentin dose to relieve leg pain was 1320±50 mg daily. Patients who proceeded to treatment required, on average, 489±30 mg daily. Conclusions: acute LDH treatment using complex physiotherapy (acupuncture and MLS laser therapy) plus gabapentin that maintains natural inflammation is an effective and safe strategy that reduces the size of LDH.