BACKGROUND:Previous trials of yoga therapy for nonspecific low back pain (nsLBP) (without sciatica) showed beneficial effects.

OBJECTIVE:To test effects of yoga therapy on pain and disability associated with lumbar disc extrusions and bulges.

METHODS:Parallel-group, randomised, controlled trial. Sixty-one adults from rural population, aged 20-45, with nsLBP or sciatica, and disc extrusions or bulges. Randomised to yoga (n=30) and control (n=31). Yoga: 3-month yoga course of group classes and home practice, designed to ensure safety for disc extrusions.

CONTROL:normal medical care. OUTCOME MEASURES (3-4 months) Primary: Roland Morris Disability Questionnaire (RMDQ); worst pain in past two weeks. Secondary: Aberdeen Low Back Pain Scale; straight leg raise test; structural changes.

RESULTS:Disc projections per case ranged from one bulge or one extrusion to three bulges plus two extrusions. Sixty-two percent had sciatica. Intention-to-treat analysis of the RMDQ data, adjusted for age, sex and baseline RMDQ scores, gave a Yoga Group score 3.29 points lower than Control Group (0.98, 5.61; p=0.006) at 3 months. No other significant differences in the endpoints occurred. No adverse effects of yoga were reported.

CONCLUSIONS:Yoga therapy can be safe and beneficial for patients with nsLBP or sciatica, accompanied by disc extrusions and bulges.

OBJECTIVE:The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).

METHODS:One hundred twenty patients presenting through elective referral by primary care physicians to neurosurgical spine surgeons were consecutively screened for symptoms of unilateral lumbar radiculopathy secondary to LDH at L3-4, L4-5, or L5-S1. Forty consecutive consenting patients who met inclusion criteria (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation. Crossover to the alternate treatment was allowed after 3 months.

RESULTS:Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received. However, 3 patients crossed over from surgery to spinal manipulation and failed to gain further improvement. Eight patients crossed from spinal manipulation to surgery and improved to the same degree as their primary surgical counterparts.

CONCLUSIONS:Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.

OBJECTIVE: To evaluate the clinical curative effect of "oblique-pulling" maneuver in patients with lumbar intervertebral disc herniation (LIDH). METHODS: Sixty-five LIDH cases were randomly divided into experimental group and control group. In the experimental group 32 patients were treated by "oblique-pulling" maneuver, and 32 patients in the control group were treated by lumbar traction therapy. One case were excluded from the study and another one case were dropped from the study. After one course of treatment, the therapeutic effects of the two groups were compared quantitatively by using the JOA and VAS scores, including the improvement of signs, symptoms, living ability, and low back and leg pain. RESULTS: After one course of treatment, in the experimental group, 7 cases were controlled well, 16 cases were marked effect, 8 cases were effect, 1 case was no effect. In the control group, 4 cases were controlled well, 10 cases were marked effect, 13 cases were effect, 4 cases was no effect in control group. The clinical effective rate of the experimental group was 96.86%, which was higher than 87.10% of the control group (P<0.05). In the experimental group the scores of JOA and VAS were obviously improved after treatment (P<0.001) and the improvement was better than that of control group (P<0.01). CONCLUSION: The "oblique-pulling" maneuver has the characteristics of simple operation, repeatability, good efficiency, high safety.