Prognostic factors for treatment success of conservative management and role for physiotherapy in radicular pain caused by a lumbar disc herniation: a systematic review.

Introduction: Lumbar disc herniation is a frequent cause of radicular leg pain and has a pronounced impact on the quality of life. While guidelines discommend surgery in the acute phase of the condition, literature on conservative treatment is relatively scarce. In this systematic review, prognostic factors for success of conservative management are investigated as well as the effect of physiotherapy on leg pain. Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Pedro, Web of Science, Scopus, CINAHL, ICTRP, and Clinicaltrials.gov from commencement to September 2022. Following screening 22 reports were included in the analysis and assessed for risk of bias by using the RoB 2 tool for randomized trials and the ROBINS-I tool for prospective cohort studies. Results: Fifteen papers with moderate to high risk of bias reported on prognostic factors for treatment success following nonsurgical management. Extruded disc morphology was associated with better outcomes in two articles. Severe baseline symptoms and receiving workers compensation were associated with worse outcomes in three and two studies, respectively. Physiotherapy reportedly had a beneficial effect on radicular leg pain in 5 out of 7 studies with low to moderate risk of bias. Conclusion: Certain physiotherapy actions seem to have value with respect to the relief of radicular symptoms in the conservative management of LDH with radicular pain. Severe baseline symptoms seems to be a risk factor for poor outcome after conservative management. There is a need for high-quality evidence on non-surgical treatments to match the literature on surgical treatment.