الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Lumbar disc prolapse has become considered a worldwide health problem , and a common spinal disorder encountered in practice. There are numerous studies about the efficacy of conservative treatment of the lumbar disc prolapse in comparison to the invasive surgical treatment. Provided that indications for surgical interference are not present, conservative treatment is first line of treatment in lumbar disc prolapse even in massive herniations.
This retrospective study comprised of 32 patients with symptomatic lumbar disc prolapse who were treated according to conservative treatment program in spine unit in El-Hadara university hospital for 3-6 months with MRI examination was done at presentation and at least six months of follow up. MRI images were then evaluated and classified using MSU (Michigan State University) Classification.
After at least six months of follow up (mean± SD 15.59 months ± 9.95), 21 patients (65.6%) showed regression in their disc size, with 15 of these cases (46.9%) moved from higher grade to lower grade (downgrade) in MSU classification. Level of agreement between classification changes and MRI changes in the present study is 0.421. So, MSU classification has a moderate accuracy in describing these changes in MRI. Conservative treatment was successful in 19 cases (59.3 %) with 10 cases (31.3%) had their sciatica resolved. 13 cases did not improve, but only 6 patients had surgery, and the other 7 patients refused surgical interference out fear of surgical complications.. Demographic data (age and sex), level, location and size of the lesions show no statistically significant relationship with disk herniation evolution.
Regarding MSU classification in this study, there were nine cases hard to be classified or classification was somewhat subjective because of caudal or cranial migration where facet joint is not as clear as at the disc level. Also, MSU classification cannot differentiate between extruded, sequestrated or protruded disc fragment. This is considered weakness of the classification because the type of