Retrospective Statistical Analysis of Patients with Disc Herniation Treated with Cervical or Lumbar Decompression Treatment

Ye Ji Lee; Jeong il Kim; Ju Hyun Jeon; Eunseok Kim; Young Il Kim; Lee, Ye Ji; Kim, Jeong il; Jeon, Ju Hyun; Kim, Eunseok; Kim, Young Il

doi:10.13048/jkm.21011

JKM > Volume 42(2); 2021 > Article

Lee, Kim, Jeon, Kim, and Kim: Retrospective Statistical Analysis of Patients with Disc Herniation Treated with Cervical or Lumbar Decompression Treatment

Original Article

The Journal of Korean Medicine 2021; 42(2): 1-20.

Published online: June 01, 2021

DOI: https://doi.org/10.13048/jkm.21011

Retrospective Statistical Analysis of Patients with Disc Herniation Treated with Cervical or Lumbar Decompression Treatment

Ye Ji Lee¹

, Jeong il Kim²

, Ju Hyun Jeon¹

, Eunseok Kim³^{, 4}

, Young Il Kim¹^{, *}

¹Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, South Korea

²Department of Statistics, College of H-Liveral Arts, Daejeon University, Daejeon, South Korea

³Department of Acupuncture & Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, South Korea

⁴Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, South Korea

Correspondence to: Young Il Kim, Department of Acupuncture and Moxibustion Medicine, Daejeon Korean Medicine Hospital of Daejeon University, 75, Daedeok-daero 176 Beon-gil, Seo-gu, Daejeon, Korea, Tel: +82-42-470-9137, Fax: +82-42-470-9005, E-mail: omdkim01@dju.kr

본 연구는 2019년 대전대학교 석사학위 논문임.

Received January 29, 2021 Revised March 04, 2021 Accepted April 06, 2021

Abstract

Objectives

The purpose of this study was to confirm the relavance between the dependent variables and the treatment effects of nonsurgical spinal decompression(NSD).

Methods

105 patients suffering from disc herniation and treated with NSD were investigated and analyzed.

Results

The intention of retreatment showed a tendency to be higher in having occupation, western treatment only before NSD(WTB) and non-western treatment(WTN) group. As the number of NSD increased, satisfaction score and the Numeric Rating Scale(NRS) difference increased and the NRS after NSD decreased. On the other hand, as western treatment after NSD increased, satisfaction score and the NRS difference decreased and the NRS after NSD increased. The odds ratio of having intention of retreatment was lower in western treatment only after NSD(WTA) group than WTN group. The NRS difference showed a high tendency in the age group of 20s, 60s, and 70s and older. The NRS difference of group with NSD more than 10 times was higher than that of the group with less than 10 times. Satisfaction score of WTN and WTB group was higher than that of WTA group. Adjusted NRS after NSD was the lowest in non-western treatment group and the highest in WTA group. Adjusted NRS after NSD was the lowest in the group with NSD over 21 times, and the NRS after NSD increased as the number of NSD decreased.

Conclusion

This study included patients with cervical or lumbar disc herniation and showed that occupation, the number of NSD, western treatment and age statistically affected the treatment effect.

Keywords: Nonsurgical Spinal Decompression, Disc Herniation, Retrospective Statistical Analysis

Fig. 1

Study flow chart

Fig. 2

NRS difference for the number of NSD

Fig. 3

Satisfaction score for western treatment

Fig. 4

Adjusted NRS after NSD for the number of NSD

Fig. 5

Adjusted NRS after NSD for western treatment

Table 1

Frequency analysis of demographic variables

Variables			No.	%
Sex	Male		50	47.6
Sex	Female		55	52.4

Age	1–29		9	8.6
	30–39		12	11.4
	40–49		25	23.8
	50–59		32	30.5
	60–69		19	18.1
	70-		8	7.6

	Mean±SD		50.56±3.339

Occupation	Yes	office worker	45	42.9
		part time job	3	2.9
		self-employed	2	1.9

	No	unemployed	43	41.0
	No	student	6	5.7

Body weight(kg)	−55		14	13.3
	−65		30	28.6
	−75		28	26.7
	−85		22	21.0
	Over 85		11	10.5

		Mean±SD	68.71±3.231

SD : Standard Deviation

Table 2

Frequency analysis of disease variables

Variables			No.	%
Site of disease	Cervical		36	34.3
Site of disease	Lumbar		69	65.7

Stage of disc herniation	Bulging		17	16.2
	Protrusion		58	55.2
	Extrusion		28	26.7
	Sequestration		2	1.9

Radiating pain	Yes	left	43	41.0
		right	28	26.7
		both	11	10.5

	No		23	21.9

Duration of disease	Acute		26	24.8
	Subacute		8	7.6
	Chronic		71	67.6

Table 3

Frequency analysis of therapeutic variables

Variables		No.	%
Admission	Yes	60	57.1
Admission	No	45	42.9

Disc Level of NSD	C3–4	2	1.9
	C4–5	3	2.9
	C5–6	22	21.0
	C6–7	9	8.6
	L1–2	1	1.0
	L2–3	1	1.0
	L3–4	2	1.9
	L4–5	43	41.0
	L5–S1	22	21.0

Number of NSD	1–5	26	24.8
	6–9	26	24.8
	10	23	21.9
	11–20	18	17.1
	21-	12	11.4

	Mean±SD	11.35±0.191

Increase ratio of NSD(Cervical) (%)	0 – 10	8	7.6
	−12	10	9.5
	−14	10	9.5
	Over 14	8	7.6

	Mean±SD	12.5±.15

Increase ratio of NSD(Lumbar) (%)	−50	9	8.6
	−60	14	13.3
	−70	18	17.1
	−80	18	17.1
	Over 80	10	9.5

	Mean±SD	66.05±3.644

Western Treatment	WTN	57	54.3
	WTB	32	30.5
	WTA	7	6.7
	WTBA	9	8.6

SD : Standard Deviation

WTN : Non-Western Treatment

WTA : Western Treatment only after NSD

NSD: Nonsurgical Spinal Decompression

WTB : Western Treatment only before NSD

WTBA : Western Treatment both before and after NSD

Table 4

Frequency analysis of therapeutic effectiveness

Variables		No.	%
Satisfaction score	1	4	3.8
	2	19	18.1
	3	26	24.8
	4	47	44.8
	5	9	8.6

	Mean±SD	3.36±.001

Intention of retreatment	Yes	64	61.0
Intention of retreatment	No	41	39.0

NRS B	Mean±SD	6.38±.104

NRS A	Mean±SD	4.42±.406

NRS B – NRS A	Mean±SD	1.962±.808

SD : Standard Deviation

NRS : Numeric Rating Scale

NRS A : NRS After NSD

NSD : Nonsurgical Spinal Decompression

NRS B : NRS Before NSD

Table 5

Crossover analysis of occupation and intention of retreatment

Variables			Intention of retreatment		Total	x²

			Yes	No
Occupation	Yes	N	41	15	56	7.581 (0.006^**)
	Yes	%	73.2	26.8	100.0

	No	N	23	26	49
	No	%	46.9	53.1	100.0

Total		N	64	41	105
Total		%	61.0	39.0	100.0

** p < 0.01

Table 6

Crossover analysis of western treatment and intention of retreatment

Variables			Intention of retreatment		Total	x²

			Yes	No
Western Treatment	WTN	N	36	21	57	9.156 (0.027^*)
	WTN	%	63.2	36.8	100.0

	WTB	N	23	9	32
	WTB	%	71.9	28.1	100.0

	WTA	N	1	6	7
	WTA	%	14.3	85.7	100.0

	WTBA	N	4	5	9
	WTBA	%	44.4	55.6	100.0

Total		N	64	41	105
Total		%	61.0	39.0	100.0

* p < 0.05

NSD: Nonsurgical Spinal Decompression

WTB : Western Treatment only before NSD

WTBA : Western Treatment both before and after NSD

WTN : Non-Western Treatment

WTA : Western Treatment only after NSD

Table 7

Multiple linear regression analysis of satisfaction score

Independent variable	Unstandardized		Standardized	t	p	Collinearity statistics		F (p)
Independent variable	B	SE	beta	t	p	TOL	VIF	F (p)
Constant	3.740	.670		5.579	.000			2.966 (.004^**)
Sex	−.182	.201	−.091	−.905	.368	.813	1.230
Age	−.008	.008	−.111	−1.107	.271	.814	1.229
Stage of disc herniation	.137	.147	.096	.930	.355	.778	1.286
Radiating pain	−.382	.229	−.158	−1.670	.098	.913	1.095
Duration of disease	.083	.113	.072	.739	.462	.870	1.149
Admission	−.021	.193	−.010	−.108	.914	.893	1.119
Number of NSD	.023	.010	.236	2.419	.017^*	.860	1.163
WT before NSD	.050	.209	.025	.241	.810	.786	1.273
WT after NSD	−.852	.265	−.307	−3.212	.002^**	.898	1.113
Dependent variable : Satisfaction score

* p < 0.05

** p < 0.01

SE : Standard Error

VIF : Variance Inflation Factor

WT : Western Treatment

TOL : Tolerance

NSD : Nonsurgical Spinal Decompression

Table 8

Multiple linear regression analysis of the NRS difference

Independent variable	Unstandardized		Standardized	t	p	Collinearity statistics		F (p)
Independent variable	B	SE	beta	t	p	TOL	VIF	F (p)
Constant	1.693	1.188		1.425	.157			3.483 (.001^***)
Sex	−.132	.355	−.037	−.372	.711	.813	1.230
Age	−.002	.013	−.015	−.153	.879	.814	1.229
Stage of disc herniation	.226	.261	.087	.866	.389	.778	1.286
Radiating pain	−.438	.405	−.101	−1.082	.282	.913	1.095
Duration of disease	.092	.199	.044	.460	.646	.870	1.149
Admission	−.360	.342	−.099	−1.051	.296	.893	1.119
Number of NSD	.074	.017	.416	4.338	.000^***	.860	1.163
WT before NSD	.102	.370	.028	.277	.782	.786	1.273
WT after NSD	−1.018	.470	−.203	−2.166	.033^*	.898	1.113
Dependent variable : NRS B – NRS A

* p < 0.05

*** p= < 0.001***

SE : Standard Error

VIF : Variance Inflation Factor

NRS : Numeric Rating Scale

NRS A : NRS After NSD

TOL : Tolerance

NSD : Nonsurgical Spinal Decompression

NRS B : NRS Before NSD

WT : Western Treatment

Table 9

Multiple linear regression analysis of the NRS after NSD

Independent variable	Unstandardized		Standardized	t	p	Collinearity statistics		F (p)
Independent variable	B	SE	beta	t	p	TOL	VIF	F (p)
Constant	3.819	.954		4.004	.000			2.619 (.009^**)
Sex	.017	.285	.006	.061	.952	.813	1.230
Age	.007	.011	.067	.663	.509	.814	1.229
Stage of disc herniation	−.113	.209	−.056	−.540	.591	.778	1.286
Radiating pain	.423	.325	.125	1.302	.196	.913	1.095
Duration of disease	−.022	.160	−.013	−.136	.892	.870	1.149
Admission	.233	.275	.082	.848	.398	.893	1.119
Number of NSD	−.033	.014	−.241	−2.430	.017^*	.860	1.163
WT before NSD	.061	.297	.021	.206	.837	.786	1.273
WT after NSD	1.305	.377	.335	3.460	.001^***	.898	1.113
Dependent variable : NRS A

* p<0.05

** p<0.01

*** p=< 0.001

SE : Standard Error

VIF : Variance Inflation Factor

NRS : Numeric Rating Scale

WT : Western Treatment

TOL : Tolerance

NSD : Nonsurgical Spinal Decompression

NRS A : NRS After NSD

Table 10

Logistics regression analysis of intention of retreatment

Independent variable		B	SE	Wald	95% CI		p	Exp(B)
Independent variable		B	SE	Wald	Min	Max	p	Exp(B)
Western Treatment	WTN			6.925	.		074
	WTB	.399	.480	.693	.582	3.816	.405	1.491
	WTA	−2.331	1.114	4.374	.011	.864	.036^*	.097
	WTBA	−.762	.725	1.106	.113	1.932	.293	.467
Dependent variable : Intention of retreatment

* p<0.05

SE : Standard Error

WTN : Non-Western Treatment

WTA : Western Treatment only after NSD

CI : Confidence Interval

WTB : Western Treatment only before NSD

WTBA : Western Treatment both before and after NSD

Table 11

ANOVA of age and the NRS difference

Variables		NRS A – NRS B			F	p

		No.	Mean	SD
Age	1–29	9	3.4444	1.94365	2.545	0.033^*
	30–39	12	2.0000	1.47710
	40–49	25	1.6800	1.74929
	50–59	32	1.3750	1.69915
	60–69	19	2.3158	1.82734
	70-	8	2.6250	1.84681

* p < 0.05

SD : Standard Deviation

NRS B : NRS Before NSD

NRS : Numeric Rating Scale

NRS A : NRS After NSD

Table 12

ANOVA of the number of NSD and the NRS difference

Variables		NRS B – NRS A			F	p	Scheffe
Variables		No.	Mean	SD	F	p	Scheffe
Number of NSD	1–5_(a)	26	1.0000	1.13137	8.239	0.000^***	e,d,c>b,a
	6–9_(b)	26	1.1538	1.12044
	10_(c)	23	2.6087	1.97114
	11–20_(d)	18	2.8333	1.72354
	21-_(e)	12	3.2500	2.26134

*** p < 0.001

NSD: Nonsurgical Spinal Decompression

NRS : Numeric Rating Scale

NRS A : NRS After NSD

SD : Standard Deviation

NRS B : NRS Before NSD

Table 13

ANOVA of western treatment and satisfaction score

Variables		Satisfaction score			F	p	Scheffe
Variables		No.	Mean	SD	F	p	Scheffe
Western Treatment	WTA _(a)	7	2.14	1.069	4.871	0. 003^**	d,c>a
	WTBA _(b)	9	3.00	1.000
	WTB _(c)	32	3.47	0.718
	WTN _(d)	57	3.51	1.037

** p < 0.01

NSD: Nonsurgical Spinal Decompression

WTB : Western Treatment only before NSD

WTBA : Western Treatment both before and after NSD

WTN : Non-Western Treatment

WTA : Western Treatment only after NSD

Table 14

ANCOVA of western treatment and the NRS after NSD

Western treatment	No.	Adjusted Mean	SE	95% CI		Type III SS	F-value (p-value)
Western treatment	No.	Adjusted Mean	SE	Min	Max	Type III SS	F-value (p-value)
WTN	57	4.182	0.179	3.827	4.537	24.484	4.510 (0.005^**)
WTB	32	4.288	0.238	3.816	4.761
WTA	7	5.872	0.509	4.863	6.882
WTBA	9	5.254	0.451	4.359	6.149

** p < 0.01

SE : standard error

Type III SS : Type III sum of squares

WTN : Non-Western Treatment

WTA : Western Treatment only after NSD

CI : Confidence Interval

NSD: Nonsurgical Spinal Decompression

WTB : Western Treatment only before NSD

WTBA : Western Treatment both before and after NSD

Table 15

ANCOVA of the number of NSD and the NRS after NSD

Number of NSD	No.	Adjusted Mean	SE	95% CI		Type III SS	F-value (p-value)
Number of NSD	No.	Adjusted Mean	SE	Min	Max	Type III SS	F-value (p-value)
1–5	26	4.967	0.276	4.419	5.516	20.526	2.747 (0.032^*)
6–9	26	4.845	0.275	4.299	5.391
10	23	4.071	0.289	3.497	4.644
11–20	18	3.878	0.327	3.230	4.526
21-	12	3.786	0.409	2.975	4.597

* p < 0.05

SE : standard error

Type III SS : Type III sum of squares

CI : Confidence Interval

NSD: Nonsurgical Spinal Decompression

참고문헌

1. Korean Acupuncture and Moxibustion Medicine Society. Acupuncture Medicine. Seoul: Hanmi Medical Publishing Company;2016. p. 495–6.

2. Castro WHM, Grossman TW, Jerosch J. Examination and diagnosis of musculoskeletal disorders II. Seoul: Hanmi Medical Publishing Company;2002. 520:p. 532

3. Yang H, Liu H, Li Z, Zhang K, Wang J, Wang H, et al. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears. Int J Clin Exp Med. 2015; 8:1634–44.

4. Kim SM, Kim YI. 2019 National Health Insurance Statistical Yearbook. National Health Insurance Service, Health Insurance Review & Assessment Service;2020. p. 654–68. p. 686–97..

5. Esses SI. Textbook of spinal disorders. Seoul(Korea): Koonja;2008. 194:p. 202–3.

6. Fast A. Low back disorders: conservative management. Arch Phys Med Rehabil. 1988; 69:880–91.

7. Macario A, Pergolizzi JV. Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain. Pain Practice. 2006; 6:171–8.

8. Lee KH, Kim HY, Kim KY, Nam HW, Jung YH, Koh YT. Case Report of L-spine HIVD treated with Spine Decompression. The Journal of Korea CHUNA Manual Medicine for Spine & Nerves. 2007; 21:39–47.

9. Won JK, Park DS, Pi CH, Song YS, Kwon YM, Park TY. The Clinical Effects of Non Surgical Spinal Decompression Treatment on HIVD. The Journal of Korea CHUNA Manual Medicine for Spine & Nerves. 2007; 2:2. 41–8.

10. Seo SK, Kim BJ, Park KJ, Kang JH, Kim SK, Seo DW. The Clinical Studies for Non Surgical Spinal Decompression Treatment on Cervical Disc Herniation. J Oriental Rehab Med. 2011; 21:4. 131–43.

11. Ma SY, Kwon WA, Lee JH, Min DG. The Effects of Spinal Decompression Combined with Therapeutic Modalities for Patients with Lumbar Radiculopathy. Journal of the Korea Academia-Industrial cooperation Society. 2013; 14:1. 336–43.

12. Huh KY. Effect of Spinal Decompression Therapy Compared with Intermittent Mechanical Traction in Lumbosacral Disc Herniation. Master's degree. Graduate School, Kyung Hee University;2009.

13. KO Oh. The Effects of Manual Theapy and Decompression Therapy for Treatment of Lumbar Herniation Disk. Master's degree. Graduate School of Pubic Health, Inje University;2016.

14. Park SW, Kim SS, Kim JY, Kim SH, Lee GM. The Comparative Study of Effects between Acupotomy and its Cotreatment with Spine Decompression Therapy on HIVD Patients. J Korean Acupunct Moxib Soc. 2012; 29:3. 29–39.

15. Kim JI, Jeong JK, Kim MK, Jeon JH, Kim ES, Kim YI. A Retrospective Statistical Analysis of Miniscalpel Needle Therapy for Herniated Intervertebral Disc or Spinal Stenosis. J Acupunct Res. 2018; 35:4. 225–37.

16. Jeong JK, Kim MK, Park GN, Kim JH, Kim YI. A descriptive statistical analysis of inpatients with lumbar disc herniation at a Korean medicine hospital in 2014. The Acupuncture. 2017; 34:2. 19–38.

17. Kim MJ, Lee MS. Effects of Rumba Sports Dances on the ROM of Patients with Chronic Low Back Pain. Journal of Naturopathy. 2014; 3:1. 61–6.

18. Hawker GA, Mian S, Kendzerska T, French M. Measures of Adult Pain. Arthritis Care Res (Hoboken). 2011; 63:240–52.

19. Seok SI. Textbook of spinal surgery. 4st edit. Seoul(Korea): Newest Medical Company;2016. 123:p. 354–7.

20. Kim BJ, Ko HS, Seo JG, Choo SK, Kim JH. Surgical Treatment of Cervical Disc Herniation. J of Korean Orthop Assoc. 1995; 30:3. 545–50.

21. Lee JE, Lee HJ, Hong YK, Kang S, Yoon BC, Lee SH. Comparison between the Effect of Transforaminal Steroid Injection and Transforaminal Steroid Injection Combined with Spinal Decompressor on Lumbar Disc Herniation. J Korean Acad Rehab Med. 2007; 31:5. 590–5.

22. The Korean Orthopaedic Association. Orthopaedics. 5th edit. Seoul(Korea): Newest Medical Company;1999. p. 449–55.

23. Lee HE, Cho JH, Moon JY, Kim MJ, Kang I, Lee H, et al. The Clinical Study on 88 Patients of Cervical Disc Herniation. J Korean Acupunct Moxib Soc. 2008; 25:6. 145–52.

24. You JW. Lumbar Dsc Disease. Journal of Korean Spine Surg. 1999; 6:2. 208–19.

25. Weber H. Lumbar disc herniation : A controlled prospective study with ten years of observation. SAS Journal. 2009; 3:1. 30–40.

26. Jeong JD, Roh SC. Cervical HIVD Related to Long-Herm Whole Body Vibration and Awkward Posture. Korean J Occup Environ Med. 2009; 21:4. 396–405.

27. Korea Institute of Oriental Medicine. KMCPG-Lumbar Herniated Intervertebral Disc (HIVD). Seoul (Korea): Elsevier Korea L.L.C;2015. p. 38