The effect of stage and level of the disease on balance in patients with lumbar disc herniation

Objective: The aims of this study were to investigate the effects of stages (bulging and protrusion) and levels (L4-5 and L5-S1) of hernia on pain severity, disability and balance in this patient population. Methods: 119 patients with LDH were included in this study. Pain severity, Ostwestry Disability Index (ODI) and Balance abilities (postural stability, Limits of stability -LoS, and Clinical Test of Sensory Interaction and Balance-CTSIB) of the patients were measured using Biodex Balance System. Results: When we compared the balance performance of the patients with bulging and protrusion, there was a significant difference only in (R) forward direction index of the protrusion group at L4-5 level (p<0.05). ODI scores did not differ between the patients with protrusion and bulging (p>0.05). When we compare the patients according to the levels within each phase, no significant difference was found on behalf of bulging in any levels (p>0.05). On the other hand, age, overall and medial-lateral postural stability indexes and all CTSIB parameters except foam eyes-opened were significantly higher in patients with protrusion at L4-5 level (p<0.05). LoS scores were significantly lower in patients with protrusion at L4-5 level indicating worse results compared to L5-S1 level. ODI scores were not affected by the levels of the disease (p>0.05). Conclusion: The results of the study indicated that disability and balance performance were similar in patients with bulging and protrusion independent from the levels of the disease. Levels of LDH affect balance performance specifically in patients with protrusion probably due to increased age.