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1
Sanginov, A. J., I. D. Isakov, Sh A. Akhmetyanov, and A. V. Peleganchuk. "Resorption of lumbar disc herniations: a non-systematic literature review." Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika) 21, no. 1 (2024): 55–62. http://dx.doi.org/10.14531/ss2024.1.55-62.
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Objective. To analyze the information on spontaneous resorption of lumbar disc herniation.Material and Methods. A non-systematic review of 37 publications on resorption of disc herniation was conducted. The data on the timing, mechanisms and predictors of regression of lumbar disc herniation were summarized. A clinical case is presented illustrating the resorption of a herniated L4–L5 intervertebral disc over 8 months.Results. The frequency and timing of resorption of lumbar disc herniation vary depending on the number of patients, follow-up period, the type and nature of the hernial bulging, and other characteristics of patients. The results of meta-analyses indicate that the average period of spontaneous resorption of lumbar disc herniation is more than 6 months. The main theories of spontaneous resorption of lumbar disc herniation are the dehydration theory, the mechanical theory, and mechanisms associated with inflammatory processes and neovascularization. Currently, predictors of disc herniation resorption include the type and size of the hernia, follow-up period, Modic changes, etc. Existing data on the timing, mechanisms and predictors of resorption of lumbar disc herniation are insufficient to improve treatment tactics for this category of patients.Conclusion. Herniated lumbar intervertebral discs tend to undergo spontaneous regression which, however, is not observed in all patients. The mechanisms of resorption can be different, and the fact of resorption itself can occur in different types of hernia with different frequencies. An analysis of large data sets is necessary to more accurately determine the timing and predictors of resorption of lumbar disc hernias.
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Kuligowski, Tomasz. "Prevalence of Lumbar Segmental Instability in Young Individuals with the Different Types of Lumbar Disc Herniation—Preliminary Report." International Journal of Environmental Research and Public Health 19, no. 15 (2022): 9378. http://dx.doi.org/10.3390/ijerph19159378.
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Lumbar segmental instability (LSI) can cause pain and disability, and its background can be related to lumbar disc herniation (LDH). This retrospective study was conducted to analyze the prevalence of lumbar segmental instability (LSI) in young patients with different types of lumbar disc herniation (LDH). The study evaluated 133 individuals (18–25 years old) who suffered from LDH and underwent MRI and flexion-extension X-rays. Two groups were created: protrusion (PRO) and extrusion (EXT). LSI was scored positive when translatory motion was greater than 4 mm anteriorly or 2 mm posteriorly at the level of herniation. Statistica 13 was used to perform statistics. The LSI overall prevalence was 18.33% in PRO and 21.92% in EXT (p > 0.05). Out of all LSI positives, higher LSI incidence was observed in females compared to males; in PRO: 63.64%; in EXT: 68.75% (p > 0.05). LSI correlated positively with the passive lumbar extension test (PLE) (R = 0.32; p = 0.01) in the PRO group only. In summary, the results showed that the overall incidence of LSI was higher with severer disc damage. In addition, females were more prone to this pathology. However, the different types of LDH do not significantly affect the prevalence of LSI in young individuals.
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Zheng, Yuxin, Xiaojie Su, Lijuan Zhao, Guohui Zhang, Xinnan Xue, and Hong Zhang. "Mechanisms and progress in the application of traditional acupuncture methods for the treatment of lumbar disc herniation." Theoretical and Natural Science 32, no. 1 (2024): 102–13. http://dx.doi.org/10.54254/2753-8818/32/20240808.
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This paper summarizes the operational methods of nine acupuncture techniques recorded in the Ling Shu Guan Zhen and the mechanisms of special acupuncture techniques in the treatment of lumbar disc herniation over the past two decades. The techniques include the left and right crossing acupuncture method, local multi-needle acupuncture method, bone-piercing method, and tendon-piercing method. An overview of the types of lumbar disc herniation suitable for each acupuncture technique is provided, offering a theoretical reference for selecting appropriate acupuncture techniques in clinical treatment. However, current research lacks an exploration of the differential efficacy mechanisms among different acupuncture techniques for treating lumbar disc herniation. Issues such as the absence of standardized quantitative evaluation criteria, limited sample sizes, and a lack of long-term efficacy tracking still need improvement in future research.
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Shrestha, D., R. Shrestha, D. Dhoju, S. R. Kayastha, and S. C. Jha. "Study of Clinical Variables Affecting Long Term Outcome after Microdisectomy for Lumbar Disc Herniation." Kathmandu University Medical Journal 13, no. 4 (2017): 333–40. http://dx.doi.org/10.3126/kumj.v13i4.16833.
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Background Outcome of lumbar disc herniation are influenced by various clinical, socioeconomic and psychological factors. In the absence of provision of medical insurances, worker’s compensation and sick leave, predictors for outcome after lumbar disc herniation surgery will be different in Nepalese population.Objective To evaluate different clinical variables that can affect outcome after lumbar disc herniation surgery.Method Among 88 patients who underwent microdisectomy for lumbar disc herniation, 63 patients (43 male, 20 female) with follow up at least six months were retrospectively evaluated for clinical variables which can affect Oswestry disability index (ODI) score, its interpretation and Mcnab classification of post operative outcome.Result Average age of patients was 42.54±8.60 years. Mean follow up period was 34.89±23.80 months (range 6 -111 months). Thirty four patients had follow up period > 24 months. Mean ODI score before surgery and at final follow up was 37.87±8.76 vs 7.78±7.7; (p=0.00). Success rate was 90.47% (change in ODI score at least by 10), 93.65% (ODI score interpretation <40%), and 85.71%. (Mcnab outcome excellent and good). Significant correlation was found between age and ODI at final follow up but not with duration of symptoms. Male, non alcoholic, low level of education, numbness as a predominant symptom, disc at L4-L5 were significantly associated with better ODI at final follow up. For ODI score interpretation, gender, smoking habit, presence of leg pain as a predominant symptom were statistically significant factors whereas smoking and drinking habit, level of education, occupation, back pain and numbness as predominant pre-operative symptom, types of disc in MRI were significantly related to Mcnab outcome. There was 9.5% peri- or post-operative complications and recurrence in seven patients.Conclusion Age, gender, smoking and drinking habit, level of education, occupation, types of disc in MRI are important variables for ODI score, ODI score interpretation and Mcnab outcome.
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Hosseini, Behnam, Mehrdad Taheri, and Kourosh Sheibani. "Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification." Interventional Neuroradiology 25, no. 1 (2018): 111–16. http://dx.doi.org/10.1177/1591019918800458.
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Purpose To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients’ performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification. Patients and methods Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging. In all patients entering the study the severity of pain was recorded according to the visual analog scale criteria before and one and three months after the end of treatment. Oswestry Low Back Pain Disability Index (ODI) was used to compare patients’ performance before and after the treatment. Results In total 128 patients (60 females and 68 males) with mean age of 40.1 ± 10.7 entered the study. The patients were divided into eight groups based on MSU classification each including 16 patients. The reduction of pain severity and ODI score compared to baseline was statistically significant in all groups both in the first month and the third month after treatment. There was also a statistically significant difference between groups regarding the reduction of pain and ODI score indicating significantly worse treatment outcomes in groups 1-C, 2-C and 2-AB. Conclusion Based on our findings it seems that MSU classification can be used in patients’ selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation.
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Benyamin, Ramsin. "The Effectiveness of Lumbar Interlaminar Epidural Injections in Managing Chronic Low Back and Lower Extremity Pain." Pain Physician 4;15, no. 4;8 (2012): E363—E404. http://dx.doi.org/10.36076/ppj.2012/15/e363.
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Background: Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back pain. However the evidence is highly variable among different techniques utilized – namely interlaminar, caudal, and transforaminal – and for various conditions, namely – intervertebral disc herniation, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Multiple systematic reviews conducted in the evaluation of the effectiveness of interlaminar epidural injections have been marred with controversy. Consequently, the debate continues with regards to the effectiveness, indications, and medical necessity of interlaminar epidural injections. Study Design: A systematic review of lumbar interlaminar epidural injections with or without steroids. Objective: To evaluate the effect of lumbar interlaminar epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, spinal stenosis, and chronic discogenic pain. Methods: The available literature on lumbar interlaminar epidural injections with or without steroids in managing various types of chronic low back pain with or without lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, or limited based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: Overall, 82 lumbar interlaminar trials were identified. All non-randomized studies without fluoroscopy and randomized trials not meeting the inclusion criteria were excluded. Overall, 15 randomized trials and 11 non-randomized studies were included in the analysis. Analysis was derived mainly from fluoroscopically-guided randomized trials and non-randomized studies. The evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids, fair with local anesthetic only; whereas it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids, and fair for axial pain without disc herniation with local anesthetic with or without steroids, with fluoroscopically-guided epidural injections. Limitations: The limitations of this study include that we were unable to perform meta-analysis for disc herniation, and the paucity of evidence for discogenic pain and spinal stenosis. Further, methodological criteria have been highly variable along with sample sizes. The studies were heterogenous. Conclusion: The evidence based on this systematic review is good for lumbar epidural injections under fluoroscopy for radiculitis secondary to disc herniation with local anesthetic and steroids, fair with local anesthetic only; whereas it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids, and fair for axial pain without disc herniation with local anesthetic with or without steroids. Key words: Chronic low back pain, lower extremity pain, disc herniation, radiculitis, spinal stenosis, discogenic pain, lumbar interlaminar epidural injections, fluoroscopy
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Faraj, Moneer K., Ammar S. Al-adhami, Mohammed Q. Abdulrazzaq , and Ahmed Aman. "Laminectomy versus interlaminar approach for Lumbar disc herniation." Journal of the Faculty of Medicine Baghdad 60, no. 3 (2018): 126–30. http://dx.doi.org/10.32007/jfacmedbagdad.603594.
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Background: Low back pain is the most common health problem in men and women between the ages of 20 and 50 years. The lumbar disc prolapse has a major role in this condition. Treatment is either conservative or surgical. The most common surgical interventions are either laminectomy or interlaminar approach.
 Objective: To determine which is the best surgical approach for the patient according to his/her type of disc herniation.
 Patients and methods: A comparative clinical study conducted in the Neurosciences Hospital, Baghdad, Iraq from January 2016 to January 2018. In this paper we evaluated the clinical outcome following both approaches
 Results: We studied sixty cases; thirty-four patients had interlaminar approach for lumbar discectomy while twenty-six patients had laminectomy with discectomy.
 Conclusion: Both methods can manage different types of lumbar disc prolapse, apart from far-lateral disc which favors laminectomy approach.
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Li, Pengfei, Fengkai Yang, Ying Chen, and Youxin Song. "Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study." Journal of International Medical Research 49, no. 10 (2021): 030006052110550. http://dx.doi.org/10.1177/03000605211055045.
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Objective To introduce the concept of ‘nerve root as the core’ and to investigate the surgical procedure and curative effect of percutaneous translaminar endoscopic discectomy (PTED) surgery in the treatment of different types of lumbar disc herniation (LDH). Methods This retrospective study analysed the clinical data from patients with LDH that underwent single-segment PTED surgery. They were divided into three groups based on LDH location: central canal zone group, lateral recess zone group and foraminal/far lateral zone group. Different working cannula placement methods were used for the different types of LDH. All patients were followed for at least 12 months. Clinical and follow-up data were compared between the three groups. Results A total of 130 patients were enrolled in the study: 44 (33.8%) in the central canal zone group, 72 (55.4%) in the lateral recess zone group and 14 (10.8%) in the foraminal/far lateral zone group. All three groups of patients achieved good postoperative results. The improvements in leg pain and disability were most marked in the first postoperative month in all three groups. Conclusion PTED achieved adequate decompression for different types of LDH. The concept of ‘nerve root as the core’ facilitated the accurate placement of the working cannula.
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Hadgaonkar, Shailesh, and Divya Tomer. "Analogy of Lumbar Disc: Retained, Residual, or Recurrent Disc?" Journal of Orthopaedic Case Reports 13, no. 12 (2023): 1–4. http://dx.doi.org/10.13107/jocr.2023.v13.i12.4052.
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Discectomy is a standard surgery for disc herniation performed by senior, experienced as well as young trainee spine surgeons. Yet, they both have patients returning with radicular pain. Sometimes, it is attributed to insufficient decompression in the primary surgery, sometimes to re-herniation at the same level, and sometimes thought as new disc herniation at a different level. The primary surgery is often blamed for the recurrence of the pain, without an assessment of the clinical condition of the patient. Surgeons use the terms recurrent, residual, and retained disc interchangeably as per their convenience without understanding the actual disc pathology. This causes errors in further treatment and dissatisfaction in patients. In this short review, we intend to clear the baffling terminologies pertaining to discectomy and help the readers to identify the exact nodus of the patient’s plight. The optimal extent of disc excision for a satisfactory outcome is not strictly defined [1]. Two main types of discectomy are subtotal discectomy, in which the annulus is opened and all accessible disc material is removed by curettage of the endplate; and limited discectomy, in which only the loose fragments are removed [1]. Patients who undergo subtotal discectomy experience progressive degeneration and back pain at the operated level compared with patients who undergo limited discectomy, which may eventually require spinal fusion at that level [2, 3] The problem with limited discectomy, on the other hand, is the higher recurrence rate due to the remaining disc material herniating later [2]. The surgical method may also have a bearing on the results. Open discectomy is based on direct visualization of decompression of the nerve root, whereas newer techniques such as microscopic and percutaneous endoscopic discectomy use indirect methods to confirm the adequacy of decompression, such as checking the free mobility of the traversing nerve root, the free mobility of the probe in the epidural space, and the removal of loose fragments which were identified on pre-operative magnetic resonance imaging (MRI) [1]. Percutaneous endoscopic discectomy allows for smaller incisions, less soft-tissue trauma, and faster recovery, resulting in greater relief of back pain and allowing an earlier return to work [4]. However, studies have shown that up to 2.8–15% of patients treated with limited discectomy using percutaneous endoscopic disc removal had residual disc material on immediate post-operative MRI examination [5]. Therefore, these techniques are subjective and dependent on the surgeon’s experience and skill and may result in inadequate decompression. Post-operatively, these patients may not experience the expected pain relief and continue to have radicular symptoms. In some patients, pain may be relieved for a short period of time, after which the same symptoms may recur, either due to re-herniation at the same level or at adjacent levels. Hence, it is very important to know the types of inefficiencies in disc removal, namely recurrence, retained, residual, and relapsed disc. Distinguishing the causes of pain after surgery can help surgeons do better pre-operative planning and make better intraoperative decisions, thereby helping them to choose a clear endpoint for decompression. This can also help patients by preventing the need for reoperation and achieving better functional outcomes after surgery. Recurrent Disc A disc recurrence is defined as a re-herniation of disc material at the previously operated level with the recurrence of similar pain after a period of relief of minimum 6 months and MRI confirmation, which may occur on the same or contralateral side (Fig. 1) [6-9]. In up to 5–15% patients, disc herniation can recur [10]. However, if stricter definition of recurrence is used, with cases restricted to recurrence at the same level and side as previous operation, the recurrence rate was found to be 2–5%. [9, 10] Risk factors for recurrence of a lumbar disc prolapse include disc degeneration, modic changes in the endplate, trauma to back, advanced age, and smoking [11] Radiological features such as increased disc height, lumbosacral transitional vertebrae, and segmental instability may also predict recurrence [4, 12]. It has been suggested that contralateral nucleus pulposus herniation may occur if the annulus on the opposite side is damaged during primary discectomy and only limited fragments are removed. In the case of a recurrent disc herniation on the opposite side, removal of the opposite annulus and disc material may damage the posterior longitudinal ligament and affect lumbar biomechanics and spinal stability. The average time between primary surgery and recurrent disc herniation symptoms was reported to be 17 ± 21 months by Eun et al. [4]. Surgical management of recurrence is debatable due to a need for high-level evidence [8]. Repeat discectomy remains the main procedure for it, with only minimal improvement often reported in the patient’s clinical condition as compared to the primary surgery [13]. There also remains risk of further instability. Therefore, many authors advocate the use of instrumented spinal fusion with repeat discectomy, despite the absence of instability at the time of recurrence [14]. Residual Disc A residual disc is defined as the disc material that remains at the symptomatic operated level after the extruded fragment has been removed and enough decompression has been achieved (Fig. 2). The residual disc material may cause painful radicular symptoms to persist post-operatively, with patients complaining of inadequate relief. Such patients require re-operation. Discectomy usually involves removal of only the herniated disc material and decompression of the nerve roots, leaving the remaining disc in situ. However, this may cause more disc material to come out and recompress or inflame the nerve roots [15]. To deal with this, Aoyama et al. used intraoperative ultrasound to differentiate between nerve roots and disc material in 30 patients. By this method, they were able to confirm the adequacy of decompression in all 30 patients and also identified residual disc material in 2 patients which they were able to remove satisfactorily [15]. However, it was found to be more useful for patients with a large surgical field undergoing procedures such as removal of spinal tumors or arachnoid cysts to check the remaining fragments [16]. In 2.8–15% of patients undergoing percutaneous endoscopic lumbar discectomy (PELD), residual disc fragments were observed on immediate post-operative MRI [5]. Although the presence of a residual disc fragment with persistent compression is a reason for reoperation, not all residual disc fragments observed on immediate post-operative MRI are symptomatic (i.e., they are clinically silent). Only 1.3% of patients with residual disc tissue had to go for repeat discectomy [17]. In a retrospective study by Baek et al., the long-term clinical outcomes of PELD patients in whom complete disc fragment removal was achieved (complete group) were compared with those in whom residual fragments were detected on post-operative MRI (residual group). Early reoperation (within the first 3 post-operative months) was performed in 3 patients in the residual group (7.9%) and 4 patients in the complete group (2.1%). They concluded that in patients with asymptomatic disc remnants, “watchful waiting” can be performed instead of immediate re-exploration [17]. Careful examination of post-operative MRI findings (within 24 h of surgery) revealed that some of the disc-like material was actually edematous tissue due to the fluid used during surgery. Therefore, analysis of T1-weighted MRI images is preferable, before taking up the patient for an unnecessary repeat surgery [18]. Retained Disc Retained disc is the one at same level where only nerve root decompression or deroofing was considered assuming that it should give symptomatic relief. Also retained disc can be dealing with two level discs where only one level disc is removed or decompressed and the other disc is kept as it assuming it will not create symptoms. (Fig. 3) In both the above mentioned scenarios, the discs which were untreated/ retained creates symptoms after a while because of worsening of disc or extrusion. Though this was thought to be uncommon, this entity is seen at many instances which is the Retained disc variation. Therefore, supervised neglect of the retained disc carries its risks. Careful clinical examination is important to differentiate retained disc from recurrence. . Conclusion: Clinical examination of the patient plays a crucial role in identifying the level of radiculopathy. Dermatomal pain in the same region after discectomy often indicates recurrence, whereas pain in an adjacent or new dermatomal distribution could be due to the retained disc. MRI findings help to confirm the pathological level and differentiate between a recurrent and retained disc. Understanding the different types of disc re-herniations is important in deciding treatment options such as physiotherapy, nerve root block, and surgical modalities.
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Parr, Allan T. "Lumbar Interlaminar Epidural Injections in Managing Chronic Low Back and Lower Extremity Pain: A Systematic Review." Pain Physician 1;12, no. 1;1 (2009): 163–88. http://dx.doi.org/10.36076/ppj.2009/12/163.
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Background: Low back pain with or without lower extremity pain is the most common problem among chronic pain disorders with significant economic, societal, and health impact. Epidural injections are one of the most commonly performed interventions in the United States in managing chronic low back pain. However the evidence is highly variable among different techniques utilized – namely interlaminar, caudal, transforaminal – and for various conditions, namely – intervertebral disc herniation, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Study Design: A systematic review of lumbar interlaminar epidural injections with or without steroids. Objective: To evaluate the effect of lumbar interlaminar epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, spinal stenosis, and chronic discogenic pain. Methods: Review of the literature and methodologic quality assessment were performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF) for therapeutic interventions. Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Results of analysis were performed for multiple conditions separately. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: The available literature included only blind epidural injections without fluoroscopy. The indicated evidence is positive (Level II-2) for short-term relief of pain of disc herniation or radiculitis utilizing blind interlaminar epidural steroid injections with lacking of evidence with Level III for long-term relief for disc herniation and radiculitis. The evidence is lacking with Level III for short and long-term relief for spinal stenosis and discogenic pain without radiculitis or disc herniation utilizing blind epidural injections. Limitations: The limitations of this study include paucity of literature, lack of quality evidence, lack of fluoroscopic procedures, and lack of applicable evidence in contemporary interventional pain management practices. Conclusion: The evidence based on this systematic review is limited for blind interlaminar epidurals in managing all types of pain except for short-term relief of pain secondary to disc herniation and radiculitis. This evidence does not represent contemporary interventional pain management practices and also the evidence may not be extrapolated to fluoroscopically directed lumbar interlaminar epidural injections. Key words: Chronic low back pain, lower extremity pain, disc herniation, radiculitis, spinal stenosis, discogenic pain, lumbar interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, epidural steroids, local anesthetic
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Lan, Weibin, Xiaomeng Wang, Xuezhao Tu, Xiunian Hu, and Haichuan Lu. "Different phylotypes of Cutibacterium acnes cause different modic changes in intervertebral disc degeneration." PLOS ONE 17, no. 7 (2022): e0270982. http://dx.doi.org/10.1371/journal.pone.0270982.
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Background The contribution of Cutibacterium acnes (C. acnes) infection to intervertebral disc degeneration (IDD) and the antibiotic therapy has evoked several controversies in recent years. While some microbiology studies report bacterial disc infection within IDD patients, others attribute the positive results to contamination during prolonged cultures. In addition to the clinical controversy, little was known about the mechanism of C. acnes-caused Modic changes (MCs) if C. acnes was the pathogenic factor. Objectives This study aimed to investigate the inflammatory mechanism of MCs induced by different phylotypes of C. acnes in patients with IDD. Methods Specimens from sixty patients undergoing microdiscectomy for disc herniation were included, C. acnes were identified by anaerobic culture, followed by biochemical and PCR-based methods. The identified species of C. acnes were respectively inoculated into the intervertebral discs of rabbits. MRI and histological change were observed. Additionally, we detected MMP expression in the rabbit model using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Results Of the 60 cases, 18 (30%) specimens were positive for C. acnes, and we identified 4 of 6 defined phylogroups: IA, IB, II and III. The rabbits that received Type IB or II strains of C. acnes showed significantly decreased T1WI and higher T2WI at eighth weeks, while strain III C. acnes resulted in hypointense signals on both T1WI and T2WI. Histological examination results showed that all of the three types of C. acnes could cause disc degeneration and endplates rupture. Moreover, endplate degeneration induced by type IB or II strains of C. acnes is related with MMP13 expression. Meanwhile, strain III C. acnes might upregulated the level of MMP3. Conclusion This study suggested that C. acnes is widespread in herniated disc tissues. Different types of C. acnes could induce different MCs by increasing MMP expression.
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Bokov, Dr Andrey. "An Analysis of Reasons for Failed Back Surgery Syndrome and Partial Results after Different Types of Surgical Lumbar Nerve Root Decompression." Pain Physician 6;14, no. 6;12 (2011): 545–57. http://dx.doi.org/10.36076/ppj.2011/14/545.
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Background: Despite the evident progress in treating vertebral column degenerative diseases, the rate of a so-called “failed back surgery syndrome” associated with pain and disability remains relatively high. However, this term has an imprecise definition and includes several different morbid conditions following spinal surgery, not all of which directly illustrate the efficacy of the applied technology; furthermore, some of them could even be irrelevant. Objective: To evaluate and systematize the reasons for persistent pain syndromes following surgical nerve root decompression. Study Design: Prospective, nonrandomized, cohort study of 138 consecutive patients with radicular pain syndromes, associated with nerve root compression caused by lumbar disc herniation, and resistant to conservative therapy for at least one month. The minimal period of follow-up was 18 months. Setting: Hospital outpatient department, Russian Federation Methods: Pre-operatively, patients were examined clinically, applying the visual analog scale (VAS), Oswestry Disability Index (ODI), magnetic resonance imaging (MRI), discography and computed tomography (CT). According to the disc herniation morphology and applied type of surgery, all participants were divided into the following groups: for those with disc extrusion or sequester, microdiscectomy was applied (n = 65); for those with disc protrusion, nucleoplasty was applied (n = 46); for those with disc extrusion, nucleoplasty was applied (n = 27). After surgery, participants were examined clinically and the VAS and ODI were applied. All those with permanent or temporary pain syndromes were examined applying MRI imaging, functional roentgenograms, and, to validate the cause of pain syndromes, different types of blocks were applied (facet joint blocks, paravertebral muscular blocks, transforaminal and caudal epidural blocks). Results: Group 1 showed a considerable rate of pain syndromes related to tissue damage during the intervention; the rates of radicular pain caused by epidural scar and myofascial pain were 12.3% and 26.1% respectively. Facet joint pain was found in 23.1% of the cases. Group 2 showed a significant rate of facet joint pain (16.9%) despite the minimally invasive intervention. The specificity of Group 3 was the very high rate of unresolved or recurred nerve root compression (63.0%); in other words, in the majority of cases, the aim of the intervention was not achieved. The results of the applied intervention were considered clinically significant if 50% pain relief on the VAS and a 40% decrease in the ODI were achieved. Limitations: This study is limited because of the loss of participants to follow-up and because it is nonrandomized; also it could be criticized because the dynamics of numeric scores were not provided. Conclusion: The results of our study show that an analysis of the reasons for failures and partial effects of applied interventions for nerve root decompression may help to understand better the efficacy of the interventions and could be helpful in improving surgical strategies, otherwise the validity of the conclusion could be limited because not all sources of residual pain illustrate the applied technology efficacy. In the majority of cases, the cause of the residual or recurrent pain can be identified, and this may open new possibilities to improve the condition of patients presenting with failed back surgery syndrome. Key words: microdiscectomy, nucleoplasty, epidural scar, facet joint pain, recurrent herniation, myofascial pain
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Guimbard Pérez, Joint Halley, Mariano Pomba, Gustavo Alejandro González, and Nicolás Ortiz. "Dispositivos interespinosos en discectomías lumbares primarias. ¿Favorecen la recurrencia de la hernia de discos? [Interspinous device in primary lumbar discectomy. Does it favor the recurrence of disc herniation?]." Revista de la Asociación Argentina de Ortopedia y Traumatología 84, no. 2 (2019): 105–11. http://dx.doi.org/10.15417/issn.1852-7434.2019.84.2.755.
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Objetivo: Evaluar si la colocación de los dispositivos interespinosos siliconados tipo DIAM favorecen una tasa más alta de recidiva de la hernia discal homolateral clínica y por imágenes comparada con la discectomía pura.Materiales y Métodos: Se realizó un estudio prospectivo, observacional, aleatorizado desde mayo de 2009 hasta mayo de 2013, en nuestro Centro. Se evaluó a 123 pacientes, 3 se perdieron en el seguimiento; l muestra incluyó 120 sujetos. Todos fueron operados por el mismo equipo quirúrgico. Se formaron dos grupos: grupo A: discectomía más colocación de dispositivo interespinoso siliconado, 30 pacientes (16 mujeres y 14 hombres), con mayor frecuencia L4-L5 (27 pacientes, 90%) y grupo B: discectomías puras, 90 pacientes (53 mujeres y 37 hombres) con más frecuencia L4 y L5 (72 pacientes, 80%).Resultados: Seis de los pacientes del grupo A (20%) tuvieron una recidiva clínica y por imágenes, y 3 (10%) fueron operados nuevamente; en el grupo B, hubo 4 recidivas discales (4,4%), uno fue operado nuevamente (1,1%). Se hallaron diferencias significativas en las tasas de recidiva y reintervención entre los grupos (p = 0,0073 y p = 0,0188, respectivamente).Conclusiones: Los beneficios de los dispositivos interespinosos para tratar el canal estrecho lumbar secundario a hernia de disco son controvertidos, pero en nuestro estudio, se halló una diferencia significativa según el grupo. Al mantener el movimiento del segmento y cambiar ligeramente las cargas fisiológicas aumentarían la tasa de recidiva discal; no obstante, son necesarios estudios con mayor evidencia científica para corroborar estas tendencias. AbstractObjective: The objective of this study was to evaluate if discectomy with placement of an interspinous silicon DIAM spacer is associated with a different rate of clinical and radiographic ipsilateral disc herniation recurrence than discectomy alone.Methods: A prospective, observational,randomized study was performed from May 2009 to May 2013 at XXXXX. Of the 123 patients included in the study, 3 were lost to follow-up, leaving 120 patients for data analysis. All patients were operated on by the same surgical team. Patients received one of two types of treatment. Group A consisted of 30 patients (16 women and 14 ment) who underwent discectomy with placement of an interspinous silicone DIAM spacer. Group B was composed of 90 patients (53 women and 37 men) who received discectomy alone.Results: Discectomy at L4-L5 was the most common level, occurring in 90% (27) Group A patients and 80% (72) Group B patients. Group A demonstrated clinical and radiographic disc herniation recurrence in 6/30 (20%) of patients. Disc herniation recurrence developed in 4/90 (4.4%) Group B patients. One patient underwent reoperation (1.1%). Both recurrence and reoperation was significantly higher in Group A (p = 0.007 and p = 0.019, respectively).Conclusions: The benefits of interespinosos devices for the treatment of the lumbar spinal stenosis secondary to herniated disc while they are controversial in the present study showed significant difference according to the Group. In this study, patients that underwent discectomy and interspinous spaceer placement had higher reoperation and recurrence rates than discectomy patients that did not receive an interspinous spacer. Interspinous spacers may increase the rate of disc herniation by maintaining movement at the level of prior disc herniation and changing the physiologic load. More studies are needed to corroborate and evaluate these trends.
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Paudel, Byapak. "Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases." January 2018 1, no. 21;1 (2018): E401—E408. http://dx.doi.org/10.36076/ppj.2018.4.e401.
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Background: Lumbar disc herniation (LDH) is being treated with limited indication by percutaneous full endoscopic lumbar discectomy. However, microscopic lumbar discectomy (MLD) is still considered as a gold standard. Objective: With the advances in spinal endoscopic instruments and surgical techniques, all LDHs have now become operable with percutaneous full endoscopic lumbar discectomy procedure. We report the results of percutaneous full endoscopic lumbar discectomy (PELD) for all patients diagnosed with LDH, including severely difficult and extremely difficult LDH cases who visited our clinic with leg pain and lower back pain. Study Design: Retrospective study of consecutive prospective patients. Setting: Spine center, Nanoori Suwon Hospital, Suwon, Korea. Methods: Electronic medical records of 98 consecutive patients (104 levels) who underwent surgery from October 2015 to May 2016, by PELD for different LDHs either by percutaneous endoscopic transforaminal lumbar discectomy (PETLD) or percutaneous endoscopic interlaminar lumbar discectomy (PEILD) approach were reviewed retrospectively. The L5-S1 level was accessed with PEILD approach and the other levels were accessed with PETLD approach. Outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), Mac Nab Criteria and endoscopic surgical success grade/score. Results: There were 75 (72.1%) men and 29 (27.9%) women patients with a mean age of 48.12 ± 15.88 years. Follow-up range from a minimum of 10 to 15 months (mean 12.77 ± 1.84 months). Most of the LDHs were located at L4-5 level. There were 76% severely difficult and extremely difficult cases. PETLD was the choice of approach in most of the cases (78 cases, 75%). VAS decreased significantly. ODI improved from preoperative 54.67 ± 7.52 to 24.50 ± 6.45 at last follow-up. 96.1% good to excellent result was obtained as per Mac Nab criteria. 98.1% of patients were managed with a successful to completely successful grade according to the endoscopic surgical success grading/ scoring. Two cases (1.9%) developed transient motor weakness. Limitation: Retrospective analysis of consecutive prospective patients. Conclusion: With more than 96% success (98.1% as per endoscopic success grading/scoring) all kinds of LDHs, including severely difficult and extremely difficult LDHs, are accessible by the PELD (PETLD and PEILD) technique. PELD can now be considered an alternative to microscopic lumbar discectomy (MLD) in the treatment of all kinds of disc herniations with the added benefits of keyhole surgery even for severely difficult and extremely difficult LDH cases. Key words: Lumbar disc herniation (LDH), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic transforaminal lumbar discectomy (PETLD), percutaneous endoscopic interlaminar discectomy (PEILD), evolution of PELD, difficult LDH, highly migrated LDH, high canal compromised LDH, revision LDH, LDH with discal cyst, calcified LDH
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Kokubo, Yasuo, Kenzo Uchida, Shigeru Kobayashi, et al. "Herniated and spondylotic intervertebral discs of the human cervical spine: histological and immunohistological findings in 500 en bloc surgical samples." Journal of Neurosurgery: Spine 9, no. 3 (2008): 285–95. http://dx.doi.org/10.3171/spi/2008/9/9/285.
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Object In this paper the authors' goal was to identify histological and immunohistochemical differences between cervical disc herniation and spondylosis. Methods A total of 500 cervical intervertebral discs were excised from 364 patients: 198 patients with disc herniation and 166 patients with spondylosis. We examined en bloc samples of endplate-ligament-disc complexes. Types of herniation and graded degrees of disc degeneration on MR images were examined histologically and immunohistochemically. Results The herniated discs showed granulation tissue, newly developed blood vessels, and massive infiltration of CD68-positive macrophages, which surrounded the herniated tissue mainly in the ruptured outer layer of the anulus fibrosus. The vascular invasion was most significant in uncontained (extruded)-type herniated discs. Chondrocytes positive for matrix metalloproteinase (MMP)–3, tumor necrosis factor (TNF)–α, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were abundant in both herniated and spondylotic discs. Free nerve fibers, positive for nerve growth factor (NGF), neurofilament 68, growth-associated protein (GAP)-43, and substance P, were strongly apparent in and around the outer layer of uncontained (extruded)-type herniated discs, with enhanced expression of NGF. The authors observed that herniated discs showed more advanced degeneration in the outer layer of the anulus fibrosus around the granulation tissue than spondylotic discs. On the other hand, spondylotic discs showed more advanced degeneration in the cartilaginous endplate and inner layer of the anulus fibrosus than herniated discs. Spondylotic discs also had thicker bony endplates and expressed TNFα and MMP-3 more diffusely than herniated discs, especially in the inner layer of the anulus fibrosus. Conclusions The authors' results indicate that herniated and spondylotic intervertebral discs undergo different degenerative processes. It is likely that TNFα, MMP-3, bFGF, and VEGF expression is upregulated via the herniated mass in the herniated intervertebral discs, but by nutritional impairment in the spondylotic discs. Macrophage accumulation around newly formed blood vessels in the herniated disc tissues seemed to be regulated by MMP-3 and TNFα expression, and both herniated and spondylotic discs exhibited marked neoangiogenesis associated with increased bFGF and VEGF expression. Nerve fibers were associated with NGF overexpression in the outer layer of the anulus fibrosus as well as in endothelial cells of the small blood vessels.
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Oshita, Yusuke, Daisuke Matsuyama, Daisuke Sakai, et al. "Multicenter Retrospective Analysis of Intradiscal Condoliase Injection Therapy for Lumbar Disc Herniation." Medicina 58, no. 9 (2022): 1284. http://dx.doi.org/10.3390/medicina58091284.
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Background and Objectives: Intradiscal injection of Condoliase (chondroitin sulfate ABC endolyase), a glycosaminoglycan-degrading enzyme, is employed as a minimally invasive treatment for lumbar disc herniation (LDH) and represents a promising option between conservative treatment and surgical intervention. Since its 2018 approval in Japan, multiple single-site trails have highlighted its effectiveness, however, the effect of LDH types, and influences of patient age, sex, etc., on treatment success remains unclear. Moreover, data on teenagers and elderly patients has not been reported. In this retrospective multi-center study, we sought to classify prognostic factors for successful condoliase treatment for LDH and assess its effect on patients < 20 and ≥70 years old. Materials and Methods: We reviewed the records of 137 LDH patients treated through condoliase at four Japanese institutions and assessed its effectiveness among different age categories on alleviation of visual analog scale (VAS) of leg pain, low back pain and numbness, as well as ODI and JOA scores. Moreover, we divided them into either a “group-A” category if a ≥50% improvement in baseline leg pain VAS was observed or “group-N” if VAS leg pain improved <50%. Next, we assessed the differences in clinical and demographic distribution between group-A and group-N. Results: Fifty-five patients were classified as group-A (77.5%) and 16 patients were allocated to group-N (22.5%). A significant difference in Pfirrmann classification was found between both cohorts, with grade IV suggested to be most receptive. A posterior disc angle > 5° was also found to approach statical significance. In all age groups, average VAS scores showed improvement. However, 75% of adolescent patients showed deterioration in Pfirrmann classification following treatment. Conclusions: Intradiscal condoliase injection is an effective treatment for LDH, even in patients with large vertebral translation and posterior disc angles, regardless of age. However, since condoliase imposes a risk of progressing disc degeneration, its indication for younger patients remains controversial.
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Moon, Sang Ho, Jun Young Park, Seong-Sik Cho, et al. "Comparative effectiveness of percutaneous epidural adhesiolysis for different sacrum types in patients with chronic pain due to lumbar disc herniation." Medicine 95, no. 37 (2016): e4647. http://dx.doi.org/10.1097/md.0000000000004647.
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Shi, Zhen, Pengfei Li, Wentao Wu, Yunduo Jiang, and Yansong Wang. "Analysis of the Efficacy of Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation with Different Types/Grades of Modic Changes." Journal of Pain Research Volume 16 (June 2023): 1927–40. http://dx.doi.org/10.2147/jpr.s403266.
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Tan, Hongping, Jing Zhou, Yijin Pu, Lin He, and Liu Wang. "Efficacy of Selective Nerve Root Block for Different Types of Lumbar Disc Herniation: Study Protocol for a Single-Blind, Prospective Cohort Study." Journal of Pain Research Volume 18 (February 2025): 1035–43. https://doi.org/10.2147/jpr.s494496.
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Feng, Xiangyu, Sunqi Nian, Jiayu Chen, Na Li, and Pingguo Duan. "Modic changes in patients with lumbar disc herniation followed more than 1 year after lumbar discectomy: a systematic review and meta-analysis." PeerJ 12 (August 7, 2024): e17851. http://dx.doi.org/10.7717/peerj.17851.
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Background Modic changes (MCs) are identified as an independent risk factor for low back pain. Different subtypes of MCs vary in their impact on postoperative pain relief. However, consensus on the transformation of postoperative MC fractions in patients with distinct MC subtypes is lacking. Methods This comprehensive systematic review and meta-analysis searched English-language articles in PubMed, Cochrane Library, Web of Science, and Embase databases until January 2024. Studies included focused on patients transitioning between various microcrack subtypes post-discectomy. The primary outcome measure was the transformation between different postoperative microcrack fractions. Results Eight studies with 689 participants were analyzed. Overall, there is moderate to high-quality evidence indicating differences in the incidence of MC conversion across MC subtypes. The overall incidence of MC conversion was 27.7%, with rates of 37.0%, 20.5%, and 19.1% for MC0, MC1, and MC2 subtypes, respectively. Thus, postoperative MC type transformation, particularly from preoperative MC0 to MC1 (17.7%) or MC2 (13.1%), was more common, with MC1 transformation being predominant. Patients with preoperative comorbid MC1 types (19.0%) exhibited more postoperative transitions than those with MC2 types (12.4%). Conclusion This study underscores the significance of analyzing post-discectomy MCs in patients with lumbar disc herniation, revealing a higher incidence of MCs post-lumbar discectomy, particularly from preoperative absence of MC to MC1 or MC2. Preoperative MC0 types were more likely to undergo postoperative MC transformation than combined MC1 or MC2 types. These findings are crucial for enhancing surgical outcomes and postoperative care.
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Li, Jingchi, Wenqiang Xu, Qingfeng Jiang, et al. "Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis." BioMed Research International 2020 (February 7, 2020): 1–13. http://dx.doi.org/10.1155/2020/2960642.
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Background. Translaminar percutaneous endoscopic discectomy (PED) was used widely in the treatment of lumbar disc herniation (LDH), especially for the training of novice surgeons. A larger range of osteotomy was a suitable method to get enough operation space and reduce intraoperative risks. But osteotomy, especially facetectomy, may be associated with the biomechanical deterioration and resulting adjacent segment diseases (ASD). Hence, the objects of this study were to investigate whether different levels of surgical experience in performing different ranges of osteotomy (especially facetectomy) affected the risk for ASD and to identify the safe indications for the training of PED novice surgeons. Study Design. In this study, a three-dimensional lumbosacral model was constructed and validated. Corresponding translaminar PED models with different ranges of osteotomy for armpit, periradicular, and shoulder types of LDH were constructed. The von Mises stress on the endplates, the shear stress on the annulus, the intradiscal pressure, and the range of motion (ROM) in the L3-L4 segment disc were computed. Results. Computational results in our well-validated model indicated that large ranges of osteotomy led to deterioration in most of the biomechanical indicators, and this trend was most significant in the shoulder-type LDH model. Conclusions. To ensure the appropriateness of the surgical prognosis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded from such indications until novices can perform PED within a relatively small range of osteotomy. Mini Abstract. Based on biomechanical variations in our finite element analysis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded until novices can perform PED within a relatively small range of osteotomy.
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Terbetas, Gunaras, and Aurelija Vaitkuvienė. "Perkutaninė lazerinė liumbalinio tarpslankstelinio disko dekompresija." Lietuvos chirurgija 7, no. 1-2 (2009): 0. http://dx.doi.org/10.15388/lietchirur.2009.1.2139.
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Gunaras Terbetas1, Aurelija Vaitkuvienė21 Vilniaus universiteto Medicinos fakulteto Neurologijos ir neurochirurgijos klinika,Šiltnamių g. 29, LT-04130 Vilnius2 Vilniaus universiteto Medžiagotyros ir taikomųjų mokslų institutas,Saulėtekio al. 9-III, 3, LT-10222 VilniusEl paštas: terbetas@gmail.com Įžanga Tarpslankstelinio disko išvarža yra dažna juosmens ir radikulopatinio kojos skausmo priežastis. Daugeliu atvejų tarpslankstelinio disko išvaržos sukeltų simptomų natūrali eiga yra gerybinė dėl disko išvaržos spontaninės rezorbcijos. Dauguma disko išvaržas turinčių pacientų sveiksta taikant konservatyvų gydymą. Jei konservatyvus gydymas nesukelia pagerėjimo, pacientus tenka operuoti. Šiame straipsnyje pristatomas naujas Lietuvoje disko išvaržos chirurginio gydymo būdas – perkutaninė lazerinė disko dekompresija (PLDD). Pacientai ir metodai Nuo 2007 m. gegužės iki 2009 m. birželio 20 pacientų atrinkta PLDD operacijai. Skausmo intensyvumas prieš operaciją įvertintas pagal VAS (Visual Assessment Analogue Scale) skalę, gyvenimo kokybė ir neįgalumo laipsnis – pagal ODI (Oswestry Disability Index) klausimyną. VAS skausmo indeksas prieš operaciją buvo nuo 3 iki 7 balų esant ramybės būsenos (vid. – 5,0), judesio metu – nuo 5 iki 9 balų (vid. – 6,75). ODI neįgalumo indeksas nuo 20% iki 60% (vid. – 47,5%). Atliktos 24 PLDD operacijos, naudota vietinė nejautra ir rentgenoskopo kontrolė. Pooperacinis įvertinimas atliktas praėjus 2 ir 6 mėn. po operacijos. Rezultatai Geras, ilgai trunkantis efektas buvo 14 pacientų (70%). Po 6 mėn. – VAS esant ramybės būsenos svyravo nuo 1 iki 5 (vid. – 1,75), judesio metu nuo 1 iki 7 balų (vid. – 2,6). Vidutinis VAS kritimas: esant ramybės būsenos – 3,25; judesio metu – 4,15. ODI po 6 mėn. nuo 2% iki 48% (vid. ODI – 18,8%); vidutinis ODI kritimas – 28,7%. Išvados Disko išvaržos chirurginio gydymo kriterijai galutinai nėra nustatyti, tebevyksta diskusija apie chirurginio gydymo privalumus ir trūkumus. Disko išvaržos chirurginis gydymas sukelia greitesnį simptomų regresą, po jo greitesnė reabilitacija, greičiau pavyksta atkurti darbingumą, bet yra vėlyvų komplikacijų rizika. Perkutaninė lazerinė disko dekompresija pastaruoju metu pripažįstama esanti efektyvus, minimaliai invazyvus chirurginis disko išvaržos gydymo būdas, taikytinas kai kurioms disko išvaržoms. Atvira disko išvaržos operacija (mikrodiskektomija) ir PLDD neturėtų būti vertinami kaip du alternatyvūs metodai gydyti tą patį pacientą, nes įtraukimo PLDD ir atvirai operacijai kriterijai skiriasi. Gydymo metodo pasirinkimą lemia išvaržos morfologija, nustatoma MRT tyrimu. Abu metodai turėtų būti prieinami ir gyvuoti greta ligoninėse, kur operuojama stuburo patologija. Ligoniai, turintys disko sekvestrą, pratrūkusią disko išvaržą ar masyvią subligamentinę disko išvaržą, turėtų būti operuojami atvira operacija; ligoniai, kurių disko išvarža nepratrūkusi, nesukelia didelės nervinės šaknelės kompresijos, turėtų būti operuojami minimaliai invaziniais intradiskiniais metodais (PLDD). Reikšminiai žodžiai: tarpslankstelinio disko išvarža, juosmens skausmai, lazerinė chirurgija Percutaneous lazer lumbar disc decompression Gunaras Terbetas1, Aurelija Vaitkuvienė21 Clinic of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University,Šiltnamių str. 29, Vilnius LT-04130, Lithuania2 Institute of Materials Science and Applied Research, Vilnius University,Saulėtekio al. 9-III, 3, Vilnius LT-10222, LithuaniaE-mail: terbetas@gmail.com Background Lumbar disc hernia (LDH) is a common cause of low back pain and radicular leg pain. The natural course of lumbar disc hernia-induced symptoms is benign in many cases because of spontaneous resorption of herniated nucleus pulposus. It is well known that the majority of LDH patients recover spontaneously; others will require surgery after failure of conservative treatment. Here we present new in Lithuania surgical treatment method for intervertebral disc hernia- Percutaneous Laser Disc Decompression (PLDD). Material and Methods During the period from 2007 May to 2009 June, 20 patients have been selected to be operated on disc herniation by means of Percutaneous Laser Disc Decompression (PLDD). All patients preoperatively were evaluated by Visual Assessment Analogue Scale (VAS) and Oswestry Disability Index (ODI). VAS pain index preoperatively ranged from 3 to 7 points at rest (mean- 5.0 points), to 5-9 points at movement (mean-6.75 points). ODI preoperatively ranged from 20% to 60% (mean 47.5%). 24 PLDD procedures were performed under local anesthesia, using C-arm control. Post operative evaluation was made at 2 and 6 months. Results 14 patients (70%) experienced long lasting relief of their symptoms. At 6 month follow-up VAS score ranged from 1 to 5 at rest (mean 1.75), at movement range was from 1 to 7 (mean 2.6 points). Mean VAS drop was 3.25 points at resting state, and 4.15 points at movement. ODI at 6 month follow-up ranged from 2% to 48%, mean being 18.8%. Mean ODI drop was 28.7%. Conclusions There is ongoing discussion about disc herniation surgery. Surgical treatment provides faster rehabilitation and faster decrease of symptoms, but has a certain danger of late complications. Percutaneous Laser Disc Decompression (PLDD) has been recently accepted as effective surgical intervention on certain types of disc herniation. Open microdiscectomy and PLDD should not be compared as two different ways of treating the same patient because inclusion criteria for both methods differ due to morphology of disc herniation on MRI. Patients having sequestration, transligamentous or extensive subligamentous extrusion should go for open surgery; patients having moderate or mild protrusion of intervertebral disc with no obvious compression of nerve roots should go for PLDD. Key words: Intervertebral disc hernia, low back pain, laser surgery
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Chang, Chih-Chang, Jau-Ching Wu, Peng-Yuan Chang, et al. "Stepwise illustration of teeth-fixation semi-constrained cervical disc arthroplasty." Neurosurgical Focus 42, videosuppl1 (2017): V4. http://dx.doi.org/10.3171/2017.1.focusvid.16389.
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There are many kinds of artificial discs available for cervical disc arthroplasty (CDA), with various designs of fixation and articulation mechanisms. Each of these designs has different features and theoretically fits most optimally in selected types of patients. However, there has been insufficient literature to guide individualized selection among these CDA devices. Since CDA aims to restore the joint function rather than arthrodesis, tailor-made size, shape, and mechanical properties should be taken into account for each candidate's target disc. Despite several large-scale prospective randomized control trials that have demonstrated the effectiveness and durability of CDA for up to 8 years, none of them involved more than one kind of artificial disc. In this video the authors present detailed steps and technical aspects of the newly introduced ProDisc-C Vivo (DePuy Synthes Spine), which has the same ball-and-socket design for controlled, predictable motion as the ProDisc-C. The newly derived teeth fixation provides high primary stability and multilevel capability by avoidance of previous keel-related limitations and complications (e.g., split vertebral fracture). Please note that the ProDisc-C Vivo is currently not available on the US market.The authors present the case of a 53-year-old woman who had symptoms of both radiculopathy and myelopathy caused by a large, calcified disc herniation at C4–5. There was no improvement after 4 months of medical treatment and rehabilitation. A single-level CDA was successfully performed with the ProDisc-C Vivo, and her symptoms were completely ameliorated afterward. The follow-up images demonstrated preservation of motion at the indexed level.The video can be found here: https://youtu.be/4DSES1xgvQU.
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Anjum, Humaira, Mahnoor Rehman Khan, Sadaf Naveed, Samia Ifthikhar, and Humna Imdad. "THE RELATIONSHIP OF AGE AND GENDER WITH LUMBAR SPINE DEGENERATIVE CHANGES IN PATIENTS WITH LOW BACK PAIN." Khyber Journal of Medical Sciences 17, no. 1 (2024): 9–16. https://doi.org/10.70520/kjms.v17i1.471.
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Objective: To evaluate the prevalence of various types of degenerative changes and to assess the relationship between the degenerative changes with age and gender of patients presenting with low back pain. Methods: A retrospective cross-sectional observational study was conducted on patients who presented with LBP to the Radiology Department of Khyber Teaching Hospital Peshawar from June 2017 to May 2018 for a lumbosacral spine MRI. Frequencies and distribution of Pfirrman grading, Modic changes, disc herniation, and annulus tear were assessed. Additionally, their association with the age and gender of the patient was assessed by regression analysis. Statistical analysis was done using SPSS 23 software. Results: 163 MRI lumbar spine of patients between 30 and 90 years were included in our study. The mean age of patients was 46.88 with a 12.136 standard deviation. 83 patients were male (50.9%) and 80 (49.1%) were female. Age has a significant association with Pfirrman grading at L2-L3 to L5-S1 level (p-value <0.01). The proportion of degenerated segments also increased with increasing age. The greatest number of Modic changes were seen in the age range of 61-70 years (38.2%). Most annulus tears were seen at L4-L5 levels followed by L3-L4. 19% of males had annulus tears while 23.3% of females had annulus tears. The most disc bulges were seen in 31-40 years (n=155) followed by 41-50 years(n=75). Conclusion: Endplate changes and disc degenerative changes are associated with increasing age. Degenerative changes in the lumbar spine are not statistically different in male and female populations.
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Azemi, Edona Sopaj, Sandër Kola, Irena Kola, Marjeta Tanka, Fatmir Bilaj, and Erjona Abazaj. "Lumbar Disk Herniation: A Clinical Epidemiological and Radiological Evaluation." Open Access Macedonian Journal of Medical Sciences 10, B (2022): 1588–94. http://dx.doi.org/10.3889/oamjms.2022.8828.
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BACKGROUND: A herniated disc in the spine is a condition during which a nucleus pulposus is displaced from intervertebral space. AIM: The study aimed to investigate and observe variation of clinical, epidemiological, and radiological aspects for patients suspected of lumbar herniation based on observed evaluation of CT and MRI imagery. METHODS: This is a cross-sectional study conducted during the periods March 2015 and November 2019. Patients were subjected to MRI and CT based on the emergency or scheduled of diagnose. All MRI scans were obtained with 1.5 tesla MRI machine and for CT had undergone examinations with one of the following equipment: Siemens with 128 slice and Phillips 64 slice. The patients were placed in supine position. RESULTS: Overall 194 symptomatic patients were recruited as a participant in this study, 118 men and 76 women with an average age of 44.9 ±10.4 years. Patients belong to the active age (35–44-years-old and 45–54-years-old) appeared to have the highest percentage of lumbar disk herniation (LDH) 30.9% and 25.8%, respectively. There were a significant association between such as epidemiological data (such as gender, BMI, age groups, and employment status) and presence of LDH, p ˂ 0.05. Acute pain was presented in 69.07% of patients and according to complaint associated with low back pain (LBP), most of them 47.4% appeared with Right Sciatica. MRI is the most diagnostic methods used in evaluation of LDH in 52% of patients, and CT was used in 48% of them. The most common changes were between L2-L3, L3-L4, and L4-L5. Furthermore, the grading findings which corresponding to lumbosacral segment were Grade I and Grade II. Grade V was less common. CONCLUSION: This study involving patients with lumbar disk herniation and associated LBP showed that a combination of clinical features and epidemiological predicted the presence or absence of a significant association. Further research is required to validate these findings in different types of LDH and LBP for other findings and conditions.
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Chehrassan, Mohammadreza, Farshad Nikouei, Mohammadreza Shakeri, et al. "The effect of cage type on local and total cervical lordosis restoration and global spine alignment in single-level anterior cervical discectomy and fusion based on EOS® imaging: A comparison between standalone conventional interbody polyether ether ketone cage and integrated cage and plate (Perfect-C®)." Journal of Craniovertebral Junction and Spine 14, no. 4 (2023): 399–403. http://dx.doi.org/10.4103/jcvjs.jcvjs_108_23.
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Background: There is a small level of evidence regarding the alterations in global spine alignment following the restoration of cervical lordosis using anterior cervical discectomy and fusion (ACDF). Different cage types are available to restore cervical lordosis through ACDF. In this study, we evaluate the impact of two types of these cages on local and global spine alignments. Patients and Methods: Thirty-two patients with a mean age of 46 ± 10 who underwent ACDF for cervical disc herniation were included in this retrospective study. Patients were divided according to their cage type into two groups, 17 patients with standalone conventional polyether ether ketone cages and 15 patients with integrated cage and plate (ICP) (Perfect-C®). Cervical alignment and global spine alignment were evaluated on the pre- and post-operative EOS® images. Results: Three months after the ACDF, total cervical lordosis correction was higher in patients with ICP (P = 0.001), while the local cervical lordosis correction was not significantly different between conventional cages and prefect-C cages (P = 0.067). Lumbar lordosis and pelvic tilt change were significantly higher among patients with Perfect-c cages (P = 0.043). Conclusion: In patients undergoing ACDF, alignment of the global spine changes along with the restoration of the cervical spine. Cage type affects this association, mainly through the compensatory alteration of pelvic tilt.
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Kuai, Shengzheng, Xinyu Guan, Weiqiang Liu, et al. "Prediction of the Spinal Musculoskeletal Loadings during Level Walking and Stair Climbing after Two Types of Simulated Interventions in Patients with Lumbar Disc Herniation." Journal of Healthcare Engineering 2019 (December 18, 2019): 1–11. http://dx.doi.org/10.1155/2019/6406813.
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Background. Low back pain (LBP) continues to be a severe global healthy problem, and a lot of patients would undergo conservative or surgical treatments. However, the improving capacity of spinal load sharing during activities of daily living (ADLs) after interventions is largely unknown. The objective of this study was to quantitatively predict the improvement of spinal musculoskeletal loadings during level walking and stair climbing after two simulated interventions. Material and Methods. Twenty-six healthy adults and seven lumbar disc herniation patients performed level walking and stair climbing in sequence. The spinal movement was recorded using a motion capture system. The experimental data were applied to drive a musculoskeletal model to calculate all the lumbar joint resultant forces and muscle activities of seventeen main trunk muscle groups. Rehabilitation and reconstruction were selected as the representative of conservative and surgical treatment, respectively. The spinal load sharing after rehabilitation and reconstruction was predicted by replacing the patients’ spine rhythm with healthy subjects’ spine rhythm and altering the center of rotation at the L5S1 level, respectively. Results. During both level walking and stair climbing, the joint resultant forces of the lower lumbar intervertebral discs were predicted to reduce after the two simulated inventions. In addition, the maximum muscle activities of the most trunk muscle groups decreased after simulated rehabilitation and conversely increased after simulated reconstruction. Conclusion. The predictions revealed the different compensatory responses on the spinal load sharing after two simulated interventions, severing as guidance for making preoperative planning and rehabilitation planning.
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Munawar, Saira, Aliya Zahid, Tahira Athar, G. P. William, and Qurat Ul Ain. "Incidence of Sacralization of 5th Lumbar and First Coccygeal Vertebrae: An Osteological Study on Dried Sacra of Pakistani Population." Journal of Fatima Jinnah Medical University 18, no. 3 (2024): 138–43. https://doi.org/10.37018/agfp1467.
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Background: Sacralization can occur when the fifth lumbar or the first coccygeal vertebra fuses with the sacrum. Given the increasing incidence of lower back pain and its impact on human health and wellbeing, understanding the etiology of sacralization is important. The study aimed to estimate the incidence of sacralization of the fifth lumbar and first coccygeal vertebrae in the sacrum and to define the types of sacralization observed in the cadaveric sacra. Methods: A descriptive study was done on 285 adult human dry sacra from bone bank of Fatima Jinnah Medical University and Rashid Latif Medical College in Lahore, Pakistan. The study involved examining the number of vertebral segments and sacral foramina and classifying the sacra into different types. We also calculated the sacral index and measured the length and width of these sacra. Result: Out of the sample, 68% of sacra were typical, while sacralization was observed in 32% of cases. Among the sacralized sacra, 70 % were fused with the fifth lumbar vertebra (L5) and 30% were fused with the first coccygeal vertebra. The incidence of sacralization was similar in both genders. Conclusion: Sacralization is common and can be asymptomatic or associated with low back pain, disc degeneration/ herniation, scoliosis, and spondylolisthesis. Surgeons, anesthetists, obstetricians, and physicians can benefit from this knowledge to treat a wide range of patients.
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Guo, Jianwei. "Comparison of Percutaneous Endoscopic Transforaminal and Interlaminar Approaches in Treating Adjacent Segment Disease Following Lumbar Decompression Surgery: A Clinical Retrospective Study." Pain Physician Journal 26, no. 7 (2023): E833—E842. http://dx.doi.org/10.36076/ppj.2023.26.e833.
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BACKGROUND: Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery (PELD) has been used to treat ASD through either a transforaminal or interlaminar approach. However, to our limited knowledge there are no reports comparing the 2 approaches for treating ASD. OBJECTIVE: To evaluate clinical outcomes of PELD in treating ASD and comparing the surgical results and complications between the 2 approaches. This may be helpful for spinal surgeons when decision-making ASD treatment. STUDY DESIGN: A clinical retrospective study. SETTING: This study was conducted at the Department of Orthopedics of the Affiliated Hospital of Qingdao University. METHODS: From January 2015 through December 2019, a total of 68 patients with ASD who underwent PELD after lumbar posterior decompression with fusion surgery were included in this study. The patients were divided into a percutaneous endoscopic transforaminal decompression (PETD) group and a percutaneous endoscopic interlaminar decompression (PEID) group according to the approach used. The demographic characteristics, radiographic and clinical outcomes, and complications were recorded in both groups through a chart review. RESULTS: Of the 68 patients, 40 underwent PEID and 28 patients underwent PETD. Compared with their preoperative Visual Analog Scale (VAS) pain score and Oswestry Disability Index (ODI) score, all patients had significant postoperative improvement at 3 months, 6 months, one year and at the latest follow-up. There were no significant statistical differences in the VAS and ODI scores between PETD and PEID groups with a P value > 0.05. There was a significant statistical difference in the average fluoroscopy times between the PETD and PEID groups with a P value = 0.000. Revision surgery occurred in 8 patients: 6 patients who underwent PETD and 2 patients who underwent PEID. The revision rate showed a significant statistical difference between the 2 approaches with a P value = 0.039. LIMITATIONS: Firstly, the number of patients included in this study was small. More patients are needed in a further study. Secondly, the follow-up time was limited in this study. There is still no conclusion about whether the primary decompression with instruments will increase the reoperation rate after a PELD, and a longer follow-up is needed in the future. Thirdly, this study was a clinical retrospective study. Randomized or controlled trials are needed in the future in order to achieve a higher level of evidence. Fourthly, there were debates about PELD approach choices for ASDs, which may affect the comparison results between PETD and PEID. In our study, the approaches were mainly determined by the level and types of disc herniation, and the surgeons’ preference. More patients with an ASD with different levels and types of disc herniation and surgical approaches are needed in the future to eliminate these biases. CONCLUSION: Percutaneous endoscopic lumbar decompression surgery is a feasible option for ASD following lumbar decompression surgery with instruments. Compared with PETD, PEID seems to be a better approach to treat symptomatic ASDs. KEY WORDS: Lumbar degenerative disease, adjacent segment disease, percutaneous endoscopic lumbar decompression surgery, outcome
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Bai, Jinzhu. "Novel Physical Examination Tests for the Diagnosis of Chronic Sacroiliac Joint Dysfunction and Differentiate It From Lumbar Disc Herniation." Pain Physician Journal 26, no. 3 (2023): 289–98. http://dx.doi.org/10.36076/ppj.2023.26.289.
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BACKGROUND: Traditional sacroiliac joint (SIJ) provocation tests have been used to diagnose SIJ pain. However, this can simply be changed to chronic SIJ dysfunction (cSIJD) manifests as mechanical changes in the pelvis and lower extremities in addition to pain. A novel composite of physical examinations based on the iliac pronation, pubic tubercle tenderness, and plantar fascia tenderness tests (IPP triple tests) was designed for the diagnosis of cSIJD. OBJECTIVES: To evaluate IPP triple tests in the diagnosis of cSIJD and differential diagnosis from lumbar disc herniation (LDH) in comparison with traditional provocation tests. STUDY DESIGN: Prospective single-blind controlled study. SETTING: This study was conducted at the Department of Spine and Spinal Cord Surgery of China Rehabilitation Research Center in Beijing, China. METHODS: One hundred and sixty-six patients were assigned into the cSIJD group, LDH group, or healthy control group. The cSIJD diagnosis was confirmed by SIJ injection. The diagnosis of LDH was confirmed according to the 2014 North American Spine Association diagnosis and treatment guidelines for LDH. All patients were examined with IPP triple tests and traditional provocation tests. The sensitivity, specificity, positive and negative likelihood ratios, and areas under the curve (AUCs) were used to evaluate the diagnostic accuracy of the composites or single of the IPP triple tests, and traditional provocation tests. The Delong’s test was used for the comparison among AUCs. The kappa analysis was used for the IPP triple tests and traditional provocation tests compared with the reference standard (REF). The independent t test and chi-square test were used to analyze the influence factors (i.e., age, gender), and group on diagnostic accuracy. RESULTS: There was no statistical difference in gender (chi-squared = 0.282, P = 0.596) and age (F = 0.096, P = 0.757) between the 3 groups. The AUC of the iliac pronation test was 0.903 when it was used alone; the AUC of the novel composites of the IPP triple tests was 0.868 (95% confidence interval [CI] = 0.802-0.919); and the diagnostic accuracy of the traditional provocation test was relatively low (AUC = 0.597, 95% CI = 0.512-0.678). The diagnostic accuracy of the IPP triple tests was higher than that of the traditional provocation test, P < 0.05. Kappa consistency comparison showed that the kappa value between the IPP triple tests and the REF was 0.229, the kappa between the traditional provocation test and the REF was 0.052. The age of the patients with inaccurate diagnosis was higher than that of the patients with accurate diagnosis in both methods (traditional tests, P = 0.599; IPP:P = 0.553). Different types of diseases (groups) affect the accuracy of diagnosis, the proportion of inaccuracy of traditional provocation tests was higher than that of the IPP triple tests (77.8% vs 23.6%) in cSIJD, while the 2 methods have high differential diagnostic accuracy in LDH (96.77%) and control groups (97.56%). LIMITATIONS: Small size of LDH patients and differences in physical tests among examiners. CONCLUSIONS: The novel composites of IPP triple tests have higher accuracy than the traditional provocation tests in diagnosing cSIJD and both have good accuracy in differentiating cSIJD from LDH. IPP triple tests may be an alternative physical examination for clinical screening of cSIJD. KEY WORDS: Sacroiliac joint dysfunction, low back pain, lumbar disc herniation, provocation test, physical examination, kinematics
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Lee, Seungcheol, Ji Hoon Kang, Umesh Srikantha, Il-Tae Jang, and Sung-Hun Oh. "Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome." Journal of Neurosurgery: Spine 20, no. 4 (2014): 371–79. http://dx.doi.org/10.3171/2013.12.spine12629.
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Object Extraforaminal compression of the L-5 nerve encompasses multiple pathological entities and may result from disc herniations as well as bony (osteophytes or sacral ala) or ligamentous (sacroiliac ligament and lumbosacral band) compression. Several other factors, such as disc space collapse or coronal wedging, can also contribute to narrowing of the extraforaminal space. The extraforaminal space at L5–S1 has unique anatomical features compared with the upper lumbar levels, which makes surgical access to this region difficult. Minimally invasive techniques offer easier access to the region. The purpose of this study was to analyze the contributing factors for extraforaminal compression of the L-5 nerve and assess clinical outcome following surgical decompression. Methods Fifty-two consecutive patients who underwent a minimally invasive far-lateral approach for extraforaminal compression of the L-5 nerve were retrospectively analyzed for clinical data, outcomes, and imaging features (type of disc prolapse, coronal wedging, degree of disc and facet degeneration, facet tropism, foraminal stenosis, osteophytes, and adjacent-level disease). The authors describe the surgical technique used in this study. Results The mean age of the patient sample was 57 years. Sixteen patients each had an extraforaminal ruptured disc or contained protrusion, and the remaining 20 patients had disc protrusions extending into the foraminal region or the lateral recess. Associated foraminal stenosis was found in 38.5%, and adjacent-level stenosis was noted in 22 cases (42.3%) and spondylolisthesis in 4 (7.7%). Osteophytes were noted in 18 cases. A coronal wedging angle ≥ 3° was found in 46.2%, and the laterality of wedging corresponded to the symptomatic side in 91% of cases. Fifteen patients (28.8%) complained of postoperative dysesthesias, which completely resolved in all cases within 6 months. The incidence of dysesthesias was more common in the ruptured disc group. There were no differences in clinical outcome among the different types of disc prolapses. The mean preoperative and postoperative visual analog scale scores were 7.6 and 3.6, respectively. The mean preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were 6.4 and 13.8, respectively. The mean JOA recovery rate was 86.1%. According to the Macnab functional grading system, 96% of the patients had excellent or good grades at follow-up. Conclusions A minimally invasive far-lateral approach to L5–S1 requires a good understanding of the regional anatomy and can provide good to excellent clinical results in properly selected cases. This approach is effective in decompressing the far-lateral and foraminal zones. Adequate preoperative diagnosis and tailoring the surgical procedure to address the relevant compressive element in each case is essential to achieving good clinical results.
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Staartjes, Victor E., Anita M. Klukowska, Moira Vieli, et al. "Machine learning–augmented objective functional testing in the degenerative spine: quantifying impairment using patient-specific five-repetition sit-to-stand assessment." Neurosurgical Focus 51, no. 5 (2021): E8. http://dx.doi.org/10.3171/2021.8.focus21386.
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OBJECTIVE What is considered “abnormal” in clinical testing is typically defined by simple thresholds derived from normative data. For instance, when testing using the five-repetition sit-to-stand (5R-STS) test, the upper limit of normal (ULN) from a population of spine-healthy volunteers (10.5 seconds) is used to identify objective functional impairment (OFI), but this fails to consider different properties of individuals (e.g., taller and shorter, older and younger). Therefore, the authors developed a personalized testing strategy to quantify patient-specific OFI using machine learning. METHODS Patients with disc herniation, spinal stenosis, spondylolisthesis, or discogenic chronic low-back pain and a population of spine-healthy volunteers, from two prospective studies, were included. A machine learning model was trained on normative data to predict personalized “expected” test times and their confidence intervals and ULNs (99th percentiles) based on simple demographics. OFI was defined as a test time greater than the personalized ULN. OFI was categorized into types 1 to 3 based on a clustering algorithm. A web app was developed to deploy the model clinically. RESULTS Overall, 288 patients and 129 spine-healthy individuals were included. The model predicted “expected” test times with a mean absolute error of 1.18 (95% CI 1.13–1.21) seconds and R2 of 0.37 (95% CI 0.34–0.41). Based on the implemented personalized testing strategy, 191 patients (66.3%) exhibited OFI. Type 1, 2, and 3 impairments were seen in 64 (33.5%), 91 (47.6%), and 36 (18.8%) patients, respectively. Increasing detected levels of OFI were associated with statistically significant increases in subjective functional impairment, extreme anxiety and depression symptoms, being bedridden, extreme pain or discomfort, inability to carry out activities of daily living, and a limited ability to work. CONCLUSIONS In the era of “precision medicine,” simple population-based thresholds may eventually not be adequate to monitor quality and safety in neurosurgery. Individualized assessment integrating machine learning techniques provides more detailed and objective clinical assessment. The personalized testing strategy demonstrated concurrent validity with quality-of-life measures, and the freely accessible web app (https://neurosurgery.shinyapps.io/5RSTS/) enabled clinical application.
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Kim, Young-Ki, Dongmug Kang, Ilho Lee, and Se-Yeong Kim. "Differences in the Incidence of Symptomatic Cervical and Lumbar Disc Herniation According to Age, Sex and National Health Insurance Eligibility: A Pilot Study on the Disease’s Association with Work." International Journal of Environmental Research and Public Health 15, no. 10 (2018): 2094. http://dx.doi.org/10.3390/ijerph15102094.
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The aim of this research was to identify the differences in the incidence of symptomatic cervical and lumbar disc herniation according to age, sex, and national health insurance eligibility. We evaluated the hospital documents of patients who received medical treatment for symptomatic cervical and lumbar disc herniation between 2004 and 2010 and excluded those who claimed to have expenses at oriental medical clinics or pharmacies. Furthermore, any duplicate documents from the labor force population aged 20–69 years were excluded from the analysis. The results showed that the number of individuals diagnosed with symptomatic cervical and lumbar disc herniation increased with age, and the incidence of these diseases was higher in women than in men. Additionally, the incidence differed depending on the subject’s qualification for health insurance. The incidence of lumbar disc herniation showed differences depending on the degree of the lumbar burden. The present study findings may help determine whether lumbar disc herniation is associated with tasks performed at the patient’s workplace. Further research is needed to classify the risk of lumbar disk herniation in the workplace into detailed categories such as types of business, types of occupation, and lumbar compression force.
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Blumenkopf, Bennett. "Thoracic Intervertebral Disc Herniations: Diagnostic Value of Magnetic Resonance Imaging." Neurosurgery 23, no. 1 (1988): 36–40. http://dx.doi.org/10.1227/00006123-198807000-00008.
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ABSTRACT Thoracic disc herniation is relatively rare and frequently poses a challenge in clinical diagnosis. These protrusions have been categorized into two major anatomical types and three main clinical syndromes. A number of characteristic radiographic features have been reported. Recently, magnetic resonance imaging (MRI) has gained popularity as a neurodiagnostic imaging tool. A series of nine cases of thoracic intervertebral disc herniation is reported. The clinical aspects of the cases are discussed, and the potential value of spine MRI for thoracic disc herniation diagnosis is emphasized.
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Waqas Noor Chughtai, Muhammad Umar Jamal, Saeed Ahmad, Nauman Ahmed, Tahira Fatima, and Muhammad Umer Farooq. "Significance of Relationship Between Lumbar Disc Degeneration and Modic Changes in Acute Disc Herniation." Pakistan Journal Of Neurological Surgery 27, no. 4 (2023): 516–32. http://dx.doi.org/10.36552/pjns.v27i4.944.
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Objective: To determine the significance of the relationship between lumbar disc degeneration and Modic changes in acute disc herniation. Materials and Methods: This study included 323 patients 25 to 42 years of age having acute symptoms of acute single-level lumbar disc herniation. A simple random sampling technique was used to enroll these patients. MRI lumbosacral spine 1.5 tesla was done on all patients. The patients and MRIs were evaluated by a consultant neurosurgeon and anesthetist both having more than five years of clinical experience. The disc herniations, their types, disc degeneration by Pfirrmann grading, Modic changes in end plates, their types, and location were assessed. Results: The mean age was 34.2±3 years. Males were 185 and females were 138. A total of 1615 discs from L1 to S1 of 323 patients were evaluated. 785 (48.6%) discs had degeneration, 356(22.0%) discs had herniation, 339(20.9%) discs had Modic changes. Out of the 356 herniated discs, 347(97.4%) discs had disc degeneration while 9(2.5%) discs did not have degeneration with a p-value <0.001. Out of the 356 herniated discs, 66(18.5%) discs had Modic changes while 290(81.4%) discs did not have Modic changes with a p-value <0.001. Conclusion: We conclude that disc degeneration and Modic changes had a significant association with acute disc herniation.
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Stromqvist, Fredrik, Björn Strömqvist, Bo Jonsson, and Magnus Karlsson. "Lumbar Disc Herniation Surgery in Different Ages." Spine Journal 17, no. 10 (2017): S67—S68. http://dx.doi.org/10.1016/j.spinee.2017.07.041.
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Shastri, Kshipra. "Immediate effect of one-fifth, one-third, and half of body weight lumbar traction on disc morphology in patients with disc herniation - a case series." Journal of Medical Pharmaceutical and Allied Sciences 14, no. 3 (2025): 09–15. https://doi.org/10.55522/jmpas.v14i3.6854.
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Lumbar traction is a widely utilized treatment option for lumbar disc herniation; however, the optimal traction dosage remains uncertain. This study intending to compare the immediate effects of varying traction weights on disc morphology and pain levels using real time MRI in individuals with Lumbar disc herniation, addressing a critical gap in clinical practice. in human plasma. Method novelty, sensitivity, rapidity, precision, and accuracy were evaluated. Three patients, (60-year-old female, a 60-year-old male, and a 64-year-old male), with diagnosed with posterior or posterolateral lumbar intervertebral disc herniation at the L4-L5 or L5-S1 levels were enrolled. Real time MRI used to assess were lumbar height and disc herniation, while pain intensity was evaluated using Visual analogue Scale (VAS). Traction was applied at three different weights: one fifth, one third and one half of each patient’s body weight. Measurements were taken before and after traction session. Traction with half of the body weight resulted in a considerable improvement in lumbar height compared to lesser weights (P <0.001) with notable reduction in disc herniation (P < 0.003). All groups experienced reduced pain levels, with no significant differences in VAS scores among the different weights (P = 0.07). Half-body weight traction showed immediate improvements in lumbar disc morphology, such as increased disc height and smaller herniation size. Although all traction weights relieve pain, half-body weight traction provided additional structural improvement. These findings highlight the importance of individualized traction dosage based on patient-specific factors and treatment objectives.
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Erario, María de los Ángeles, Eduardo Croce, Maria Teresita Moviglia Brandolino, Gustavo Moviglia, and Aníbal M. Grangeat. "Ozone as Modulator of Resorption and Inflammatory Response in Extruded Nucleus Pulposus Herniation. Revising Concepts." International Journal of Molecular Sciences 22, no. 18 (2021): 9946. http://dx.doi.org/10.3390/ijms22189946.
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Ozone therapy has been used to treat disc herniation for more than four decades. There are several papers describing results and mechanism of action. However, it is very important to define the characteristics of extruded disc herniation. Although ozone therapy showed excellent results in the majority of spinal diseases, it is not yet fully accepted within the medical community. Perhaps it is partly due to the fact that, sometimes, indications are not appropriately made. The objective of our work is to explain the mechanisms of action of ozone therapy on the extruded disc herniation. Indeed, these mechanisms are quite different from those exerted by ozone on the protruded disc herniation and on the degenerative disc disease because the inflammatory response is very different between the various cases. Extruded disc herniation occurs when the nucleus squeezes through a weakness or tear in the annulus. Host immune system considers the nucleus material to be a foreign invader, which triggers an immune response and inflammation. We think ozone therapy modulates this immune response, activating macrophages, which produce phagocytosis of extruded nucleus pulposus. Ozone would also facilitate the passage from the M1 to M2 phase of macrophages, going from an inflammatory phase to a reparative phase. Further studies are needed to verify the switch of macrophages.
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Conn, Ann. "Systematic Review of Caudal Epidural Injections in the Management of Chronic Low Back Pain." Pain Physician 1;12, no. 1;1 (2009): 109–35. http://dx.doi.org/10.36076/ppj.2009/12/109.
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Background: Caudal epidural injection of local anesthetics with or without steroids is one of the most commonly used interventions in managing chronic low back and lower extremity pain. However, there has been a lack of well-designed randomized, controlled studies to determine the effectiveness of caudal epidural injections in various conditions — disc herniation and radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic low back pain of disc origin without disc herniation or radiculitis. Study Design: A systematic review of caudal epidural injections with or without steroids in managing chronic pain secondary to lumbar disc herniation or radiculitis, post lumbar laminectomy syndrome, spinal stenosis, and discogenic pain without disc herniation or radiculitis. Objective: To evaluate the effect of caudal epidural injections with or without steroids in managing various types of chronic low back and lower extremity pain emanating as a result of disc herniation or radiculitis, post-lumbar laminectomy syndrome, spinal stenosis, and chronic discogenic pain. Methods: A review of the literature was performed according to the Cochrane Musculoskeletal Review Group Criteria as utilized for interventional techniques for randomized trials and the Agency for Healthcare Research and Quality (AHRQ) criteria for observational studies. The level of evidence was classified as Level I, II, or III based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature of the English language identified through searches of PubMed and EMBASE from 1966 to November 2008, and manual searches of bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term ≥ 6 months). Secondary outcome measures of improvement in functional status, psychological status, return to work, and reduction in opioid intake were utilized. Results: The evidence showed Level I for short- and long-term relief in managing chronic low back and lower extremity pain secondary to lumbar disc herniation and/or radiculitis and discogenic pain without disc herniation or radiculitis. The indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing low back pain of post-lumbar laminectomy syndrome and spinal stenosis. Limitations: The limitations of this study include the paucity of literature, specifically for chronic pain without disc herniation. Conclusion: This systematic review shows Level I evidence for relief of chronic pain secondary to disc herniation or radiculitis and discogenic pain without disc herniation or radiculitis. Further, the indicated evidence is Level II-1 or II-2 for caudal epidural injections in managing chronic pain of post lumbar laminectomy syndrome and spinal stenosis. Key words: Chronic low back pain, lower extremity pain, lumbar disc herniation, lumbar radiculitis, lumbar discogenic pain, post lumbar laminectomy or surgery syndrome, spinal stenosis, caudal epidural injections, steroids, local anesthetic
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Yan, Song, Tian Taotao, Yun Shunwei, Li Haitao, and Chang Cheng. "Cervical Spondylopathy and Lumbar Intervertebral Disc Herniation Coexist in Free Radical Metabolism and Focus Separation in the Body." Journal of Healthcare Engineering 2021 (November 27, 2021): 1–10. http://dx.doi.org/10.1155/2021/1480282.
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Lumbar disc herniation is a common lumbar disease in clinics, which is related to improper use of lumbar vertebrae and osteoporosis. Surgical removal of nucleus pulposus and maintenance of lumbar structural stability are important for the treatment of lumbar disc herniation. At present, in clinical percutaneous intervertebral foramen endoscopic surgery for lumbar disc herniation, interlaminar and intervertebral foramen approaches can be selected. Different approaches have different degrees of difficulty in the treatment of lumbar disc herniation, and the clinical effects that may be obtained are different. In this study, we observed the influencing factors of plasma nitric oxide (NO) and free radical metabolism in patients with lumbar disc herniation and the correlation between the effects of focus separation. The organic combination of local and total illness differentiation and dialectics, conventional acupuncture, and electrical stimulation was highlighted in this study, which linked local acupoints squeezed by nerve roots with distant acupoints along meridians. The use of authoritative quantitative standards and a multifactor assessment of the disease can accurately represent the disease's severity. The patient's condition changes in each period may be expressed more accurately, thoroughly, and objectively through the rise or reduction of the score, making self-evaluation easier for the patient. Electroacupuncture at point may be one of the most important strategies to minimize free radical damage, based on changes in plasma levels.
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Madhusudhan Kumar Ummadisetty and Srinivasa Mahendra Muniswamy Parasuraman. "Perspective Study of Spontaneous Resorption of Lumbar Disc Herniation in Female Population of Telangana State, India." Indian Journal of Public Health Research & Development 14, no. 3 (2023): 142–44. http://dx.doi.org/10.37506/ijphrd.v14i3.19374.
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Background: Herniation of the disc is the one of the disadvantages human population is facing due to the erect posture. Herniation is the abnormal protrusion of nucleus pulposus from weak site in the annulus fibrosus of the intervertebral disc. It impairs the locomotion of the patients affected with herniation of the disc until the resorption occurs.Method: 30 females aged between 35 to 55 years treated with conservative treatment for low back pain were included in the study. MRI was done to confirm diagnosis and to know the degree of herniation. Routine blood investigations were done to rule out any associated diseases.Results: Out of 30 (12 (40%) were normal, 10 (33.3%) had type-II DM and 8 (26.6%) had HTN. Comparison of spontaneous resorption (in months) 7.5 (±2.4) mean value in large disc, 12.2 (±2.6) in small disc and p value was highly significant (p<0.001).Conclusion:Spontaneous resorption of herniated disc can occur by different mechanisms(retraction, dehydration, and inflammatory mediated mechanism). Early clinical recovery is usually associated with quick resorption of herniated disc.
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Kang, Taewook, Si Young Park, Gun Woo Park, Soon Hyuck Lee, Jong Hoon Park, and Seung Woo Suh. "Biportal endoscopic discectomy for high-grade migrated lumbar disc herniation." Journal of Neurosurgery: Spine 33, no. 3 (2020): 360–65. http://dx.doi.org/10.3171/2020.2.spine191452.
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OBJECTIVEAlthough endoscopic procedures for lumbar disc herniation have improved greatly and offer many advantages, the indications are limited mostly to nonmigrated or low-grade migrated disc herniation. Endoscopic application in migrated disc herniation cases is still challenging and technically demanding. The goal in this study was to determine the feasibility of biportal endoscopic discectomy for removal of high-grade migrated disc herniation.METHODSA retrospective review was performed in 262 patients who had undergone biportal endoscopic discectomy after the diagnosis of lumbar herniated disc. According to preoperative MRI findings, disc herniation was classified into 5 zones based on the direction and distance from the disc space. Patients were divided into 2 groups—a high-grade migration group and a low-grade migration group. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified Macnab criteria, and those outcomes and operation time were compared between the 2 groups.RESULTSThere were 10 patients with “high-grade up,” 8 with “low-grade up,” 98 with disc-level, 102 with “low-grade down,” and 44 with “high-grade down” herniation, thereby yielding 54 patients in the high-grade group and 208 in the low-grade group. Demographic data for the 2 groups showed no significant difference. There was no significant difference between the 2 groups in ODI, VAS, and modified Macnab criteria. Operation time between the 2 groups was not significantly different (60.74 vs 65.63 minutes, p > 0.05).CONCLUSIONSBiportal endoscopic discectomy can be effective for high-grade migrated lumbar disc herniation with no prolonged operation time and satisfactory clinical outcomes.
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Mallick, Shantanu. "Comparison of Clinical Effectiveness between the Management of Cervical and Lumbar Disc Herniation with Percutaneous Laser Disc Decompression Followed by Interlaminar Cervical Epidural and Lumbar Transforaminal Epidural Steroid Injection Respectively." Indian Journal of Pain 37, no. 3 (2023): 178–83. http://dx.doi.org/10.4103/ijpn.ijpn_124_22.
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Background: Different treatments for discogenic axial back/neck pain or radicular pain to limbs are there from conservative therapies and minimally invasive therapies to open spine surgeries with lots of controversial outcomes. Percutaneous laser disc decompression (PLDD) is one of the minimally invasive therapies which is done under local anesthesia and has been successfully performed in many selected patients for their lumbar and cervical disc herniation problems. In PLDD, a part of the nucleus pulposus is vaporized with the help of laser energy to reduce the intradiscal pressure of the diseased discs causing nerve compression. In this case series after a 1-year follow-up, the clinical effectiveness of PLDD with epidural steroid injection is assessed in selected lumbar and cervical disc herniation cases. Materials and Methods: Ninety-six patients underwent the PLDD procedure at the cervical and lumbar disc with epidural steroid injections for their disc herniation causing radicular pain in the upper and lower limbs, respectively. The patients were followed at 8 weeks, 3 months, 6 months, and 1 year. The main outcome measures were done through the visual analog scores (VASs) and the Oswestry Disability Index (ODI) for upper and lower limb pain. Results: The primary outcome showed that there is a significant clinically relevant difference between the two groups at a 1-year follow-up. VAS and mean disability score based on the ODI were significantly lower in cervical disc herniation patients. The reoperation rate in the cervical group is also much less than the lumbar group. Conclusion: Like all other surgical modalities for disc herniation, PLDD has its own advantages and disadvantages. However, compared to lumbar disc herniation, it may give better results in cervical disc herniation. In selected cases, combined PLDD with epidural steroid injection can be chosen as a “first-choice-minimally-invasive-treatment,” when standard conservative therapies do not give satisfactory outcome.
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Qiang, Fu. "The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study." Pain Physician 19, no. 2;2 (2016): 69–75. http://dx.doi.org/10.36076/ppj/2016.19.69.
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Background: Percutaneous endoscopic interlaminar discectomy (PEID), which poses advantages for certain types of herniated disc, is gaining wider acceptance in clinical practice. We retrospectively analyzed the efficacy of the PEID technique in treatment of calcified lumbar disc herniation. Study Design: A retrospective case-control study. Setting: University hospital in China. Objective: To evaluate the efficacy of the PEID technique in treatment of calcified lumbar disc herniation, and a comparison between calcified and noncalcified disc herniation was drawn to analyze the causes of herniated disc calcification. Methods: Data from patients who underwent full-endoscopic lumbar discectomy in our department between March 2011 and May 2013 were collected. Thirty cases with calcified lumbar disc herniation were included in the study group, and 30 age-, gender-, and body mass index (BMI)-matched cases with noncalcified lumbar disc herniation served as controls. Perioperative data, preoperative and postoperative Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) values, MacNab scores, and postoperative low-extremity dysesthesia among patients in the 2 groups were collected. Results: The values of computed tomography (CT) in the calcified group were significantly higher than those in the noncalcified group (P < 0.01). The preoperative disease courses in the 2 groups were similar. However, there was a statistically significant difference in the duration of traditional Chinese medicines (TCM) administration (P < 0.01). VAS and ODI scores improved significantly after surgery, but there were no significant differences between the 2 groups (P > 0.05). Three months after surgery, the rate of low-extremity dysesthesia in the calcified group was significantly higher than that in the control group (P = 0.03) but became similar at 6 months. By applying MacNab criteria the proportions of good and excellent were greater than 90% in both groups, and there was no difference between groups (P > 0.05). Limitations: The sample size was small in this retrospective study. Conclusion: The PEID technique is an effective method in the treatment of calcified lumber disc herniation, although the rate of postoperative dysesthesia is higher in this group during the early postoperative period. Long-term TCM administration may be related to the calcification of herniated lumbar discs. Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy, interlaminar approach, calcification
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Bakar, Bülent, Alemiddin Özdemir, Ahmet Melih Erdoğan, et al. "Morphometric analysis of the spine in patients with single-level lumbar disc herniations: clinical study." Anatolian Current Medical Journal 7, no. 3 (2025): 311–19. https://doi.org/10.38053/acmj.1675007.
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Aims: It was reported in the literature that sagittal balance may be impaired in patients with spinal deformities and lumbar degenerative diseases. In this study, we analyzed the relationship between disc herniation and the results of spinal column morphological measurements related to sagittal balance on lumbar direct radiographs and preoperative blood biochemistry results in patients with single-level lumbar disc herniation and healthy subjects. Methods: Patients who underwent surgery for L4-L5 or L5-S1 intervertebral disc herniation and healthy individuals were included in the study. The participants were then grouped into the control group (n=15) and the LDH group (n=30). Patients were also grouped into the L4-5 HNP group (n=15) and the L5-S1 HNP group (n=15). Age, gender, blood count, and serum C-reactive protein values of all individuals and L1-S1 Cobb angles, T12 and S1 slope angles, L4-S1 Cobb angles, each disc height, and L1-L5 vertebral column height were measured on lumbar direct radiographs. Results: Age (p=0.035), T12 slope angle (p=0.032), L4-S1 Cobb angle (t=3.649, p=0.001), L1-L2 intervertebral disc height (p=0.032), L5-S1 intervertebral disc height (p=0.033), and eosinophil counts (p=0.039) were different between the control group and LDH group. However, there was no statistical difference between patients with L4-L5 disc herniation and patients with L5S1 disc herniation in terms of study parameters. ROC-curve and regression analysis revealed that if age over 39 years if the T12 slope angle was less than 21.50 degrees if the L4-S1 Cobb angle was less than 32.43 degrees if L1-L2 disc height was above 7.45 mm and if L5-S1 disc height was below 8.15 mm (p=0.041) these parameters could be used predictive markers for the diagnosis of the lumbar disc herniation (p
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Sopaj Azemi, Edona, Irena Kola, Sandër Kola, and Marjeta Tanka. "Prevalence of Lumbar Disk Herniation in Adult Patients with Low Back Pain Based in Magnetic Resonance Imaging Diagnosis." Open Access Macedonian Journal of Medical Sciences 10, B (2022): 1720–25. http://dx.doi.org/10.3889/oamjms.2022.8768.
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Background: Lumbar disc degenerative disease has now been proven as the most common cause of low back pain throughout the world. Approximately 5–15% of patients with low back pain suffer from lumbar disc herniation. Presenting symptoms of lumbar disc degeneration are lower back pain and sciatica which may be aggravated by walking, sitting, standing, bending, lifting etc.
 Aim: To evaluate based on MRI images the prevalence of LDH in patients with low back pain and its correlation between various demographic data.
 Methods: This Cross sectional and observational study was conducted from January 2016 to December 2017 at department of Imagery in the University Hospital Center `Mother Theresa`. During the two years’ period of this study, 342 patients of low back pain were presented to department of imagery suspected for lumbar disc herniation. Diagnostic criteria were based upon abnormal findings in MRI. All MRI scans were obtained with 1.5 tesla MRI machine. Data analysis was carried out with SPSS software for Windows version 20.0.
 Results: Overall 342 patients with LBP came into Imagery department, the prevalence of lumbar disc herniation resulted 31.9% (109/342). Most of patients 60.5% were presented with continuous LBP with a predominance of deterioration of pain by the walking activity 65.2%. The average age of patients with LDH resulted 51.12 years old with min 32 years and max 74 years old. The ratio M:F of LDH patients resulted 1.4, with predominance of males 59.6%. The active age 40-49 years (28.9%) old and 50-59 years (36.9%) were the most affected by LDH compared to other age groups. Based on MRI images disc herniation was most commonly present at the level of L3/L4 and L4/L5. Commonest types of disc herniation were protrusion 63.3% (69/109) followed by extrusion 21.1% (23/109). In the overall multivariate regression analysis, a significant relation between lumbar disk herniation and some of occupation was found (p˂0.05)
 Conclusions: Biologically, the lumbar herniation disc is a potential contributor to low back pain. The prevalence of LDH among patients with LBP resulted 31.9%, and men were more prone to suffered from disc herniation than women, due to increased mechanical stress and injury. Results reported the frequent occurrence of lumbar disc degenerative disease in active age. The lumbar discs most often affected and leads to herniation are L3-L4, and L4–L5. Research efforts should endeavor to reduce risk factors and improve the quality of life.
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Wu, Jau-Ching, Wen-Cheng Huang, Tsung-Hsi Tu, et al. "Differences between soft-disc herniation and spondylosis in cervical arthroplasty: CT-documented heterotopic ossification with minimum 2 years of follow-up." Journal of Neurosurgery: Spine 16, no. 2 (2012): 163–71. http://dx.doi.org/10.3171/2011.10.spine11497.
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Object Cervical arthroplasty is a valid option for patients with single-level symptomatic cervical disc diseases causing neural tissue compression, but postoperative heterotopic ossification (HO) can limit the mobility of an artificial disc. In the present study the authors used CT scanning to assess HO formation, and they investigated differences in radiological and clinical outcomes in patients with either a soft-disc herniation or spondylosis who underwent cervical arthroplasty. Methods Medical records, radiographs, and clinical evaluations of consecutive patients who underwent single-level cervical arthroplasty were reviewed. Arthroplasty was performed using the Bryan disc. The patients were divided into a soft-disc herniation group and a spondylosis group. Clinical outcomes were measured using the visual analog scale (VAS) for neck and arm pain and the Neck Disability Index (NDI), whereas HO grading was determined by studying CT scans. Radiological and clinical outcomes were analyzed, and the minimum follow-up duration was 24 months. Results Forty-seven consecutive patients underwent a single-level cervical arthroplasty. Forty patients (85.1%) had complete radiological evaluations and clinical follow-up of more than 2 years. Patients were divided into 1 of 2 groups: soft-disc herniation (16 cases) and the spondylosis group (24 cases). Their mean age was 45.51 ± 11.12 years. Sixteen patients (40%) were female. Patients in the soft-disc herniation group were younger than those in the spondylosis group, but the difference was not statistically significant (42.88 vs 47.26, p = 0.227). The mean follow-up duration was 38.83 ± 9.74 months. Sex, estimated blood loss, implant size, and perioperative NSAID prescription were not significantly different between the groups (p = 0.792, 0.267, 0.581, and 1.000, respectively). The soft-disc herniation group had significantly less HO formation than the spondylosis group (1 HO [6.25%] vs 14 Hos [58.33%], p = 0.001). Almost all artificial discs in both groups remained mobile (100% and 95.8%, p = 0.408). The clinical outcomes were not significantly different between the groups at all postoperative time points of evaluation, and clinical improvements were also similar. Conclusions Clinical outcomes of single-level cervical arthroplasty for soft-disc herniation and spondylosis were similar 3 years after surgery. There was a significantly higher rate of HO formation in patients with spondylosis than in those with a soft-disc herniation. The mobility of the artificial disc is maintained, but the long-term effects of HO and its higher frequency in spondylotic cases warrant further investigation.
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Hakan, Tayfun, and Serkan Gürcan. "Spontaneous Regression of Herniated Lumbar Disc with New Disc Protrusion in the Adjacent Level." Case Reports in Orthopedics 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/1538072.
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Spontaneous regression of herniated lumbar discs was reported occasionally. The mechanisms proposed for regression of disc herniation are still incomplete. This paper describes and discusses a case of spontaneous regression of herniated lumbar discs with a new disc protrusion in the adjacent level. A 41-year-old man was admitted with radiating pain and numbness in the left lower extremity with a left posterolateral disc extrusion at L5-S1 level. He was admitted to hospital with low back pain due to disc herniation caudally immigrating at L4-5 level three years ago. He refused the surgical intervention that was offered and was treated conservatively at that time. He had no neurological deficit and a history of spontaneous regression of the extruded lumbar disc; so, a conservative therapy, including bed rest, physical therapy, nonsteroidal anti-inflammatory drugs, and analgesics, was advised. In conclusion, herniated lumbar disc fragments may regress spontaneously. Reports are prone to advise conservative treatment for extruded or sequestrated lumbar disc herniations. However, these patients should be followed up closely; new herniation at adjacent/different level may occur. Furthermore, it is important to know which herniated disk should be removed and which should be treated conservatively, because disc herniation may cause serious complications as muscle weakness and cauda equine syndrome.
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Brilianto, Bagus Iman, Bintang Soetjahjo, Rieva Ermawan, and Romaniyanto . "Evaluation of Visual Analogue Scale, Oswestry Disability Macnab Index and Criteria Post Action Percutaneous Laser Disc Decompression (Pldd) on Types of Lumbal Disc Herniation in Rsud Dr. Moewardi Surakarta." IAR Journal of Medical Sciences 3, no. 01 (2022): 10–15. http://dx.doi.org/10.47310/iarjms.2022.v03i01.003.
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Percutaneous Laser Disc Decompression (PLDD) is a minimally invasive procedure for disc herniation that is known to be faster and effective. This retrospective study is analytic observational. The study was conducted at the Regional General Hospital Dr. Moewardi Surakarta. Subjects were patients who had PLDD from January 2020 to December 2020 with total sample of 30 respondents. Evaluation of the Visual Analogue Scale (VAS) and The Oswestry Disability Index (ODI) was performed before the PLDD action was carried out, 1 month, and 3 months after. The Macnab criteria was evaluated 3 months after the PLDD action. There was a significant difference in VAS between before and after PLDD, 1 month, and 3 months. There was a significant difference in the ODI score before and after 1 month and 3 months, but not in the ODI value after 1 month and 3 months. Twenty patients (66.7%) showed good good satisfaction following PLDD with Macnab criteria. The significant improvement in VAS of patients with lumbar disc herniation after PLDD were directly as a result of decreasing intradiscal pressure due to vaporization by laser energy, especially in the herniated area and tissue pressure. As the pain subsided, ODI scores in this patients would improve. PLDD in patients with intact lumbar disc herniation led to a significant improvement in VAS and ODI scores. PLDD can be used as an option in the management of patients with low back pain due to an intact lumbar disc herniation.
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Xiao, Lin, Loufeng Liang, Anwei Liang, and Guangxian Tan. "Application Progress of Spinal Endoscopy in the Treatment of Lumbar Disc Herniation: A Literature Review." Academic Journal of Science and Technology 2, no. 1 (2022): 64–69. http://dx.doi.org/10.54097/ajst.v2i1.898.
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Lumbar disc herniation (LDH) is one of the most common spinal diseases. The surgical options can be open or minimally invasive which is adopted according to the condition of patient. With the development of minimally invasive technology, spinal endoscopic therapy has gradually become the main surgical option to treat LDH. According to the situation of patients with lumbar disc herniation and its influence on peripheral nerves and other tissues, combined with the advantages of different endoscopic spinal surgical options, choosing the most suitable surgical option can improve the surgical effect, reduce the occurrence of complications and accelerate the postoperative rehabilitation. This article reviews the progress of endoscopic treatment of lumbar disc herniation.