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Background: Aortoiliac injury after intervertebral disc surgery is an uncommon but potentially fatal complication. This case study emphasizes how crucial it is to identify this uncommon complication, which can manifest itself in a variety of ways, including leg oedema, heart failure, and deep vein thrombosis. This case is unique in that it presents with an uncommon post-spinal surgery complication of fistulized pseudoaneurysm of the common iliac artery and vein. This combination calls for an immediate diagnosis and careful care. Case presentation: A 36-year-old female patient presented with progressively worsening orthopnea, accompanied by chest pain and palpitations. Her medical history revealed gradually increasing right lower limb swelling since three months, following a discectomy procedure for the management of lower back pain associated with a herniated lumbar disc at the L5-S1 level. Doppler ultrasonography demonstrated an arterialized flow within the right common iliac vein. Subsequent computed tomography angiography identified a pseudoaneurysm of the right common iliac artery, which had formed a fistulous connection to the right common iliac vein. This uncommon complication was likely attributable to prior disc surgery. The patient received endovascular intervention, which was executed in two primary stages: first, embolization of the right internal iliac artery was performed, followed by the exclusion of the arteriovenous fistula through the deployment of a covered stent graft within the right common iliac artery. The intervention successfully resolved both the pseudoaneurysm and the arteriovenous fistula. Conclusions: This case report underscores the importance of considering vascular complications in patients presenting with unusual symptoms following intervertebral disc surgery, even after a significant time lapse. While both open surgical and endovascular approaches can yield good results in treating such complications, the endovascular method, as demonstrated in this case, is associated with minimal morbidity. This approach offers a less invasive alternative that can effectively manage complex vascular injuries resulting from disc surgery. Clinicians should be aware of this rare but serious complication to ensure timely diagnosis and appropriate management, potentially improving patient outcomes in similar cases. [ABSTRACT FROM AUTHOR]

Background: Lumbar disc herniation (LDH) is a common cause of lower back pain and radiculopathy. In recent years, the enhanced recovery after surgery (ERAS) concept has been increasingly applied in orthopedics and gastrointestinal surgery. Purpose: To investigate the effect of using rapid rehabilitation surgical care for lumbar disc herniation by meta-analysis. Data source: Google Scholar, PubMed Medical, Cochrane and Embase databases were used for the analysis. Research selection: An initial search yielded a total of 322 relevant articles. Duplicate pieces of literature were screened using Endnote. In addition, non-randomized controlled trials and studies with a sample size of less than 30 were excluded. A total of seven papers were included in this study. Main outcomes: The Rapid Rehabilitation Surgical Nursing (RRSN) group showed significantly higher patient satisfaction (RR = 1.24; 95% CI: 1.06, 1.26; p < 0.01) and self-assessed health (Total MD = 5.67; 95% CI: 4.27, 7.06; p < 0.01) compared to the Normal Nursing (NN) group. Pain levels (MD = −0.66; 95% CI: −0.97, −0.36; p < 0.01), disability levels (MD = −18.64; 95% CI: −32.53, −4.76; p < 0.01), anxiety risk (SAS-MD = −4.33; 95% CI: −6.23, −2.44; p < 0.01), and depression risk (SDS-MD = −4.29; 95% CI: −7.50, −1.07; p < 0.01) were significantly lower in the RRSN group compared to the NN group. According to the GRADE classification, the certainty for patient satisfaction is high, while the certainty for post-care pain, functional capacity, risk of psychological disorders, and self-assessed health status is moderate. Conclusions: Rapid recovery surgical nursing can significantly improve postoperative recovery of lumbar disc herniation, increase patient satisfaction, reduce the risk of psychological disorders, improve lumbar function, and alleviate patient pain. [ABSTRACT FROM AUTHOR]

Introduction. The literature describes several ways to approach the thoracic spinal segment, but there are still many dilemmas regarding what is best to do after a complete discectomy, regardless of the surgical approach chosen. The incidence of postoperative kyphosis is higher if a posterior surgical approach to the spine is performed, and there are no clearly defined indications for the application of intervertebral fusion (IF) after an anterior approach. The aim of the paper was to highlight the low morbidity of the transthoracic multidisciplinary approach, as well as a potential solution for a good, natural IF of the adjacent vertebrae without expanding and prolonging the duration of the surgical procedure itself. Case report. A 44-year-old woman presented with severe anterior compressive myelopathy caused by a calcified thoracic disc herniation in the space between the T10-11 vertebrae. A minimally invasive, open, transthoracic approach was performed with decompression of the spinal canal at the specified level a nd IF was achieved with an autologous rib graft during the same procedure. A control examination of the thoracolumbar segment using the magnetic resonance imaging showed that there is no more compression of the spinal cord and also showed a good IF without an increase in the level of kyphosis. Conclusion. Significant thoracic disc herniation is a rare and challenging surgical lesion. The anterior mini-open transthoracic approach provides good exposure to the relevant structures and is considered minimally invasive. The benefits of subsequent IF after the transthoracic surgical approach should always be taken into account for each individual patient, thus minimalizing the postoperative morbidity. [ABSTRACT FROM AUTHOR]

Background: Recent advancements in cervical interlaminar epidural steroid injections have given rise to the modified paramedian interlaminar (mPIL) approach. The objective of this study was to perform an analysis of the contrast spread pattern within the cervical epidural space, taking into account different needle tip positions in the mPIL approach. Methods: A total of 48 patients were included in the study and randomly assigned to either the medial or lateral group based on the needle tip's position in the anterior–posterior view. The primary outcome measured was the contrast flow under fluoroscopic visualization. As a secondary outcome, we analyzed the location of the needle tip position in both lateral and contralateral oblique views. Clinical effectiveness was assessed by measuring pain intensity and functional disability post‐procedure. Results: Significant disparities were noted in the ventral distribution of contrast between the medial and lateral groups. In the lateral images, needle tips in the lateral group were positioned more ventrally compared to those in the medial group. Both groups exhibited statistically significant improvements in neck and radicular pain, as well as functional status, 4 weeks after treatment, with no significant differences between them. Conclusions: Our results suggest that the ventral dispersion of contrast material during cervical interlaminar epidural steroid injections using the mPIL approach may vary depending on the needle tip location. [ABSTRACT FROM AUTHOR]

This trial assessed the efficacy of naproxen in patients with sciatica in outpatient clinics across 4 Norwegian hospitals. A total of 123 adults with radiating pain below the knee (≥4 on a 0-10 numeric rating scale) and signs consistent with nerve root involvement were included. Participants were randomized to receive either naproxen 500 mg or a placebo twice daily for 10 days. The primary outcome, daily leg pain intensity measured on a 0 to 10 numeric rating scale throughout the treatment period, revealed a statistically significant difference in favor of naproxen, with an adjusted mean difference of −0.5 (95% CI −0.8 to −0.1, P = 0.015). In the naproxen group, the treatment effect was significantly related to time, and over the whole 10-day period, the average adjusted difference was −0.6 (95% CI −0.8 to −0.5). Mean numbers needed to treat for 30% and 50% improvement were 9.9 (95% CI 4.7-15.0) and 20.7 (8.7-32.7), respectively. The adjusted mean difference for back pain was −0.4 (95% CI −0.8 to 0.0), and for Roland Morris Disability Questionnaire for Sciatica, it was −1.5 (95% CI −3.0 to 0.0). No differences were found for sciatica bother someness or consumption of rescue medication or opioids. Participants in the naproxen group exhibited an adjusted odds ratio of 4.7 (95% CI 1.3-16.2) for improvement by 1 level on the global perceived change scale. In conclusion, naproxen treatment showed small, likely clinically unimportant benefits compared with placebo in patients with moderate-to-severe sciatica. [ABSTRACT FROM AUTHOR]

Background: In recent years, radiomics has been shown to be an effective tool for the diagnosis and prediction of diseases. Existing evidence suggests that imaging features play a key role in predicting the recurrence of lumbar disk herniation (rLDH). Thus, this study aimed to evaluate the risk of rLDH in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) using radiomics to facilitate the development of more rational surgical and perioperative management strategies. Method: This was a retrospective case-control study involving 487 patients who underwent PELD at the L4/5 level. The rLDH and negative groups were matched using propensity score matching (PSM). A total of 1409 radiomic features were extracted from preoperative lumbar MRI images using intraclass correlation coefficient (ICC) analysis, t-test, and LASSO analysis. Afterward, 6 predictive models were constructed and evaluated using ROC curve analysis, AUC, specificity, sensitivity, confusion matrix, and 2 repeated 3-fold cross-validations. Lastly, the Shapley Additive Explanation (SHAP) analysis provided visual explanations for the models. Results: Following screening and matching, 128 patients were included in both the recurrence and control groups. Moreover, 18 of the extracted radiomic features were selected for generating six models, which achieved an AUC of 0.551–0.859 for predicting rLDH. Among these models, SVM, RF, and XG Boost exhibited superior performances. Finally, cross-validation revealed that their accuracy was 0.674–0.791, 0.647–0.729, and 0.674–0.718. Conclusion: Radiomics based on MRI can be used to predict the risk of rLDH, offering more comprehensive guidance for perioperative treatment by extracting imaging information that cannot be visualized with the naked eye. Meanwhile, the accuracy and generalizability of the model can be improved in the future by incorporating more data and conducting multicenter studies. [ABSTRACT FROM AUTHOR]

This retrospective case series evaluated the effectiveness of minimally invasive spine surgery-transforaminal lumbar interbody fusion (MIS-TLIF) using the "trial-in-situ" technique for reducing high-grade spondylolisthesis. The surgical management of grade ≥III spondylolisthesis has been controversial, with various methods documented in the literature, including in-situ fusion, in-situ trans-sacral delta fixation, distraction techniques, and external reduction techniques. Recently, MIS techniques have gained popularity. This study analyzed 18 cases of high-grade spondylolisthesis treated with MIS-TLIF using the "trial-in-situ" technique. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and the modified Oswestry Disability Index (mODI) scores. The spinopelvic parameters and sagittal balance were also analyzed. Preoperatively, the spinopelvic parameters were deranged, with a mean pelvic tilt of 28.31°, which improved to 13.91° postoperatively. Similarly, the sacral slope improved from 45.65° to 38.01°. VAS and mODI scores improved postoperatively, indicating the effectiveness of the "trial-in-situ" technique in reducing high-grade spondylolisthesis and achieving a better sagittal profile and spinopelvic parameters. The findings indicate that MIS-TLIF using the "trial-in-situ" technique is a viable and effective method for treating high-grade spondylolisthesis. [ABSTRACT FROM AUTHOR]

Reports of Cutibacterium acnes isolated in cultures of intervertebral disc samples suggest it as possibly responsible for inflammatory conditions causing Modic changes on spinal magnetic resonance imaging (MRI). Our objective was to investigate the prevalence of C. acnes in samples of intervertebral disc of patients with lumbar disc herniation; to investigate prognostic factors and the relationship of Modic changes with infection 1 year after microdiscectomy. Prospective cohort study. In this single-center study, patients consecutively operated on for disc herniation had samples of the disc, multifidus muscle and ligamentum flavum (as an indication of contamination) extracted for culture. Age, sex, alcohol and tobacco consumption, body mass index; function, pain, and Modic chances in MRI before surgery and MRI 1 year later; rate of disc, muscle and ligament infection (primary outcome); diabetes and corticoid use (confoundings). The protruded disc, muscle and ligament samples were sent for culture analysis in up to 30 minutes. A subsample of 17 patients underwent next-generation sequencing (NGS) molecular analysis too. We performed descriptive analysis and comparison of groups of patients with and without infection or contamination using Student's t, Mann-Whitney, chi-square, or Fisher's exact tests as appropriate, and pre- and postsurgical comparisons with the Wilcoxon test. From January 2018 to September 2019, 112 patients underwent open lumbar microdiscectomy, 67 (59.8%) men. Cultures showed 7 (6.3%) positive cases in the disc (2 with C. acnes), 3 (2.7%) in the ligament, and 12 (10, 7%) in muscle. No evidence of a difference in Modic alterations pre- or postoperatively was found between patients with and without positive culture 1 year after surgery. No association was found between culture positivity and functional or pain differences either. NGS results were all negative for C. acnes. We identified infective bacterial presence in the herniated disc in less than 2% of patients with disc herniation. C. acnes was not identified in any disc microbiome analysis. No significant association was observed between positivity for tissue infection and any clinical prognostic factor. [ABSTRACT FROM AUTHOR]

Abstract Background Aortoiliac injury after intervertebral disc surgery is an uncommon but potentially fatal complication. This case study emphasizes how crucial it is to identify this uncommon complication, which can manifest itself in a variety of ways, including leg oedema, heart failure, and deep vein thrombosis. This case is unique in that it presents with an uncommon post-spinal surgery complication of fistulized pseudoaneurysm of the common iliac artery and vein. This combination calls for an immediate diagnosis and careful care. Case presentation A 36-year-old female patient presented with progressively worsening orthopnea, accompanied by chest pain and palpitations. Her medical history revealed gradually increasing right lower limb swelling since three months, following a discectomy procedure for the management of lower back pain associated with a herniated lumbar disc at the L5-S1 level. Doppler ultrasonography demonstrated an arterialized flow within the right common iliac vein. Subsequent computed tomography angiography identified a pseudoaneurysm of the right common iliac artery, which had formed a fistulous connection to the right common iliac vein. This uncommon complication was likely attributable to prior disc surgery. The patient received endovascular intervention, which was executed in two primary stages: first, embolization of the right internal iliac artery was performed, followed by the exclusion of the arteriovenous fistula through the deployment of a covered stent graft within the right common iliac artery. The intervention successfully resolved both the pseudoaneurysm and the arteriovenous fistula. Conclusions This case report underscores the importance of considering vascular complications in patients presenting with unusual symptoms following intervertebral disc surgery, even after a significant time lapse. While both open surgical and endovascular approaches can yield good results in treating such complications, the endovascular method, as demonstrated in this case, is associated with minimal morbidity. This approach offers a less invasive alternative that can effectively manage complex vascular injuries resulting from disc surgery. Clinicians should be aware of this rare but serious complication to ensure timely diagnosis and appropriate management, potentially improving patient outcomes in similar cases.

This retrospective case series evaluated the effectiveness of minimally invasive spine surgery-transforaminal lumbar interbody fusion (MIS-TLIF) using the “trial-in-situ” technique for reducing high-grade spondylolisthesis. The surgical management of grade ≥III spondylolisthesis has been controversial, with various methods documented in the literature, including in-situ fusion, in-situ trans-sacral delta fixation, distraction techniques, and external reduction techniques. Recently, MIS techniques have gained popularity. This study analyzed 18 cases of high-grade spondylolisthesis treated with MIS-TLIF using the “trial-in-situ” technique. The clinical outcomes were assessed using the Visual Analog Scale (VAS) and the modified Oswestry Disability Index (mODI) scores. The spinopelvic parameters and sagittal balance were also analyzed. Preoperatively, the spinopelvic parameters were deranged, with a mean pelvic tilt of 28.31°, which improved to 13.91° postoperatively. Similarly, the sacral slope improved from 45.65° to 38.01°. VAS and mODI scores improved postoperatively, indicating the effectiveness of the “trial-in-situ” technique in reducing high-grade spondylolisthesis and achieving a better sagittal profile and spinopelvic parameters. The findings indicate that MIS-TLIF using the “trial-in-situ” technique is a viable and effective method for treating high-grade spondylolisthesis.

Abstract Background In recent years, radiomics has been shown to be an effective tool for the diagnosis and prediction of diseases. Existing evidence suggests that imaging features play a key role in predicting the recurrence of lumbar disk herniation (rLDH). Thus, this study aimed to evaluate the risk of rLDH in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) using radiomics to facilitate the development of more rational surgical and perioperative management strategies. Method This was a retrospective case-control study involving 487 patients who underwent PELD at the L4/5 level. The rLDH and negative groups were matched using propensity score matching (PSM). A total of 1409 radiomic features were extracted from preoperative lumbar MRI images using intraclass correlation coefficient (ICC) analysis, t-test, and LASSO analysis. Afterward, 6 predictive models were constructed and evaluated using ROC curve analysis, AUC, specificity, sensitivity, confusion matrix, and 2 repeated 3-fold cross-validations. Lastly, the Shapley Additive Explanation (SHAP) analysis provided visual explanations for the models. Results Following screening and matching, 128 patients were included in both the recurrence and control groups. Moreover, 18 of the extracted radiomic features were selected for generating six models, which achieved an AUC of 0.551–0.859 for predicting rLDH. Among these models, SVM, RF, and XG Boost exhibited superior performances. Finally, cross-validation revealed that their accuracy was 0.674–0.791, 0.647–0.729, and 0.674–0.718. Conclusion Radiomics based on MRI can be used to predict the risk of rLDH, offering more comprehensive guidance for perioperative treatment by extracting imaging information that cannot be visualized with the naked eye. Meanwhile, the accuracy and generalizability of the model can be improved in the future by incorporating more data and conducting multicenter studies.

Study Design Retrospective cohort study. Purpose This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH. Overview of Literature Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery. Methods The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Results Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Conclusions Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

BACKGROUND: Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE: This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS: At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P < 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P < 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P < 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD = - 0.05, 95% CI [ - 0.67, 0.57], P = 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P < 0.01). CONCLUSION: Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Purpose: This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH. Overview of Literature: Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery. Methods: The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Results: Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Conclusions: Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between facet joints cross-sectional area asymmetry (FCAA) and cervical intervertebral disc herniation (CDH). Methods: Overall, we retrospectively recruited 390 consecutive patients with CDH who underwent surgical treatment at our institution and 50 normal participants. Clinical variables and radiological findings related to CDH were collected. Results: Patients with CDH were more likely to have a higher absolute value of the facet asymmetry factor (FAF) (p <.001), in which the FAF value of the left group was significantly higher than the other groups (p <.001) and the right group was lower than the central group (p <.001). 9.62% (C3/4), 12.19% (C4/5), 8.70% (C5/6), and 8.14% (C6/7) were determined as cutoff values for each variable that maximized sensitivity and specificity. Furthermore, multivariate analysis showed that cross-sectional area asymmetry of the facet joint (FCAA) was an independent risk factor for the occurrence of CDH. Also, the Chi-square test showed a significant difference in the distribution of the degeneration classification of the disc between the facet-degenerated group and the nondegenerated group at C5/6 (p = 0.026) and C6/7 (p = 0.005) in the facet asymmetry (FA) group. Conclusions: FCAA is evaluated as an independent risk factor for CDH and associated with the orientation of disc herniation. And facet joint orientation may also play a role in cervical spine degeneration rather than facet joint tropism. [ABSTRACT FROM AUTHOR]

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Background: Aside from the rarity of mobile spinal schwannomas, the coexistence of these tumors with herniated intervertebral disc is also scarce. Furthermore, cauda equina syndrome (CES), as a manifestation of intraspinal schwannomas has been reported rarely. Described here is a case of simultaneous lumbar disc bulge and mobile spinal schwannoma presented with intermittent symptoms of CES. Case Report: A 62-year-old man presented with severe but intermittent leg pain for 2 weeks, which later progressed to an episode of lower extremity weakness and difficulty in urination. Magnetic resonance imaging revealed an intraspinal tumor that moved in position relative to the L1-2 disc bulge on scans 6 h apart, with associated spontaneous regression in symptoms. The tumor was found to be a mobile spinal schwannoma, originated from a nerve root. A standard microdissection technique was used to remove the tumor through a spinous processsparing unilateral approach, with complete laminectomy of L1. Use of intraoperative ultrasound facilitated the accurate tumor localization. Postoperatively, the patient no longer had symptoms. Conclusions: This report presents a combination of a common spinal pathology, intervertebral disc herniation, alongside a rare condition, mobile spinal schwannoma, whose uncommon clinical manifestations, such as CES can cause irreversible neurological deficits. Surgeons need to remain vigilant of potential atypical scenarios when treating patients. Surgical treatment challenges regarding the mobility of tumors, such as accurate localization, should be addressed using intraoperative imaging to avoid wrong-level surgery. To mitigate the irreversible neurological complications, patients should receive comprehensive information for alarming signs of CES. [ABSTRACT FROM AUTHOR]

Selecting an efficient treatment for patients with radiculopathy caused by lumbar disc herniation (LDH) unresponsive to conservative management remains a challenging task under investigation, yielding varying results. This study aims to compare the outcomes of the 2 most prevalent invasive treatments. In this retrospective longitudinal study, we enrolled patients with confirmed refractory symptomatic LDH who sought treatment at Valiasr Hospital and underwent either discectomy surgery or epidural steroid injection (ESI) between 2019 and 2022. The outcome measures included pain intensity using the Visual Analog Scale (VAS) and quality of life (QoL) using the SF-36 questionnaire. A total of 202 individuals (112 in the discectomy group and 90 in the ESI group) consisting of 90 males and 112 females, with a mean age of 50.9 ± 13.5 years, underwent analysis. In the univariate analysis, QoL scores were significantly higher in the discectomy group (57.4 ± 2.4) compared to the ESI group (44.2 ± 2.4) (P < 0.01). Furthermore, the surgery group exhibited a significantly greater reduction in the Leg VAS score after treatment compared to the ESI group (mean difference: −2.59, 95% confidence interval (CI): −3.45 to −1.70, P < 0.01). After adjusting for the most important confounding variables using multiple linear regression analysis, the association between surgery and higher QoL scores remained statistically significant (Unstandardized Coefficients B = 7.65, 95% CI: 0.55, 14.76, P = 0.03). Our findings indicate that discectomy surgery has a more pronounced effect on patient outcomes and is a preferable treatment option for LDH patients. [ABSTRACT FROM AUTHOR]

Lumbar disc herniation (LDH) often results in significant pain and disability, and histopathologic evaluation of intervertebral discs offers critical insights into treatment outcomes. This prospective observational study explores histopathologic (HP) changes in intervertebral discs (IVD) and their association with clinical outcomes following surgical treatment for lumbar disc herniation (LDH). A cohort of 141 patients undergoing MRI-confirmed LDH surgery underwent HP evaluation using a semi-quantitative Histopathologic Degeneration Score (HDS). Preoperatively and at a six-month follow-up, comprehensive clinical assessment included the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS), with a minimal clinically important difference (MCID) calculated from ODI and VAS. Results indicated significant associations between higher HDS and adverse clinical outcomes, including persistent pain and greater disability post-surgery. Specifically, an HDS ≥ 7 was predictive (OR = 6.25, CI: 2.56-15.23) of disability outcomes measured with MCID-ODI (AUC: 0.692, CI: 0.609-0.767, P < 0.001), and HDS ≥ 8 was predictive (OR = 1.72, CI: 1.04-2.77) of persistent pain measured with MCID-VAS (AUC = 0.628, CI: 0.598-0.737, P = 0.008), highlighting the diagnostic potential of HDS in assessing postoperative recovery. This study underscores the potential of HP evaluation using HDS to provide valuable insights into disease progression and outcomes in LDH patients, complementing conventional radiologic methods. The findings support the application of personalized treatment strategies based on HP findings while acknowledging challenges in interpretation and clinical implementation.

We aimed to analyze the association between the average lumbar subcutaneous fat tissue thickness (LSFTT) at each intervertebral level and the presence of hernias in patients with low back pain from an insurance network hospital in Mexico. This observational prospective study included 174 patients with non-traumatic lumbago who underwent magnetic resonance imaging with a 1.5T resonator. Two independent radiologists made the diagnosis, and a third specialist provided a quality vote when needed. The sample size was calculated with a 95% confidence interval using random order selection. Anonymized secondary information was used. Percentages and means with confidence intervals were tabulated. The area under the curve, specificity, and sensitivity of LSFTT were calculated. A regression analysis was performed to analyze the presence of hernias with LSFTT using each intervertebral level as a predictor. The odds of herniation at any intervertebral level increased directly with LSFTT. The average LSFTT predicted the overall presence of hernias; however, the LSFTT at each intervertebral level better predicted hernias for each intervertebral space. The area under the curve for LSFTT in predicting hernias was 68%. In conclusion, the average LSFTT was associated with the overall presence of hernias; patients with more hernias had higher LSFTT values.

Objective: Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc. Methods: This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery. Results: A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month: p=0.045, B=0.52; 6 months: p=0.008, B=0.78; 12 months: p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months. Conclusion: In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of Die Orthopädie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We aimed to analyze the association between the average lumbar subcutaneous fat tissue thickness (LSFTT) at each intervertebral level and the presence of hernias in patients with low back pain from an insurance network hospital in Mexico. This observational prospective study included 174 patients with non-traumatic lumbago who underwent magnetic resonance imaging with a 1.5T resonator. Two independent radiologists made the diagnosis, and a third specialist provided a quality vote when needed. The sample size was calculated with a 95% confidence interval using random order selection. Anonymized secondary information was used. Percentages and means with confidence intervals were tabulated. The area under the curve, specificity, and sensitivity of LSFTT were calculated. A regression analysis was performed to analyze the presence of hernias with LSFTT using each intervertebral level as a predictor. The odds of herniation at any intervertebral level increased directly with LSFTT. The average LSFTT predicted the overall presence of hernias; however, the LSFTT at each intervertebral level better predicted hernias for each intervertebral space. The area under the curve for LSFTT in predicting hernias was 68%. In conclusion, the average LSFTT was associated with the overall presence of hernias; patients with more hernias had higher LSFTT values. [ABSTRACT FROM AUTHOR]

Objective: To analyze the efficacy of single-channel percutaneous endoscopic lumbar discectomy (PELD) and conventional open surgery in the treatment of lumbar disc herniation (LDH). Methods: This is a retrospective study. A total of 66 patients with LDH admitted to Tianjin Medical University from June 2017 to June 2018 were divided into two groups: the observation group (single-channel PELD) and the control group (posterior lumbar interbody fusion), with 33 cases in each group. The two groups were compared in terms of visual analogue scale(VAS), oswestry disability index (ODI), Japanese Orthopaedic Association Score(JOA), perioperative indicators, clinical efficacy, postoperative complications, changes in inflammatory factors and serum T lymphocyte subsets. Results: The operation time, incision length, intraoperative blood loss, time in bed, hospital stay in the observation group were all lower than those in the control group. At 7d after treatment, the improvement of ODI, VAS and JOA in the observation group were better than that in the control group. At the last follow-up, there was no significant difference in Cobb angle and lumbar lordosis angle between the two groups. The levels of serum IL-1, IL-6 and TNF-α in the observation group were lower than those in the control group. The degree of reduction of serum CD3+ and CD4+ in the observation group were higher than those in the control group. And the level of elevation of CD8+ in the observation group was lower than that in the control group. Moreover, there was no significant difference in CD4+/ CD8+ level between the two groups. The excellent rate of surgical results in the observation group was higher than that in the control group. Complications occurred in both groups, with no significant difference between the two groups. Conclusions: Single-channel PELD can achieve superior clinical efficacy over conventional open surgery in the treatment of LDH. [ABSTRACT FROM AUTHOR]

Study Design Prospective study. Purpose To propose a scoring system for predicting the need for surgery in patients with lumbar disc herniation (LDH). Overview of Literature The indications for surgery in patients with LDH are well established. However, the exact timing of surgery is not. According to surgeons, patients with failed conservative treatment who underwent delayed surgery, often after 6 months post-symptom initiation, have poor functional recovery and outcome. Methods The current study included patients with symptomatic LDH. Patients with an indication for emergent surgery such as profound or progressive motor deficit, cauda equina syndrome, and diagnoses other than single-level LDH were excluded from the analysis. All patients followed a conservative treatment regimen (a combination of physical therapy, pain medications, and/or spinal epidural steroid injections). Surgery was indicated for patients who continuously experienced pain despite maximal conservative therapy. Results In total, 134 patients met the inclusion and exclusion criteria. Among them, 108 (80.6%) responded to conservative management, and 26 (19.4%) underwent unilateral laminotomy and microdiscectomy. The symptom duration, disc degeneration grade on magnetic resonance imaging (Pfirrmann disc grade), herniated disc location and type, fragment size, and thecal sac diameter significantly differed between patients who responded to conservative treatment and those requiring surgery. The area under the receiver operating characteristic curve of the scoring system based on the anteroposterior size of the herniated disc fragment and herniated disc location and type was 0.81. Conclusions A scoring system based on herniated disc/fragment size, location, and type can be applied to predict the need for surgery in patients with LDH. In the future, this tool can be used to prevent unnecessarily prolonged conservative management (>4–8 weeks).

Background Conservative traditional Chinese medicine (TCM) treatment has clinically proven to have a clear curative effect on lumbar disc herniation (LDH) , and its mechanism of action and biomechanical effects are the hot spots in current research. Objective To perform a wearable inertial sensors-based gait analysis in LDH patients with qi-stagnation and blood-stasis before and after treatment, and to verify the advantages of comprehensive TCM therapy by biomechanical methods. Methods This study selected 40 inpatients with an admission diagnosis of LDH treated with comprehensive TCM therapy from Tuina Department, the Affiliated Hospital of Changchun University of Chinese Medicine from June 2020 to December 2021. The patients' age, gender, the lower limb with pain, baseline body mass index, hospitalization time and pre- and post-treatment scale scores for low back pain were collected. Gait parameters were collected by wearable inertial sensors at pre- and post-treatment. Results Among the 40 patients, 18 were males and 12 were females. Eighteen patients had pain in the left lower limb, 8 had pain in the right lower limb, and the other 14 had pain in both lower limbs. Patients had a mean age of (52.3±15.2) years, a mean body mass index of (25.2±4.2) kg/m2, and a mean length of hospitalization of (17.5±6.2) days. The treatment was effective or marketed effective in 35 cases, ineffective in 5 cases, achieving an overall response rate of 87.5%. The Visual Analogue Scale score and Oswestry Disability Index decreased, and the Japanese Orthopaedic Association Score increased after treatment compared with the baseline levels (P

Objective The aim of this study was to emphasize on the interaction of spatial and temporal gait parameters and analyse the gait asymmetry in the patients with lumbar disc herniation (LDH) before and after microdiscectomy. Methods This was a prospective, observational study conducted on 59 cases of LDH planned for lumbar microdiscectomy, and healthy control group with 54 participants for analysis was performed prior to surgery and 15 days after surgery. The spatiotemporal gait parameters were measured using a “Win-Track” gait analysis platform system. All the participants walked barefoot for 10 times with their normal walking speed in the same day. The 3 flawless walking data were recorded and the arithmetic means were computed. The gait symmetry index was used to calculate the walking asymmetry. The pain intensity of the patients was recorded shortly before performing the analysis by a visual analogue scale. Results In the postoperative assessment LDH patients had significantly shorter temporal parameters, longer spatial parameters, faster walking speed, and more cadence than the preoperative assessment (p < 0.05). There were improvements in the asymmetry values of the postoperative gait parameters compared to the preoperative values, but these differences were not significant (p > 0.05). In addition, there was a significant difference in all parameters in terms of gait asymmetry between the postoperative assessment and the healthy controls (p < 0.05). Conclusion These results can guide the patient-specific evaluating and implementation of gait rehabilitation programs, and design protocols before or after surgery in the LDH patients.

Doori Kim,1 Eun-San Kim,1 Yoon Jae Lee,1 Jee Young Lee,2 Kyong Sun Park,3 So Young Jung,4 Changsop Yang,5 Chang-Hyun Han,6,7 In-Hyuk Ha1 1Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, 06110, Republic of Korea; 2Department of Korean Internal Medicine, Integrative Cancer Center, Cha Ilsan Medical Center, Goyang-si, Gyeonggi-do, Republic of Korea; 3Jaseng Hospital of Korean Medicine, Seoul, 06110, Republic of Korea; 4Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea; 5Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea; 6Korean Convergence Medical Science, University of Science & Technology (UST), School of Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of Korea; 7KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, 34054, Republic of KoreaCorrespondence: In-Hyuk Ha, Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 540 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea, Tel +82-2-2222-2740, Fax +82-2-2222-2737, Email hanihata@gmail.com Chang-Hyun Han, KM Science Research Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea, Tel +82-(0)42-868-9498, Fax +82-(0)42-869-2775, Email chhan@kiom.re.krPurpose: We aimed to compare the efficacy, safety, and cost-effectiveness of non-pharmacological- and pharmacological treatment strategies for Lumbar disc herniation (LDH) in pragmatic clinical settings.Patients and Methods: This study was a pilot, two-armed, parallel pragmatic randomized controlled trial. Thirty patients aged 19– 70 years with a numeric rating scale (NRS) score ≥ 5 for sciatica and confirmed LDH on magnetic resonance imaging (MRI) were included. Participants were assigned in a 1:1 ratio to non-pharmacological (non-Phm) or pharmacological (Phm) treatment group. They were treated for 8 weeks and a total follow-up period was 26 weeks after randomization. Non-Phm treatment included acupuncture, spinal manual therapy, etc., Phm included medication, injection, nerve block, etc., The primary outcome was a numeric rating scale (NRS) of radiating leg pain. NRS for low back pain, Oswestry disability index, visual analog scale, Fear-Avoidance Beliefs Questionnaire, patient global impression of change, Short Form-12 Health Survey, version 2, 5-level European Quality of Life-5 dimensions (EQ-5D) were also measured. Linear mixed model was used to evaluated the difference in change of outcomes from baseline between two groups. An economic evaluation was conducted using incremental cost-effectiveness ratios.Results: There was no significant difference between the two groups in the intervention period, but non-Phm group showed significantly greater degree of improvement in follow-up of Week 14. Difference in the NRS for sciatica and ODI were 1.65 (95% CI 0.59 to 2.71, p=0.003) and 8.67 (95% CI 1.37 to 15.98, p=0.21), respectively in Week 14. The quality-adjusted life year (QALY) value calculated by EQ-5D and Short Form-6 Dimension were 0.006 (95% CI − 0.012 to 0.024, p=0.472) and 0.015 (95% CI − 0.008 to 0.038, p=0.195) higher in non-Phm group than in Phm group. The cost was lower in non-Phm group than in Phm group (Difference: − 682, 95% CI − 3349 to 1699, p=0.563).Conclusion: We confirmed that the non-Phm treatment could be more cost-effective treatments than Phm treatments and feasibility of a large-scale of main study in future.Keywords: conservative treatment, intervertebral disc displacement, low back pain, sciatica

Tetanus is a life-threatening and fatal disease that can be prevented by vaccination. The diagnosis of tetanus is based solely on medical history and clinical symptoms and is very prone to misdiagnosis, undertreatment, and delayed treatment. We reported a deaf and mute patient with tetanus with low back pain, bilateral knee pain, and abdominal distension and constipation as the first symptoms. The patient visited the department of orthopedic pain management with low back pain, bilateral knee pain and abdominal distension and constipation as the chief complaint. During treatment, he was found to have symptoms such as fatigue, coughing with yellow sputum, neck stiffness and discomfort, bilateral temporomandibular joint pain and difficulty in opening the mouth gradually developed after a history of contaminated wound trauma, and thoracic muscle spasm, abdominal muscle tension and neck muscle spasm detected by physical examination, then he was diagnosed with tetanus and transferred to the neuro-ICU department for antitoxin treatment of tetanus and other symptomatic treatments, and discharged after 22-day treatment. Our case report and literature review suggest that to properly prevent and treat tetanus to reduce the risk of tetanus mortality, clinicians should strengthen the propaganda of preventing tetanus by preventive vaccination and timely vaccination after a contaminated traumatic wound, and pay attention to improve their capabilities of identifying, diagnosing and managing tetanus to reduce the possibility of misdiagnosis, and to timely deliver effective treatment after making a correct diagnosis.

Background: Oxygen-ozone (O2-O3) gas mixture as a newly prescribed substance became popular among clinicians to relieve low back pain (LBP) in discogenic patients as an alternative method rather than surgery. We developed this study to uncover whether this combination could be helpful in the Middle Eastern population or not. Methods: In the present randomized clinical trial, we included 40 patients with L1 to S1 disc herniation assigned to schedule for intervention [a single course of ozone (O3) therapy without corticosteroids] or to consider as the control (physiotherapy including exercises based on extension). All patients were followed with a mean time of 12 weeks after injection, and pain severity and level of quality of life (QOL) were assessed. The severity of disc herniations was evaluated by a spine surgeon within the Michigan State University (MSU) classification frame. Results: The current study represented two identical groups regarding lumbosacral segment involvement during 12 weeks of our survey (P > 0.05). The QOL level was equivalent in two groups. The mean pain score was decreased in the intervention group against the control group after two weeks, but it failed to thrive in the further weeks and was raised afterward. On the other hand, the mean pain score for the control group [6.1; 95% confidence interval (CI): 5.4-6.8] proceeded with a steady slope notably lower than the intervention group (7.5; 95% CI: 6.9-8.2) (P < 0.001). Conclusion: Patients with LBP do not get more benefit from O2-O3 mixture injection. [ABSTRACT FROM AUTHOR]

Study Design: Prospective study. Purpose: To propose a scoring system for predicting the need for surgery in patients with lumbar disc herniation (LDH). Overview of Literature: The indications for surgery in patients with LDH are well established. However, the exact timing of surgery is not. According to surgeons, patients with failed conservative treatment who underwent delayed surgery, often after 6 months postsymptom initiation, have poor functional recovery and outcome. Methods: The current study included patients with symptomatic LDH. Patients with an indication for emergent surgery such as profound or progressive motor deficit, cauda equina syndrome, and diagnoses other than single-level LDH were excluded from the analysis. All patients followed a conservative treatment regimen (a combination of physical therapy, pain medications, and/or spinal epidural steroid injections). Surgery was indicated for patients who continuously experienced pain despite maximal conservative therapy. Results: In total, 134 patients met the inclusion and exclusion criteria. Among them, 108 (80.6%) responded to conservative management, and 26 (19.4%) underwent unilateral laminotomy and microdiscectomy. The symptom duration, disc degeneration grade on magnetic resonance imaging (Pfirrmann disc grade), herniated disc location and type, fragment size, and thecal sac diameter significantly differed between patients who responded to conservative treatment and those requiring surgery. The area under the receiver operating characteristic curve of the scoring system based on the anteroposterior size of the herniated disc fragment and herniated disc location and type was 0.81. Conclusions: A scoring system based on herniated disc/fragment size, location, and type can be applied to predict the need for surgery in patients with LDH. In the future, this tool can be used to prevent unnecessarily prolonged conservative management (>4-8 weeks). [ABSTRACT FROM AUTHOR]

Purpose: The main purpose of this study was to evaluate the intervertebral disc height and intervertebral disc degeneration between the normal group and the group with disc herniation at the level of the L4–L5 intervertebral disc by MRI using the Pfirrmann grading system. Materials and Methods: 385 patients were included in this study. MRI images were reevaluated and intervertebral disc heights were measured from the anterior, middle and posterior segments. Researchers divided disc pathologies into two groups. In the non-herniated group; normal or bulging ones; in the herniated group, they included those with protrusion or extrusion. Results: 385 lumbar MRI examinations meeting the study criteria were included in study. There were 56.9% (219/385) females and 43.1% (166/385) males in the study. For the whole patients in the study group, the intervertebral disc height values at the L4–5 level were measured as 12.34 mm, 11.58 mm, and 7.60 mm in the anterior, middle, and posterior localizations, respectively. Conclusions: At the L4–5 level, the height of the disc distances in the herniated group was lower than in the normal group. The Pfirrman score was found to be higher in the herniated group in terms of disc degeneration compared to the normal group. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of loganin on pain response in rats with lumbar disc herniation (LDH) by regulating CXCL12/CXCR4 signal pathway. Methods Ten of the 50 rats were randomly selected as the sham group according to random number table method, and LDH rat model was established in other rats. Model rats were randomly divided into the model group, the CXCR4 antagonist group (AMD3100 group, intrathecal injection, 20 μg), the loganin group (5 mg/kg, intraperitoneal injection), and the loganin (5 mg/kg, intraperitoneal injection) +CXCL12 group (intrathecal injection, 250 ng), with 10 animals in each group. After the intervention according to drug groups, the latency of thermal foot withdrawal reaction and the threshold of mechanical foot withdrawal threshold were measured respectively. HE staining was applied to observe histomorphological changes of spinal dorsal horn. Levels of TNF-α, IL-1β and IL-6 in spinal dorsal horn were detected by ELISA. Immunofluorescence staining was applied to detect the activation of microglia. Western blot assay was used to detect the level of CXCL12/CXCR4 pathway related proteins. Results Compared with the sham group, the model group had severe spinal cord dorsal horn tissue injury, the latency of thermal foot withdrawal reaction and mechanical foot withdrawal threshold were lower, and levels of microglia, levels of TNF-α, IL-1β, IL-6, and protein expression levels of CXCL12, CXCR4, NLRP3, caspase-1 and IL-1β in spinal dorsal horn tissue were higher (P＜0.05). Compared with the model group, the pathological injury of spinal dorsal horn tissue was reduced in the AMD3100 group and the loganin group. The latency of thermal foot withdrawal reaction and mechanical foot withdrawal threshold were higher, and levels of microglia, levels of TNF-α, IL-1β, IL-6, and the protein expression levels of CXCL12, CXCR4, NLRP3, caspase-1 and IL- 1β in the spinal dorsal horn tissue were also lower (P＜0.05). CXCL12 could weaken the improvement effect of loganin on pain response in LDH rats (P＜0.05). Conclusion Loganin can improve the pain response of LDH rats, which may be related to the inhibition of CXCL12/CXCR4 signal pathway. [ABSTRACT FROM AUTHOR]

Foraminal disc herniation at the C2–3 level is a very rare entity, for which a consensus treatment protocol has not been established. This case report explains that unilateral biportal endoscopic foraminotomy is a very effective, minimally invasive, and safe procedure for this condition. A 62-year-old woman presented to our clinic with complaints of a 6-week history of posterior axial neck pain and sudden onset of hypoesthesia over the right periauricular region, face and lip. Magnetic resonance imaging (MRI) revealed C2–3 right foraminal disc herniation, and posterior cervical foraminotomy was done using the unilateral biportal endoscopic technique. The patient reported complete relief of the axial neck pain soon after surgery and gradual improvement of the hypoesthesia. Postoperative MRI showed complete removal of the compressing disc fragment. In conclusion, this case shows that a minimally invasive biportal endoscopic procedure can be a better choice for decompression than many extensive and destructive procedures. This is the first case report in the literature describing the management of C2–3 foraminal disc herniation by posterior cervical unilateral biportal endoscopic foraminotomy.

ABSTRACT A previous study has reported the therapeutic effects of interlaminar/transforaminal approaches under full-endoscopic visualization to treat L5-S1 lumber disc herniation (LDH). However, the comparison of interlaminar/transforaminal approaches to treat other segments of LDH remains unclear. Objective: To evaluate the clinical efficacy of full-endoscopic interlaminar and transforaminal lumbar discectomy to treat LDH. Methods: A total of 93 patients with LDH who underwent fully-endoscopic lumbar interlaminar/transforaminal discectomy were retrospectively collected. Patients were divided into a Transforaminal group (n=41) and an Interlaminar group (n=52). Clinical efficacy was evaluated by visual analogue scale (VAS), the Oswestry disability index (ODI), and the modified MacNab scoring system. Results: Of the 93 patients, involving segments in LDH referred to L3-4, L4-5, and L5-S1. The fluoroscopy times in the Interlaminar group were smaller than that of the Transforaminal group. We found no obvious significances between the Transforaminal and Interlaminar groups regarding operation time, incision length, postoperative landing time, hospitalization, and incision healing time. Postoperative VAS and ODI scores notably improved at follow-up. Besides, almost 90% LDH patients achieved excellent/good outcomes. Conclusion: The full-endoscopic visualization technique via interlaminar and transforaminal approaches safely and effectively treat LDH. Level of Evidence III, Retrospective Study.

Objective: The aim of this study was to emphasize on the interaction of spatial and temporal gait parameters and analyse the gait asymmetry in the patients with lumbar disc herniation (LDH) before and after microdiscectomy. Methods: This was a prospective, observational study conducted on 59 cases of LDH planned for lumbar microdiscectomy, and healthy control group with 54 participants for analysis was performed prior to surgery and 15 days after surgery. The spatiotemporal gait parameters were measured using a “Win-Track” gait analysis platform system. All the participants walked barefoot for 10 times with their normal walking speed in the same day. The 3 flawless walking data were recorded and the arithmetic means were computed. The gait symmetry index was used to calculate the walking asymmetry. The pain intensity of the patients was recorded shortly before performing the analysis by a visual analogue scale. Results: In the postoperative assessment LDH patients had significantly shorter temporal parameters, longer spatial parameters, faster walking speed, and more cadence than the preoperative assessment (p < 0.05). There were improvements in the asymmetry values of the postoperative gait parameters compared to the preoperative values, but these differences were not significant (p > 0.05). In addition, there was a significant difference in all parameters in terms of gait asymmetry between the postoperative assessment and the healthy controls (p < 0.05). Conclusion: These results can guide the patient-specific evaluating and implementation of gait rehabilitation programs, and design protocols before or after surgery in the LDH patients. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effect of nerve stem electrical stimulation therapy in the treatment lumbar disc herniation (LDH) at 4-5 levels. Methods From January 2020 to October 2021,A total of 140 patients with LDH (three cases dropped out during the study and 137 cases actually completed the study) in the Department of Acupuncture and Moxibustion of the hospital were randomly divided into the observation group (69 cases) and the control group (68 cases). The observation group was treated with direct nerve trunk stimulation, while the control group was treated with warm acupuncture. The patients in both groups were treated continuously for two courses. The improved version of Japanese Orthopedic Association and Visual Analgesia Scale were used to evaluate the efficacy of the two groups. The the difference in marked response rate between the two groups of patients was compared. Results After treatment, the scores of the modified Japanese Orthopedic Association and Visual Analgesia Scale in the two groups were significantly improved, and the cure rate and effective rate in the observation group were significantly higher than those in the control group, with statistical significances (P＜0. 05). Conclusion Nerve stem electrical stimulation therapy is effective in the treatment of LDH at 4-5 levels, and has high clinical application value. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. The treatment of patients with lumbar disc herniation can be conservative or surgical, depending on the patient’s characteristics, the disease, and treatment possibilities. This study aims to compare the intensity of pain, the presence of Lasègue’s sign, and the degree of neurological deficits in patients with lumbar disc herniation before and after the operation. Additionally, the degree of intervertebral disc degeneration, evaluated by magnetic resonance imaging findings on the outcome will be determined. Material and Methods. A retrospective study involved 50 patients aged 18 to 45 who underwent microdiscectomy procedure. Parameters including pain intensity on the visual-analog scale, Lasègue’s nerve stretching test, sensory deficits, motor deficits, and the degree of intervertebral disc degeneration according to the Pfirrmann grading system were assessed preoperatively and in the early postoperative period. Results. Intervertebral disc herniation most commonly occurred at the L4-5 and L5-S1 levels in our patients. Pain intensity significantly decreased from a preoperative score of 7.6 to 2.4 postoperatively. There was also a significant decrease in the number of patients with positive Lasègue’s sign. According to the Pfirrmann grading system, 38% of patients had mild degenerative changes in the intervertebral disc, while 62% had severe degenerative changes. Conclusion. Microdiscectomy is the gold standard in surgical treatment of lumbar disc herniation. In the early postoperative period, patients experience a significant reduction in pain intensity with subsequent improvement of sensory and motor deficits. Surgical treatment of lumbar disc herniation, when indicated appropriately, carries a high success rate. [ABSTRACT FROM AUTHOR]

Objective To describe an alternative technique of annuloplasty for treatment of chronic discogenic back pain in an ambulatory setting. Methods A retrospective review of all patients presenting with chronic discogenic low back pain and managed by target-oriented thermal annuloplasty at our institute from May 2015 to June 2019 was performed. The procedure is carried out under local anaesthesia in prone position. The principle of the technique relies on dividing the posterior annulus into nine equal segments on AP-view of the C-arm. The trajectory is through the Kambin’s triangle in a horizontal trajectory as much as possible to target the posterior part of the disc annulus. Each of the nine segments is treated with radio-frequency probe to produce disc alterations required to relieve the pain. Results A total of 9 patients were treated by this method with an average follow-up of 28.1±11.4 months. The average VAS improved from 4.1±1.2 to 2.5±0.4 at final follow-up. The ODI improved from 42±6.7 to 19.98±5.6. None of the patients had any complications. The patient satisfaction rate was 82%, the rate of return to daily life was 100% and recommendation rate to others was 100%. Conclusion Target-oriented lumbar percutaneous nine point annuloplasty may be considered as a viable option for chronic discogenic back pain patients with relatively well-maintained disc heights. A successful outcome depends upon proper patient selection and correct trajectory.

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more costeffective manner. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Although several studies have been conducted to determine the cause of low back pain (LBP), a sufficient correlation has not been found between research findings and symptoms. Therefore there seems to be a need for studies to explain the relationship between pain and morphological changes in the paraspinal muscles of patients with LBP through comparisons with healthy control subjects. OBJECTIVE: The aim of this study was to examine degeneration in the lumbar musculus multifidus (LMF) and lumbar musculus erector spinae (LES) muscles in patients with chronic LBP with non-radiculopathy lumbar disc herniation (LDH), patients with mechanical LBP, and healthy individuals. METHODS: The study included 35 patients with mechanical LBP, 38 patients with non-radiculopathy LDH, and a control group of 36 healthy participants. In all patients and the control group, evaluations were made on axial magnetic resonance imaging slices at L3-S1 level of the LMF and LES cross-sectional areas (CSA), total CSA (TCSA = LMF + LES), fat infiltrations and asymmetries. RESULTS: The mean CSA values of the right and left LMF and LES showed significant differences between the groups (p < 0.001, p = 0.002, p = 0.002, p = 0.010, respectively). Fat infiltrations showed a difference between the right-left LMF and left LES groups (p = 0.007, p < 0.001, p = 0.026, respectively). Asymmetry was not observed between the CSA and TCSA of the right and left sides. CONCLUSION: A correlation was found between fat infiltration in the LMF and mechanical LBP and LDH. However, no significant correlation was determined between LBP and the CSA and TCSA of the LMF and LES. This was thought to be due to an incorrect result of CSA and TCSA in the evaluation of muscle mass. Therefore, for a more accurate evaluation of muscle mass, it can be considered necessary to measure muscle atrophy associated with fat infiltration or functional CSA. [ABSTRACT FROM AUTHOR]

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Low back pain is the global leading cause of disability. Herniated intervertebral discs are a common cause of lower back pain. The natural history of the herniated intervertebral disc is that it can resorb spontaneously through an immune-mediated mechanism. Despite this favourable natural history, there is an increasing reliance on surgical intervention. A 64-year-old presented with a left L3/4 disc prolapse. With reassurance, simple analgesics, and motor control exercises, the MRI scan confirmed the complete resolution of the disc prolapse within 3 months. Patients with disc prolapses should be reassured that disc prolapses will naturally resolve and advised to remain active. Surgical intervention should only be considered with the presence of red flags, progressive neurology, or when clear evidence exists that all non-interventional techniques have been exhausted. With such a favourable natural history, caution should be exercised before surgical intervention is recommended. [ABSTRACT FROM AUTHOR]

Shengwei Meng,1,&ast; Derong Xu,1,&ast; Shuo Han,1 Guanghui Li,1 Yan Wang,1 Yanqing Shen,2 Kai Zhu,1 Antao Lin,1 Ruiting Wang,3 Xuexiao Ma,1 Chuanli Zhou1 1Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 2Operating Room, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China; 3Medical Insurance Audit Department, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chuanli Zhou; Xuexiao Ma, Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, Shandong, 266000, People’s Republic of China, Tel +8618661809796 ; +8618661807895, Email justin_5257@hotmail.com; maxuexiaospinal@163.comPurpose: To evaluate the outcomes, feasibility, and safety of endoscopic unilateral laminectomy, bilateral decompression and discectomy (Endo-ULBDD) for central lumbar spinal stenosis (CLSS) combined with disc herniation (DH).Methods: This study includes 39 patients diagnosed with CLSS combined with DH who met the inclusion criteria and underwent surgery for Endo-ULBDD from April 2020 to March 2021. The mean age of the patients, operation time, hospitalization time, time in bed, and complications were recorded. Patients were followed up for at least 12 months. Visual analog scale (VAS) scores for low-back and lower-limb pain and Oswestry Disability Index (ODI) scores were evaluated preoperatively, before discharge, and at 3, 6, and 12 months postoperatively. To evaluate clinical effectiveness 12 months postoperatively, the modified MacNab criteria were used.Results: The mean age of the patients was 59.9 years, the mean operation time was 82.1 minutes, the mean hospitalization time was 3.7 days, and the mean time in bed was 20.9 hours. The mean VAS scores of low-back and lower-limb pain improved from 5.9 and 7.2 to 2.0 and 1.6, respectively (P < 0.05). The ODI score improved from 56.0 to 16.7 (P < 0.05). The overall excellent-good rate of the modified MacNab criteria was 89.7%. Two kinds of complications occurred in 4 patients (10.3%), including 1 patient whose inferior articular process was excessively removed and 3 patients who suffered from postoperative dysesthesia. No other severe complications were noted.Conclusion: Endo-ULBDD is a safe, feasible, efficient, and minimally invasive approach to treating CLSS combined with DH.Keywords: endoscopic spinal surgery, laminectomy, discectomy, lumbar spinal stenosis, intervertebral disc displacement

ABSTRACT Neuromuscular taping or kinesiotaping is a technique widely used in spinal disorders. However, the scientific evidence of its use in discopathies and degenerative spine pathology is unknown. This study aimed to analyze the published clinical trials on neuromuscular taping in subjects with discopathies and degenerative spinal injuries. For this purpose, a literature search was performed following PRISMA guidelines in the following databases: PubMed, Web of Science (WOS), Scopus, Medline, and Cinahl. In analyzing bias and methodological quality, we used: the PEDro scale, Van Tulder criteria, and risk of bias analysis of the Cochrane Collaboration. A total of 5 articles were included that obtained a mean score of 6.2 on the PEDro scale. There is moderate evidence that, in the short term, neuromuscular taping reduces analgesic consumption and improves the range of motion and muscle strength in the posterior musculature. In addition, there is limited evidence that it can improve quality, while the scientific evidence on the effect of neuromuscular taping on pain is contradictory. The application of neuromuscular taping on discopathies and degenerative processes of the spine should be cautiously undertaken until more conclusive results are obtained, and the long-term effects are assessed. Level of evidence I; Systematic review.

Introduction: Spinopelvic malalignment causes continual backache. Intervertebral Disc Degeneration (IDD) is a leading cause of low backache. Understanding the relationship between spinopelvic parameters and IDD can help with better diagnosis and treatment and avoid unnecessary investigations. Aim: To measure radiographic spinopelvic parameters of patients diagnosed with varying grades of IDD in the lumbosacral spine on Magnetic Resonance Imaging (MRI), and to compare them with radiographs of the asymptomatic population (controls). Materials and Methods: A hospital-based retrospective observational study was done from January 2021 to August 2022 at a tertiary care hospital in Uttar Pradesh, India with 80 patients diagnosed with IDD on MRI and 80 controls. Cases were defined as patients diagnosed to have IDD on MRI and controls were those individuals who did not have disc degeneration on MRI. Lateral lumbosacral spine radiographs were taken, and spinopelvic parameters {Pelvic Tilt (PT), Sacral Slope (SS), Pelvic Incidence (PI), Lumbar Lordosis (LL), lumbo-sacral angle, and sacral horizontal angle} were measured using Surgimap Spine Software. T-test and Chi-square test were used for comparison between cases and controls. Results: Six patients had asymmetric disc bulge, 11 had symmetric disc bulge, 18 had disc extrusion and 45 had disc protrusion. Mean PT in patients with IDD was 11.05±3.84°, and control was 8.65±3.19°, p-value=0.009. Mean SS in case group was 38.38±3.03° and control was 36.56±3.43°, p-value=0.031. The mean PI of cases was 49.44±8.39° and control 46.19±9.01°, p-value=0.02. LL angle was higher in IDD at 46.34°, and was 45.36° in healthy individuals, without statistically significant difference. The mean lumbo-sacral angle in both study groups was similar. The mean Sacral Inclination Angle (SIA) was found to be 43.99° and 44.96° in the case and control group respectively without showing significant differences. A statistically significant difference was found only for the comparison of PT between different grades of IDD (p-value=0.039). Conclusion: Using Surgimap Spine Software, one can predict the individuals that possess a greater propensity of developing degeneration of disc and chronic low back pain in a more cost-effective manner.

ABSTRACT Objective: Evaluate the clinical outcome of patients with lumbar disc herniation (HDL) operated by endoscopic interlaminar microdiscectomy. We evaluated epidemiology, time to return to work, and technique-related complications as secondary outcomes. Method: Prospective longitudinal study, where patients with HDL with surgical indications were evaluated. They underwent endoscopic discectomy exclusively using the interlaminar technique. Clinical results were evaluated using the Oswestry 2.0 questionnaire (ODI) and the visual analog scale (VAS). In this study, we inserted the Macnab postoperative satisfaction index. In parallel with these indices, we analyzed the results regarding epidemiology variables, time to return to work, and complications. Such questionnaires were applied preoperatively, postoperatively the day after surgery, and one year after. Results: In 132 patients selected for the study, we obtained significant clinical improvement in the ODI and VAS questionnaires, and 81.3% of the patients had excellent and good Macnab index. The hospital stay was 22.7 hours, and the return to work was 30 days. The rate of complications with the method was 12.8%, with recurrence of disc herniation being the most common complication with 9.8% of cases. Conclusion: The endoscopic technique proved effective in treating lumbar spinal disc herniation with significant clinical improvement in the analyzed period, low incidence of complications, early postoperative rehabilitation, and results close to or superior to the gold standard technique. Level of Evidence III; Prospective cohort study