Factors affecting urinary outcome after delayed decompression in complete cauda equina syndrome: "A regression model study".

To assess the impact of delayed decompression on long-term neurological and bladder function recovery in patients with cauda equina syndrome (CES) secondary to lumbar disc herniation (LDH). The clinical data of 35 patients receiving delayed decompression surgery for CES secondary to LDH were reviewed. The bladder empty function, bowel control, sexual ability and neurological functions of the lower limbs were evaluated after the operation, and the urodynamic changes were assessed in 6 patients with urodynamic data before and after the operation. Surgical decompression was performed at 4.1∓3.9 weeks in 12 patients with complete CES and at 5.5∓7.6 weeks in 23 patients with incomplete CES after the onset of symptoms. The patients were followed up for a mean of 43.0∓28.9 months (3-110 months). In the 23 patients with incomplete CES, 19 obtained full recovery, 4 had slight sensory alterations in the saddle area or the lower limbs. In the 12 patients with complete CES, 2 had full recovery, 4 reported slight sensory alterations in the saddle area or the lower limbs (including 2 with occasional constipation); 6 still had sense deficit in the saddle area and difficulties in bladder or bowl emptying, but they all reported significant improvements compared to the condition before operation. Urodynamic analysis in the 6 patients with pre- and postoperative urodynamic data showed increased abdominal pressure when voiding with significantly reduced residual urine in all the 6 patients; 4 patients with abnormal first desire volume before operation reported recovery after the operation. Patients with LDH-induced CES who missed the chance of early decompression can still expect favorable functional recovery in the long term. The improvement of bladder function following decompression is probably a result of recovery of bladder sensation and the compensation by increased intra-abdominal pressure. The key strategy to promote bladder function recovery in these patients is to promote the detrusor recovery.

Cauda equina syndrome secondary to lumbar disc herniation: Surgical delay and its relationship with prognosis

Aim: The aim of this study was to investigate the association between the level of lumbar disc herniation (LDH) and individual spinopelvic anatomy. Material and methods: Spinopelvic parameters were retrospectively evaluated in 57 patients with symptomatic LDH at L4/5 and L5/S1 undergoing minimal invasive sequestrectomy at our institution. LDH was diagnosed in 23 patients at L5/S1 and in 34 patients at L4/5. Patients with further segment degeneration at the index level were excluded from the study. Results: Spinopelvic parameters between the two groups were significantly different. Patients with LDH at L5/S1 had statistically significant lower Pelvic Incidence (PI), Pelvic Tilt (PT), Relative Lumbar Lordosis (RLL) and PI-LL than patients with LDH at L4/5. C7 Sagittal Vertical Axis (C7SVA) was statistically significant lower in patients with LDH at L5/S1. Both groups had no sagittal imbalance. Patients with LDH at L5/S1 were significantly younger than patients with LDH at L4/5. There was a significant positive correlation between age and PT. We observed no significant differences for preoperative values of Lumar Lordosis (LL) and Sacral Slope between the two groups. Conclusions: This is the first study to reveal individual spinopelvic anatomy and, in particular, PI to be associated with the distinct level of LDH. These findings substantiate the biomechanical influence of the sagittal profile on the pathogenesis of LDH. Individual spinopelvic compensatory mechanisms were available independently of the patient’s age. Minimal invasive sequestrectomy is a reliable treatment for symptomatic LDH without further segment degeneration.

Síndrome de cauda equina por hernia discal lumbar: demora quirúrgica y su relación con el pronóstico

Cervical and back pains are important clinical problems affecting human populations globally. It is suggested that Propionibacterium acnes (P. acnes) is associated with disc herniation. The aim of this study is to evaluate the distribution of P. acnes infection in the cervical and lumbar disc material obtained from patients with disc herniation. A total of 145 patients with mean age of 45.21±11.24years who underwent micro-discectomy in cervical and lumbar regions were enrolled into the study. The samples were excited during the operation and then cultured in the anaerobic incubations. The cultured P. acnes were detected by 16S rRNA-based polymerase chain reaction. In this study, 145 patients including 25 cases with cervical and 120 cases with lumbar disc herniation were enrolled to the study. There was no significant difference in the age of male and female patients (p=0.123). P. acnes infection was detected in nine patients (36%) with cervical disc herniation and 46 patients (38.3%) with lumbar disc herniation and no significant differences were reported in P. acnes presence according to the disc regions (p=0.508.). Moreover, there was a significant difference in the presence of P. acnes infection according to the level of lumbar disc herniation (p=0.028). According to the results, the presence of P. acnes is equal in patients with cervical and lumbar disc herniation. There was a significant difference in the distribution of P. acnes infection according to level of lumbar disc herniation. II.

BackgroundA previous randomised controlled trial (RCT) of patients with chronic low back pain (LBP) and vertebral bone marrow (Modic) changes (MCs) on magnetic resonance imaging (MRI), reported that a 3-month, high-dose course of antibiotics had a better effect than placebo at 12 months’ follow-up. The present study examines the effects of antibiotic treatment in chronic LBP patients with MCs at the level of a lumbar disc herniation, similar to the previous study. It also aims to assess the cost-effectiveness of the treatment, refine the MRI assessment of MCs, and further evaluate the impact of the treatment and the pathogenesis of MCs by studying genetic variability and the gene and protein expression of inflammatory biomarkers.Methods/designA double-blinded RCT is conducted at six hospitals in Norway, comparing orally administered amoxicillin 750 mg, or placebo three times a day, over a period of 100 days in patients with chronic LBP and type I or II MCs at the level of a MRI-confirmed lumbar disc herniation within the preceding 2 years. The inclusion will be stopped when at least 80 patients are included in each of the two MC type groups. In each MC type group, the study is designed to detect (β = 0.1, α = 0.05) a mean difference of 4 (standard deviation 5) in the Roland Morris Disability Questionnaire score between the two treatment groups (amoxicillin or placebo) at 1-year follow-up. The study includes cost-effectiveness measures. Blood samples are assessed for security measures and for possible inflammatory mediators and biomarkers at different time points. MCs are evaluated on MRI at baseline and after 12 months. A blinded intention-to-treat analysis of treatment effects will be performed in the total sample and in each MC type group.DiscussionTo ensure the appropriate use of antibiotic treatment, its effect in chronic LBP patients with MCs should be re-assessed. This study will investigate the effects and cost-effectiveness of amoxicillin in patients with chronic LBP and MCs at the level of a disc herniation. The study may also help to refine imaging and characterise the biomarkers of MCs.Trial registrationClinicalTrials.gov, ID: NCT02323412. Registered on 21 November 2014.

Background: Lumbar disc herniation is one of the common causes of low back pain throughout the world. Abnormalities detected in MRI do not always reflect low back pain, so these should be interpreted with consideration of thorough history and physical examination. Therefore, clinical correlation is required to delineate the importance of abnormalities in MRI. Materials and Methods: The study was a Prospective study conducted from 2015 to 2017 in the patients coming to our tertiary care centre. We selected patients with lumbar disc herniation confirmed with MRI to find out correlation of clinical features and MRI findings in determining the level of lumbar disc herniation. MRI findings analysed were level of disc herniation, position and type of disc herniation, neural canal compromise. Results: Out of the 102 patients studied, 44 had specific dermatomal distribution and 58 had non-specific distribution. Out of 139 levels of disc herniation, 62 levels showed disc bulge, 46 showed protrusion, 27 showed extrusion and 4 levels were with sequestration. Out of 139 levels of disc herniation, 42 levels had motor deficits. Conclusion: There is a good correlation between clinical findings and MRI findings. Disc bulge/protrusion/extrusion with central presentation was not significantly correlating with clinical features. But, independent of type of herniation, if there is para-central/far lateral position of disc with neural foramen compromise, there was significant correlation with clinical features.

Chiropractic care is popular for low back pain, but may increase the risk for acute lumbar disc herniation (LDH). Low back pain is a common early (prodromal) symptom of LDH and commonly precedes LDH diagnosis. Our objective was to investigate the association between chiropractic care and acute LDH with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute LDH with early surgery. Using a self-controlled case series design and population-based healthcare databases in Ontario, Canada, we investigated all adults with acute LDH requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004. The relative incidence of acute LDH with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and compared with the relative incidence of acute LDH with early surgery following PCP visits. 195 cases of acute LDH with early surgery (within 8weeks) were identified in a population of more than 100 million person-years. Strong positive associations were found between acute LDH and both chiropractic and PCP visits. The risk for acute LDH with early surgery associated with chiropractic visits was no higher than the risk associated with PCP visits. Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

Background. Lumbar disc herniation (LDH) is a disorder that involves rupture of the annulus fibrosus so that the nucleus pulposus protrudes and compresses the lumbar canal. LDH is the most common cause of lumbar radiculopathy. LDH causes functional disorders in patients, causing disability to carry out daily activities. The purpose of this study was to determine the risk factors that influence the degree of disability in lumbar nucleus pulposus herniation.
 Methods. Analytical research with a consecutive cross-sectional study approach in patients with lumbar LDH at the Neurology Outpatient Clinic, Dr. M. Djamil General Hospital Padang from March to November 2021. The risk factors assessed were age, gender, occupation, length of illness, and body mass index (BMI). The measurement of the degree of disability uses the Oswestry disability index (ODI) score. The relationship between risk factors and the degree of disability was analyzed using chi-square test. Differences in the mean age of groups with mild and moderate degrees of disability using unpaired t-test.
 Results. 40 subjects met the inclusion and exclusion criteria. Mean age 57 ± 10,976 years, male and female ratio 1:2, work with heavy lifting activities was found in 70% of subjects, duration of suffering from LDH more than one year in 60% of subjects. BMI overweight and obesity as many as 77.5% subjects. As many as 60% of the subjects experienced mild to moderate degrees of disability. There is a difference in the average age of the subjects with mild to moderate degree of disability with a severe degree of p-value of 0.044. There was no significant relationship between gender (p=0.054), occupation (p=0.398), length of illness (p=0.503) and body mass index (p=0.757), and the degree of disability.
 Conclusion. The degree of disability in patients with LDH is influenced by age. Meanwhile, gender, occupation, length of illness and body mass index were not significantly related to the degree of disability in patients.

Treatment method selection for sleep quality due to lumbar DISC herniation: Early surgery or others?; A single center clinical trial

Background:Large lumbar or lumbosacral (LS) disc herniations usually expand from the paramedian space to the neuroforamen and compress both the transversing (lower) and the exiting (upper) nerve roots, thus leading to bi-radicular symptoms. Bi-radicular involvement is a statistically significant risk factor for poor outcome in patients presenting with far lateral or foraminal disc herniation after facet preserving microdecompression. There is evidence showing that patients suffering from large lumbar disc herniations treated with interbody fusion have significant superior results in comparison with those who received a simple discectomy. We report our experiences on managing large LS disc herniation with bi-radicular symptoms by transforaminal lumbar interbody fusion (TLIF) using one diagonal fusion cage with unilateral pedicle screw/rod fixation.Materials and Methods:Twenty-three patients who suffered from single level lumbar or LS disc herniation with bi-radicular symptoms treated with unilateral decompression and TLIF using one diagonal fusion cage with ipsilateral pedicle screw/rod fixation operated between January 2005 and December 2009, were included in this study. Operation time and blood loss were recorded. The pain and disability status were pre- and postoperatively evaluated by the visual analog score (VAS) and Oswestry Disability Index (ODI). Interbody bony fusion was detected by routine radiographs and computed tomography scan. Adjacent segment degeneration was detected by routine radiographs and magnetic resonance imaging examination. Overall outcomes were categorized according to modified Macnab classification.Results:The patients were followed up for an average of 44.7 months. Pain relief in the VAS and improvement of the ODI were significant after surgery and at final followup. No severe complications occurred during hospital stay. Interbody bony fusion was achieved in every case. No cage retropulsion was observed, while 3 cases experienced cage subsidence. Adjacent segment degeneration occurred at 3 discs cephalic to the fusion segment at followup. No patients underwent revised surgery. Overall outcome was excellent in 5 patients (21.7%), good in 13 (56.5%), fine in 4 (17.5%), and poor in 1 (4.3%).Conclusions:TLIF using one cage with ipsilateral pedicle screw/rod fixation is an effective treatment option for massive lumbar or LS disc herniation with bi-radicular involvement.

Groin pain associated with sacroiliac joint dysfunction and lumbar disorders

Although the use of diagnostic ultrasound to measure the spinal canal has been proposed, the value of ultrasound for lumbar disc herniation has not been yet fully assessed. The purpose of this investigation was to evaluate the effectiveness of ultrasound in the level diagnosis of herniated nucleus pulposus. Prospective ultrasound examinations were performed on 80 consecutive patients with clinically suspected lumbar disc herniation. In 41 discs of those 40 patients with surgically confirmed lumbar disc herniation, there were 32 discs (78%) with true-positive ultrasound diagnoses, 37 discs (90%) with true-positive myelographic diagnoses, and 20 patients (50%) with true-positive neurologic diagnoses. Conversely, ultrasound diagnoses showed positive echogram in 24 (60%) of 40 nonoperative patients. These results suggest that ultrasound is of value as an aid for diagnosing the level of lumbar disc herniation.

Recurrence of lumbar disc herniation (LDH) after primary endoscopic transforaminal discectomy (PETD) is diagnosed in 3.8–15 % of cases. Objective. To study preoperative radiographic and MRI signs that potentiate LDH recurrence after PETD. Methods The study material consisted of articles identifying radiographic and MRI risk factors for recurrent LDH after PETD between 2015 and 2025 in the PubMed, Google Scholar, and Medline databases. The study method was a systematic review of relevant literature sources. Results. The level of LDH does not influence the incidence of rLDH, although some authors consider the presence of a disc herniation in the upper lumbar spine as a risk factor for recurrence. rLDH is significantly more frequently recorded with primary disc protrusion; in cases of migrated disc herniation, the risk of rLDH significantly increases with large intracanal displacement of disc material extending beyond the inferior margin of the superior or inferior vertebral pedicle. The use of PETD for resection of central disc herniations most often results in recurrent LDH (compared to foraminal, extraforaminal, and migratory) due to technical errors. A study of disc height index dynamics in the pre- and postoperative periods and the degree of Modic type endplate degeneration showed that the less severe the degenerative processes in the prolapsed intervertebral disc, the higher the risk of herniation recurrence after PETD. Conclusions. Recurrence disc herniation after PETD is significantly more common in cases of primary protrusion and significantly increases with large annular defects (≥ 6 mm). rLDH is significantly more common in discs with moderate degenerative changes, with a disc height index of approximately 0.37 ± 0.09 and Modic type 1

Background and Objectives: Although percutaneous laser disc decompression (PLDD) is one of the common treatment methods for patients with lumbar disc herniation (LDH), the recurrence of LDH after PLDD is estimated at 4–5%. This study compares the preoperative clinical data and clinical outcomes of patients who underwent primary microendoscopic discectomy (MED) or MED following PLDD. Materials and Methods: We retrospectively analyzed 2678 patients who underwent MED for LDH. The PLDD group included patients with previous PLDD history at the same level of LDH, and a matched control group was created using propensity score matching for age, sex, and body mass index. Preoperative data, preoperative radiographic findings, and surgical data of the groups were compared. To compare postoperative changes in clinical scores between the groups, a mixed-effect model was used. Results: As a result, 42 patients (1.6%) had previously undergone PLDD, and a control group with 42 patients were created. The disc degeneration severity was not significantly different between the groups. However, Modic changes were more frequent in the PLDD group than in the matched control group (p = 0.028). There were no significant differences in dural adhesion rate or surgery-related complications including dural injury, length of stay, and recurrence rate of LDH after surgery. In addition, the improvement of clinical scores did not significantly differ between the two groups (p = 0.112, 0.913, respectively). Conclusions: We concluded that patients with recurrent LDH after PLDD have advanced endplate degeneration, which may reflect endplate injury from a previous PLDD. However, a previous history of PLDD does not have a negative impact on the clinical result of MED.