The Effects of Guiyuan Cupping Combined with Thunder-Fire Moxibustion on Pain Perception, Lumbar Function, and Quality of Life in Patients with Lumbar Disc Herniation

BackgroundLumbar disc herniation (LDH) is a common disease seen in orthopedics; it is caused by nucleus pulposus herniation. Its clinical manifestations are low back pain, radiating pain of the lower limbs, and cauda equina symptoms that seriously affect patients' quality of life. At present, oral analgesics are commonly used in the treatment of LDH; but they can produce gastrointestinal reactions and other side effects. Thunder-fire moxibustion is a method that is widely used in China to treat pain syndromes. This study aimed to design a randomized controlled trial to explore the effectiveness and safety of thunder-fire moxibustion in the treatment of lumbar disc herniation.MethodsNinety patients will be enrolled and randomly divided into one of two groups: the thunder-fire moxibustion group and the acetaminophen group. The thunder-fire moxibustion group will be treated with moxa sticks at BL25, GV3, BL23, and GV4; and after 15 min of local whirling moxibustion, the contralateral acupoints will be treated with moxibustion for 15 min. The study period will include two 10-day courses of treatment, for a total study duration of 20 days. The acetaminophen group participants will take one acetaminophen sustained-release tablet twice a day for the duration of the study period. In contrast, the thunder-fire moxibustion group participants will be treated with thunder-fire moxibustion every other day for 30 min. The primary outcome will be the Japanese Orthopedic Association (JOA) score. Visual analog scale (VAS) and Oswestry Disability Index (ODI) will be used as the secondary outcome measures. Adverse events (AEs) will also be recorded. Assessments will be conducted at baseline, the end of the first and second courses of treatment.DiscussionThis study will determine whether thunder-fire moxibustion is more effective and safer than acetaminophen in the treatment of patients with LDH.Trial RegistrationChinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2000036079.

The incidence of lumbar disc herniation (LDH) is on the rise annually, with an emerging trend of affecting younger age groups. This study aims to investigate the clinical effectiveness of combining Erxian decoction with auricular acupoint pressure therapy in treating LDH. Our objective is to furnish evidence supporting the incorporation of traditional Chinese medicine (TCM) rehabilitation techniques in clinical settings. This randomized controlled trial enrolled 102 patients diagnosed with LDH and allocated them into Control and Intervention groups. The Control group underwent a 2-week rehabilitation regimen, whereas the Intervention group received an augmented treatment comprising Erxian decoction along with auricular acupoint pressure therapy based on the Control group. Main outcome measures included 3 scales - visual analog scale (VAS), Japanese Orthopedic Association (JOA), and Oswestry Disability Index - as well as 3 inflammatory markers: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). Additionally, pressure pain threshold and pain tolerance threshold values were evaluated. Participants were assessed at baseline, on 14-day, and on 28-day posttreatment. After 2 weeks of treatment, both the Control and Intervention groups exhibited significant improvements in the VAS, JOA, ODI, CRP, IL-6, TNF-α, pressure pain threshold, and pain tolerance threshold (P < .05). These improvements persisted at the 28-day in the VAS, JOA, and ODI scores (P < .05). On 14-day, the Intervention group showed significantly better outcomes compared to the Control group in terms of the VAS, JOA, ODI, CRP, TNF-α, and pressure pain threshold (P < .05). Compared to conventional rehabilitation therapy, the combination of Erxian decoction and auricular acupoint pressure therapy demonstrates clear benefits in alleviating symptoms in patients with LDH. This approach offers fresh perspectives and substantiates evidence for future treatment strategies in managing LDH.

To observe the clinical efficacy of acupuncture combined with thunder-fire moxibustion in treating low back pain with cold-damp. Seventy-two patients of low back pain with cold-damp were randomly divided into an observation group (36 cases, 1 case was eliminated) and a control group (36 cases, 1 case dropped out). The control group received acupuncture at Jizhong (GV6), Yaoyangguan (GV3), ashi points, bilateral Shenshu (BL23), Dachangshu (BL25), and Weizhong (BL40) for 30 min daily. The observation group was treated with thunder-fire moxibustion in addition to the same acupuncture regimen as the control group, once daily. Both groups were treated for 6 consecutive days followed by one rest day, for a total duration of 4 weeks. The visual analog scale (VAS) score, Oswestry disability index (ODI) score, Japanese Orthopedic Association (JOA) score, present pain intensity (PPI) score, and serum levels of β-endorphin (β-EP), 5-hydroxytryp tamin (5-HT), and substance P (SP) were compared before and after treatment, and the clinical efficacy was also compared between the two groups. Compared before treatment, the VAS scores, ODI scores, PPI scores, and serum levels of 5-HT and SP were decreased (P<0.01), while JOA scores and serum levels of β-EP were increased (P<0.01) in both groups after treatment. The observation group showed lower VAS, ODI, and PPI scores and serum levels of 5-HT and SP than those in the control group (P<0.05), as well as higher JOA score and serum level of β-EP (P<0.05). The total effective rate in the observation group was 94.3% (33/35), higher than 82.9% (29/35) in the control group (P<0.05). Acupuncture combined with thunder-fire moxibustion could effectively alleviate pain and improve lumbar function in patients of low back pain with cold-damp, possibly by regulating β-EP, 5-HT, and SP levels.

Objective To study the therapeutic effect of aquatic core stability exercise for treatment of the lumbar disc herniation. Methods Forty patients with lumbar disc herniation were randomly divided into a control and an experimental group. The two groups were all treated with physical agents therapy, traction, and traditional Chinese medical massage therapy, and aquatic core stability exercise were adopted in the experimental group. After four weeks of treatment, Japanese Orthopaedic Association (JOA), Visual Analogue Score (VAS), 36-item short-from (SF-36) and range of motion (ROM) were used for evaluation and comparison before and after treatment. Results Before treatment, the JOA, VAS, SF-36 and ROM scores in the two groups had no statistical significance (P>0.05). But after four weeks of treatment, the two groups had a significant improvement in the four scores (P<0.05). What is more, in the experimental group patients' score in JOA (25.67±6.17), VAS (1.56±1.71), SF-36 (73.25±12.17) and ROM improved significantly more than those in the control group patients, score in JOA (21.65±6.78), VAS (2.26±1.46), SF-36 (64.37±11.32) and ROM. The difference between the two groups was statistically significant (P<0.05). Conclusions The aquatic core stability exercise can improve the symptom and lumbar dysfunction caused by the lumbar disc herniation, and it can effectively improve the patients quality of life. Key words: Lumbar disc herniation; Core stability exercise; Spine stability

Objective To study the application value of nerve root decompression through posterior approach in minimally invasive surgery of lumbar disc herniation (LDH). Methods From June 2016 to June 2018, 80 patients with unilateral single segment LDH were selected and diagnosed in Yunnan Puer People′s Hospital.The patients were divided into control group and observation group according to the random number table method, 40 cases in each group.The control group was treated with posterior fenestration and nucleus pulposus extraction, and the observation group was treated with posterior neurolysis and decompression through 5.3 mm intervertebral foramen.The incision length, operation time, intraoperative blood loss and postoperative hospital stay were compared between the two groups.The visual analog scale (VAS) of pain before operation and 1, 2, 7 days after operation was compared.The Japanese Orthopedic Association (JOA) score and the Oswestry disability index (ODI) questionnaire score before operation and 1, 3, 12 months after operation were compared.The effect of lumbar function recovery 12 months after operation was compared. Results The incision length, operation time, days in-hospital after operation, and bleeding amount in observation group were (0.9±0.2) cm, (50.8±8.6) min, (16.5±5.9) ml, (4.3±0.5)d, and in control group were (4.6±0.8) cm, (72.3±15.2) min, (52.5±10.3) ml, (7.2±0.9)d.The differences between the two groups were statistically significant (t=8.625, 14.623, 32.625, 6.524, all P<0.001). The VAS scores of the observation group and the control group were (5.7±1.1), (3.3±0.6), (1.2±0.3), (0.5±0.1) and (5.5±1.2), (4.2±0.8), (1.9±0.4), (1.1±0.3) before and 1, 3 and 7 days after the operation, respectively.The differences 1, 3, 7 days after operation between the observation group and the control group were statistically significant (all P<0.05). The JOA scores of the observation group were (8.1±1.6), (19.3±4.2), (23.2±4.9), (25.8±5.2) before and 1, 3 and 12 months after operation, respectively, and those of the control group were (8.3±1.5), (15.2±3.3), (19.3±4.2), (20.6±5.5) after operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The ODI scores of the observation group were (43.7±10.6), (18.3±5.2), (10.2±3.9), (1.8±0.5) before and 1, 3 and 12 months after the operation, respectively, and those of the control group were (42.5±9.4), (25.2±5.3), (14.3±4.2), (4.6±0.9) after the operation.The differences 1, 3, 12 months after operation between the observation group and the control group were statistically significant (all P<0.05). The effective rate of the observation group was significantly higher than that of the control group (92.5%(30/40) vs.75.0%(37/40), χ2=4.501, all P=0.034). Conclusion It can bring less trauma and faster recovery with 5.3mm intervertebral endoscopy by posterior approach of nerve root decompression for LDH patients, which is better safety and efficacy. Key words: Intervertebral endoscopy; Nerve root decompression; Lumbar disc herniation; Lumbar function

Previous reports revealed a correlation between psychological problems and spinal surgery. There is a lack of knowledge on the effect of anxiety on the percutaneous transforaminal endoscopic discectomy (PTED) outcome at the twoyear follow-up. The purpose of this study is to investigate changes in anxiety after PTED among patients with lumbar disc herniation (LDH), to compare the effect of anxiety on the prognosis using propensity score matching analysis, and to identify the related parameters of anxiety. A total of 145 patients with LDH requiring PTED surgery were included. Twenty-six LDH patients with anxiety were matched with 26 control patients utilizing propensity score matching analysis. The demographic and peri-operative data were collected and analyzed. A correlation analysis was utilized. Both groups achieved significant improvements in visual analogue scale (VAS) scores for pain, Japanese Orthopedic Association (JOA) scores for neurological deficit, and 36-item Short-Form Health Survey (SF-36) scores and Oswestry Disability Index (ODI) scores for quality of life. A statistical difference was detected between the pre-operative and the post-operative Zung Self-Rating Anxiety Scale scores in the anxiety cohort. However, the difference between the anxiety group and the control group was statistically significant in the aforementioned parameters. The VAS, JOA, ODI and the SF-36 scores, and the disease duration were associated with pre-operative anxiety. PTED may provide significant improvements in clinical outcomes and symptoms of anxiety. A negative impact on the patient's prognosis may be caused by the presence of anxiety. Pain severity, neurological deficit, disease duration, and quality of life were associated with anxiety.

Objective To observe the clinical efficacy and safety of non-surgical spinal decompression combined with intervertebral foramen injection in the treatment of lumbar intervertebral disc herniation. Methods Ninety-six patients were randomly divided into a control group, a decompression group, an injection group and a combined group. All of the subjects were given loxoprofen sodium and chestnut seed extract. The decompression group was treated with non-operative spinal decompression. The injection group received intervertebral foramen injections. The combined group received both treatments. Pain perceptions, quality of life perceptions and lumbar dysfunction were observed before the treatment, and 2 days, 1 month, 6 months and 12 months afterward. Results There were no significant differences among the groups in average pain perceptions quantified using a visual analogue scale (VAS) before the treatment. The average scores on a 36-item short-form health survey, the Oswestry disability index and a Japanese Orthopedic Association instrument also were not significantly different. All of those indicators had improved significantly in the decompression, injection and combined groups at 1, 6 and 12 months after the treatment, but the combined group′s average indicators were all significantly better than the other groups′ averages at the same time points. All of the significant improvements in the combined group′s averages occurred in the first month after the combined treatment. Conclusion Non-operative spinal decompression has a synergistic effect with intervertebral foramen injection in treating patients with lumbar disc herniation. Their combined effect is better than either treatment alone. Their combined effect is lasting, safe and has few complication risks. It is worthy of clinical application. Key words: Lumbar disc herniation; Spinal decompression systems; Foramen; Inflammation; Pain

To investigate the effects of tendon-regulating and bone-setting manipulation on clinical outcomes and lumbopelvic sagittal alignment in patients with lumbar disc herniation (LDH) after undergoing transforaminal lumbar interbody fusion (TLIF). From May 2024 to May 2025, 60 patients with lumbar disc herniation (LDH) who underwent transforaminal lumbar interbody fusion (TLIF) were randomly assigned to either the treatment group or the control group, with 30 cases in each group. One patient was lost to follow-up in the treatment group and one patient was lost to follow-up and one patients was excluded from the control group. The treatment group comprised 29 cases, including 12 males and 17 females, with an age of (61.1±7.2) years, and received conventional rehabilitation therapy;the control group consisted of 28 cases, including 10 males and 18 females, with an age of (57.8±10.1) years, and received conventional rehabilitation therapy supplemented with tendon-releasing and bone-setting manual techniques. Before surgery and at 1, 3, and 6 months postoperatively, pain was assessed using the visual analogue scale(VAS), while function was evaluated with the Oswestry disability index(ODI) and the Japanese Orthopaedic Association (JOA) scoring system. Sagittal plane parameters such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) were measured preoperatively and at 6 months postoperatively. All patients were followed up, and the duration ranged from 6.0 to 7.0 months, with a mean of (6.2±0.3) months. In both groups, the VAS at 1, 3, and 6 months postoperatively were significantly lower than those before surgery, with statistically significant differences (P<0.05). No significant intergroup difference in VAS was found preoperatively or at 1 month postoperatively (P>0.05). However, the treatment group showed significantly lower VAS than the control group at 3 and 6 months postoperatively (P<0.05). ODI scores significantly improved at all postoperative time points in both groups (P<0.05). While no significant intergroup difference in ODI was observed preoperatively or at 1 month, the treatment group had significantly lower ODI scores at 3 and 6 months (P<0.05). JOA scores increased significantly at all postoperative time points in both groups (P<0.05). The treatment group demonstrated significantly higher JOA scores than the control group at 3 and 6 months postoperatively (P<0.05). At 6 months, the JOA improvement rate was significantly higher in the treatment group (83.95±10.62)% compared to the control group (64.55±14.31)%(t=5.795, P<0.001). Regarding sagittal alignment at 6 months, the treatment group showed significantly greater improvement in PT, SS, LL, and PI-LL match compared to the control group (all P<0.05). The adjunctive use of tendon-regulating and bone-setting manipulation on top of conventional rehabilitation is more effective than conventional rehabilitation alone in alleviating pain, improving functional status, and correcting lumbopelvic sagittal imbalance in LDH patients after TLIF surgery.

Introduction: This retrospective comparative effectiveness cohort study aimed to investigate the association between warm needle acupuncture (electrothermal acupuncture) combined with conventional rehabilitation training and clinical symptoms, functional recovery, and quality of life (QoL) in patients with lumbar disc herniation (LDH), compared with conventional rehabilitation training alone. Material and Method: This study was a retrospective, non-randomized, preference-based controlled retrospective cohort. A total of 200 patients diagnosed with LDH and undergoing microdiscectomy were included. Patients were assigned to groups based on their treatment preferences and clinical treatment plans (non-random allocation). The observation group (warming acupuncture group, n = 125) received warming acupuncture combined with conventional rehabilitation training, whereas the control group (conventional rehabilitation training alone, n = 75) received conventional rehabilitation training alone. There was no difference in the surgical procedure between the two groups. This study adopted a blinded outcome assessment and statistical analysis (outcome assessors and statisticians were blinded). The Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS), Generic QoL Inventory-74 (GQOLI-74), and clinical response before and after treatment were assessed. Result: After treatment, the JOA scores of patients in both groups were significantly improved, and the increase in the observation group was significantly greater than that in the control group. The VAS scores of patients in both groups were significantly reduced, and the VAS score of the observation group was significantly lower than that of the control group. The scores of all items in the observation group (especially in terms of improvement in physiological and psychological functions) were significantly higher than those in the control group. The treatment response rate in the observation group was 96.8%, significantly higher than the 84% in the control group ( P &lt; 0.05). Conclusion: Warming acupuncture combined with conventional rehabilitation training demonstrated more significant improvements in alleviating clinical symptoms, reducing pain, promoting functional recovery, and enhancing quality of life in patients with LDH, suggesting it may be superior to conventional rehabilitation training alone. However, this study has a limitation: The non-randomized allocation based on patient treatment preferences or clinical policies may introduce selection bias and indication bias, which should be considered when interpreting the results.

Systematic review and meta-analysis of thunder fire moxibustion as adjuvant therapy for lumbar disc herniation

Prospective analysis of clinical evaluation and self-assessment by patients after decompression surgery for degenerative lumbar canal stenosis

To investigate the correlation between preoperative vitamin D levels and postoperative pain and quality of life in young and middle-aged patients with lumbar degenerative disease (LDD). The 228 young and middle-aged LDD patients treated in Shanghai Sixth People's Hospital (China) between January 2022 and December 2023 were chosen for the research. The patients were categorized into an insufficient/deficient group as well as an adequate group on the basis of 25-(OH)D levels. Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and quality of life score (SF-12) of the two groups were compared, respectively. To assess the correlation between preoperative vitamin D and postoperative pain and quality of life in LDD patients. Preoperative 25-(OH)D was positively correlated with postoperative lumbar spine function and life quality, and negatively correlated with postoperative pain and ODI index (P&lt;0.05). The results of multiple linear regression analysis showed that the serum 25-(OH)D level was the main influencing factor for postoperative pain and quality of life in patients with LDD. For every 1ng/mL increase in 25-(OH)D level, the VAS score decreased by 0.091 points and the quality of life score increased by 0.349 points. The lower the preoperative serum vitamin D level in LDD patients, the higher the risk of postoperative pain, the more serious the dysfunction of patients, and the worse the quality of life.

To investigate the correlation between preoperative vitamin D levels and postoperative pain and quality of life in young and middle-aged patients with lumbar degenerative disease (LDD). The 228 young and middle-aged LDD patients treated in Shanghai Sixth People's Hospital (China) between January 2022 and December 2023 were chosen for the research. The patients were categorized into an insufficient/deficient group as well as an adequate group on the basis of 25-(OH)D levels. Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and quality of life score (SF-12) of the two groups were compared, respectively. To assess the correlation between preoperative vitamin D and postoperative pain and quality of life in LDD patients. Preoperative 25-(OH)D was positively correlated with postoperative lumbar spine function and life quality, and negatively correlated with postoperative pain and ODI index (P<0.05). The results of multiple linear regression analysis showed that the serum 25-(OH)D level was the main influencing factor for postoperative pain and quality of life in patients with LDD. For every 1ng/mL increase in 25-(OH)D level, the VAS score decreased by 0.091 points and the quality of life score increased by 0.349 points. The lower the preoperative serum vitamin D level in LDD patients, the higher the risk of postoperative pain, the more serious the dysfunction of patients, and the worse the quality of life.

Analysis of the Characteristics and Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniation

Objective To compare the clinical effects of transforaminal endoscopic minimally invasive operation and lumbar fenestration and decompression internal fixation in the treatment of lumbar disc herniation. Methods Eighty-two patients with lumbar disc herniation, who were hospitalized in our hospital, were included as the subjects in the study and randomly divided into the control group and the study group (n=41 each) . The control group was treated with conventional lumbar fenestration and decompression internal fixation, and the study group was treated with transforaminal endoscopic minimally invasive operation. The changes of the operation indexes between the two groups were compared. The postoperative pain degree was evaluated by visual analogue scale (VAS) . The recovery of the daily living ability was evaluated by Oswestry disability index table (ODI) and the scoring standard of Japanese Orthopaedic Association (JOA) . At one year after the operation, the Macnab evaluation criteria of the surgical effect in low back pain was used to evaluate the efficacy in both groups. The incidence of complications was recorded. Results The operation time, incision length and length of hospital stay in the study group were shorter than those in the control group[ (75.65±15.12) min, (0.68±0.11) cm, (5.11±1.26) d vs (11.26±2.41) d, (6.26±0.47) cm, (300.26±11.26) ml], and the intraoperative blood loss was less than that in the control group [ (26.36±10.55) ml vs (126.81±5.74) min] (P 0.05) . At 48 h, 72 h and 96 h after the operation, the VAS scores in the two groups were lower than those at 24h after the operation (P<0.05) , whereas the VAS scores in the study group at different time points after the operation were lower than those in the control group[ (3.31±0.56) , (2.23±0.56) , (1.16±0.26) , (0.71±0.11) vs (5.36±1.22) , (4.75±0.54) , (3.24±0.37) , (2.21±0.36) ] (P<0.05) . The ODI scores in the study group at 3, 6 and 12 months after the operation were lower than those in the control group[ (18.22±2.11) , (10.23±1.77) , (5.22±1.56) vs (26.87±3.26) , (19.36±1.25) , (10.21±1.28) ], whereas the JOA scores were higher than those in the control group[ (12.35±2.47) , (20.36±1.78) , (26.12±1.33) vs (8.21±1.26) , (15.26±1.46) , (22.21±1.02) ] (P<0.05) . Conclusion Using transforaminal endoscopic minimally invasive operation in the treatment of lumbar disc herniation shows less surgical trauma, high total effective rate, rapid recovery rate, and significantly improved daily living ability in the patients. Key words: Intervertebral disk displacement; Diskectomy; Surgical procedures, minimally invasive