Cases Of Lumbar Disc Herniation Research Articles

Percutaneous full-endoscopic transforaminal discectomy versus open microdiscectomy in the treatment of lumbar disc herniation: randomized controlled trial

BackgroundLumbar disc herniation is one of the most common degenerative spine conditions. In our center, the standard surgical technique for treatment of lumbar disc herniation is open microdiscectomy. The full-endoscopic transforaminal discectomy is done for selective cases of lumbar disc herniation under local anesthesia, achieving good results. This study aims to compare the clinical outcomes, operative data, and complications of the treatment of lumbar disc herniation with “percutaneous full-endoscopic transforaminal discectomy” (TED) and the gold standard “open microdiscectomy" (MD). This was a randomized controlled trial that included 65 patients with lumbar disc herniation: 32 in the TED group and 33 in the MD group.ResultsThere was no statistically significant difference between the two groups with regard to the visual analogue scale (VAS) for leg pain, the VAS for back pain, or the Oswestry Low Back Pain Disability Questionnaire (ODI) score at the end of the 1-year follow-up. The operative time in minutes was statistically shorter in the TED group, with a mean value of 50.38 (± 11.65) and 61.09 (± 12.32) in the MD group. The blood loss was 77.33 CC (± 23.14) in the TED group and 170 CC (± 56.06) in the MD group. The mean duration of hospital stay in days was statistically shorter in the TED group. Exposure to radiation in minutes was higher in the TED group: 1.09 (± 0.33) and 0.18 (± 0.08) in the TED group and MD group, respectively. There was no statistically significant difference in the rate of complications.ConclusionTED showed superiority over MD with regard to blood loss, operative time and shorter hospital stays, but with increased radiation exposure. There was no difference in clinical outcomes regarding VAS for leg and back pain and ODI score at 1 year follow-up with no significant difference in complications.

Analysis of the clinical efficacy of visualization of percutaneous endoscopic lumbar discectomy combined with annulus fibrosus suture in lumbar disc herniation

The objective of this study is to compare the clinical effectiveness of visualization of percutaneous endoscopic lumbar discectomy (VPELD) combined with annulus fibrosus suture technique and simple percutaneous endoscopic lumbar discectomy (PELD) technique in the treatment of lumbar disc herniation. A retrospective analysis was conducted on 106 cases of lumbar disc herniation treated with foraminoscopic technique at our hospital from January 2020 to February 2022. Among them, 33 cases were treated with VPELD combined with annulus fibrosus suture in group A, and 73 cases were treated with PELD in group B. The preoperative and postoperative visual analogue scale (VAS), functional index (Oswestry Disability Index, ODI), healing of the annulus fibrosus, intervertebral space height, and postoperative recurrence were recorded and compared between the two groups. All patients underwent preoperative and postoperative MRI examinations, and the average follow-up period was 12 ± 2 months. Both groups showed significant improvements in postoperative VAS and ODI scores compared to the preoperative scores (P < 0.05), with no statistically significant difference between the groups during the same period (P > 0.05). There was no significant decrease in intervertebral space between the two groups after surgery (P > 0.05). Group A showed significantly lower postoperative recurrence rate and better annulus fibrosus healing compared to group B (P < 0.05). The VPELD combined with annulus fibrosus suture technique is a safe, feasible, and effective procedure for the treatment of lumbar disc herniation. When the indications are strictly adhered to, this technique can effectively reduce the postoperative recurrence rate and reoperation rate. It offers satisfactory clinical efficacy and can be considered as an alternative treatment option for eligible patients.

Monocentric experience of transforaminal endoscopic lumbar discectomy and foraminotomy outcomes: pushing the indications and avoiding failure. Report of 200 cases.

This paper reports the results of the treatment of our first 200 cases of lumbar disc herniation and foraminal stenosis using full-endoscopic transforaminal lumbar discectomy (FETLD). We analyzed outcomes and radiological parameters to overcome failure and inappropriate indications and also highlighted the red flags for surgeons coming to this field as well as the pathways to success. Data on endoscopic procedures were retrospectively analyzed between October 2018 and March 2023. We abstracted sex, age, leg pain by NPRS, postoperative satisfaction according to the MacNaab score, postoperative surgical complications/adverse events (≤30 days), and history of any previous surgery. Furthermore, we measured different radiological parameters to determine the grade of stenosis or discopathy. Once the learning curve was completed, patients' satisfaction increased to 94%, with only a small percentage (6%) of patients unsatisfied 30 days after the operation. Perioperatively, 33.5% of the patients experienced mild to moderate transitory paresthesia. Univariate analysis showed a tendency toward a higher risk of failure in those patients with degenerative listhesis (odds ratio [OR] 4.8, 95% CI 0.97-23.9, P=0.055) as well as those with severely degenerated discs (OR 8.7, 95% CI 0.96-79.4, P=0.054). Conversely, the chances of failure seemed to be lower in patients with severe foraminal stenosis. FETLD proved its efficacy in treating several degenerative spine conditions or was useful for avoiding previous scarring in patients already operated on to the same extent. Therefore, FETLD can be safely used in patients with comorbidities, the elderly, and when the invasiveness of an open technique is not suitable.

Factors Influencing Recurrence Rates and Surgical Outcomes in Lumbar Microdiscectomy: A Retrospective Study of 130 Patients in Turkey.

BACKGROUND Lumbar disc herniation surgery, specifically lumbar microdiscectomy, shows recurrence in 3-24% of patients, necessitating potential re-operations. This study focuses on the outcomes and recurrence causes in 130 cases of lumbar disc herniations. These cases were managed by a single surgeon at a single center, offering a unique perspective on a common issue in neurosurgery. MATERIAL AND METHODS The study involved 130 patients treated for lumbar disc herniations. Analysis considered various factors: age, sex, symptoms, surgical level, complications, pre- and postoperative pain levels, and quality of life indices. RESULTS Of the 130 cases analyzed, all underwent initial surgery by the same surgeon or sought treatment from this surgeon after recurrence. Inclusion criteria were based on radiologic and clinical indications for re-operation. The demographic split was 76 males (56.4%) and 54 females (43.6%). A notable finding was a higher recurrence rate in males and patients under 45 years, although the sex difference was not statistically significant. The average age was 47.5 years. Significant changes were noted in the Oswestry Disability Index (ODI) levels during follow-ups (P<0.001). CONCLUSIONS This study underscores the effectiveness of lumbar microsurgery in treating recurrent lumbar disc herniations. Techniques such as medial facet utilization and laminectomy border expansion show promise. However, determining instability rates requires long-term patient follow-up. Our findings contribute valuable insights into surgical approaches and patient outcomes in recurrent lumbar disc herniation cases.

Lumbar Disc Herniation Cases in Herat Regional Hospital in 2021

Background and Objective: Lumbar disc herniation is the most common reason for spine surgery in the working-age population. Understanding the epidemiological pattern of lumbar disc herniation helps identify predisposing factors for this type of injury. Since epidemiological studies on lumbar disc herniation surgery in Afghanistan are scarce, the aim of this study is to investigate the epidemiological aspects of these cases in the neurosurgical department of Herat city.&#x0D; Methods: In this cross-sectional descriptive study conducted from March 2021 to March 2022 at the regional hospital in Herat, data on demographic information, occupation, symptoms, and complications related to lumbar disc herniation surgery were collected and analyzed for 68 patients.&#x0D; Results: The findings indicate that the majority of lumbar disc herniation surgeries occurred in individuals over 30 years of age (70.6%) and among males (66.2%), with about two-thirds of cases (69.1%) occurring in construction workers. Based on the results, 76.4% of the cases involved the L4-L5 vertebral level, and 88.2% of patients, in addition to lower back pain, experienced sensory disturbances in their legs. Although the majority of patients (89.7%) had no complications, the most significant complication among the patients was urinary incontinence (5.9%).&#x0D; Conclusion: The results of this study emphasize the higher prevalence of lumbar disc herniation surgeries in specific age and gender groups. Public and healthcare worker education regarding the factors and risks of lumbar disc herniation could be beneficial. Conducting broader studies nationwide to determine the exact occurrences and complications of lumbar disc herniation is crucial.

CircRNA GRB10 is a Novel Biomarker for the Accurate Diagnosis of Lumbar Degenerative Disc Disease.

Lumbar degenerative disc disease (LDDD) is frequently misdiagnosed as other spine conditions, and the accurate diagnosis is challenging. This study was conducted to explore the role of circRNA GRB10 in the accurate diagnosis of LDDD. This study included 60 cases of LDDD, 60 cases of patients with sacroiliac joint pain (SJP), 60 cases of lumbar disc herniation (LDH), 60 cases of piriformis syndrome (PS), 60 cases of entrapment neuropathy (EN) and 60 cases of healthy controls (HCs). Plasma was obtained from each patient before and after treatment. Expression of GRB10 was studied with RT-qPCR. The role of plasma GRB10 in the accurate diagnosis of LDDD was analyzed by ROC curve analysis. Compared to HCs, decreased accumulation of GRB10 RNA was only observed in LDDD group, but not in SJP, LDH, PS and EN groups. With plasma expression level of GRB10 measured before treatment as a biomarker, LDDD patients were separated from SJP, LDH, PS, EN and HC groups. After treatment, increased expression levels of GRB10 were only observed in LDDD group, but not in other groups. Therefore, GRB10 was downregulated in LDDD and may serve as a biomarker for the accurate diagnosis of LDDD.

Development and clinical application of a new transverse process retractor based on computer-aided design and 3D printing technology

To manufacture a new type of transverse process retractor by using computer-aided design(CAD) combined with 3D printing technology and investigate its clinical application effect. A new type of transverse protrusion retractor was developed by CAD combined with 3D printing technology. From September 2018 to September 2019, the new transverse process retractor was applied in clinic. Sixty patients with lumbar single segment lesions who needed treatment by pedicle screw fixation, bone grafting and interbody fusion were divided into new transverse process retractor group and control group, with 30 cases in each group. There were 14 males and 16 females in new type transverse process retractor group, the age was (68.0±4.3) years old on average; lesion segment of 8 cases were L3,4, 9 cases were L4,5, 13 cases were L5S1;5 cases of lumbar disc herniation, 20 cases of lumbar spinal stenosis, 5 cases of degenerative lumbar spondylolisthesis;new transverse process retractor was used to pedicle screw placement. While there were 15 males and 15 females in control group, with an average age of (69.2±4.5) years old;lesion segment of 8 cases were L3,4, 10 cases were L4,5, 12 cases were L5S1;5 cases of lumbar disc herniation, 21 cases of lumbar spinal stenosis, 4 cases of degenerative lumbar spondylolisthesis;the traditional lamina retractor was used for soft tissue pulling and finished pedicle screw placement by freehand. The length of surgical incision, the time required for inserting a single screw, fluoroscopy times, the times of adjusting the positioning needle or screw in insertion process, and the visual analogue scale (VAS) of surgical incision 72 hours after operation were compared between two groups. Using CAD and 3D printing technology, a new type of transverse protrusion retractor was developed quickly. The length of surgical incision, the time required for inserting a single screw, fluoroscopy time, and the times of adjusting the positioning needle or screw in insertion process in new transverse process retractor group were less than those in control group(P<0.05). There was no significant difference in VAS of lumbar incision pain at 72 hours after operation between two groups(P>0.05). Using CAD combined with 3D printing technology to develop a new transverse protrusion retractor has the advantages of convenient design, short development cycle and low cost. It provides a new idea for the research and development of new medical devices. The new transverse process retractor has the advantages of easy operation, reliable fixation, less damage to paravertebral muscle, convenient pedicle screw placement, reducing fluoroscopy time and so on.

COVID-19 and low back pain: previous infections lengthen recovery time after intradiscal ozone therapy in patients with herniated lumbar disc.

PurposeTo assess and compare the clinical effectiveness of percutaneous intradiscal ozone therapy in patients affected by lumbar disc herniation, with and without history of COVID-19 infection.Materials and MethodsAfter the rising of COVID-19 pandemics in Italy, 47 consecutive percutaneous intradiscal ozone therapies were performed on patients with low back pain and/or sciatic pain due to lumbar disc herniation. Among these, 19 had suffered from COVID-19 and successively recovered with no residual symptoms, while the remaining 28 had not previously been affected by COVID-19 and were not convalescent. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-up in order to assess the clinical outcome.ResultsThe two groups were similar in terms of patient age (p-value 0.54), treated levels (p-value 0.26) and pre-procedure ODI (p-value 0.33). Technical success was achieved in all cases. In patients previously affected by COVID-19, mean ODI decrease was 11.58 ± 9.51 (35.72%) at 1-month follow-up and 20.63 ± 9.87 (63.63%) at 3-month follow-up. In patients never affected by COVID-19, mean ODI decrease was 20.93 ± 10.53 (58.73%) at 1-month follow-up and 22.07 ± 11.36 (61.92%) at 3-month follow-up. Eventually, clinical success was registered in 84.21% (16/19) of patients with history of COVID-19 infection and in 85.71% (24/28) of patients with no history of COVID-19 infection. No major complication was registered.ConclusionsIn case of lumbar disc herniation treated with percutaneous intradiscal ozone therapy, patients previously affected by COVID-19 showed a significantly longer recovery time.

Treatment of sciatica by lumbar nerve root canal injection under X-ray angiography

To investigate the short-term clinical effect of lumbar nerve root canal injection under X-ray angiography in the treatment of sciatica. The clincal data of 78 patients with sciatica underwent lumbar nerve root canal injection under X-ray angiography from December 2017 to February 2020 was retrospectively analyzed. Including 31 males and 47 females, aged from 22 to 88 years old with a median of 65 years. There were 55 cases of lumbar disc herniation and 23 cases of lumbar spinal stenosis, the course of disease ranged from 1 to 8 weeks with a median of 3 weeks. There were 71 cases of single segment disc herniation or stenosis, including L3,4 of 5 cases, L4,5 of 61 cases, L5S1 of 5 cases, and 7 cases of multisegment herniation or stenosis. The pain visual analogue scale (VAS) was recorded and Macnab was used to evaluate the clinical effect. All patients completed standardized treatment without serious adverse reactions. VAS were (3.21±0.76) scores immediately after treatment, (2.89±0.33) scores 1 hour after treatment, (1.80±0.27) scores 6 hours after treatment, (1.10±0.20) scores 24 hours after treatment, (2.53±0.35) scores 1 week after treatment and (4.27±0.36) scores 1 month after treatment. There were significant differences in VAS between before treatment(7.83±0.56) and each time period after treatment(P<0.05). According to Macnab low back pain evaluation standard, 42 cases were effective, 34 cases were markedly effective and 2 cases were ineffective within 24 hours after treatment, with an effective rate of 97.4%;38 cases were effective, 25 cases were markedly effective, 15 cases were ineffective within one week after treatment, the effective rate was 80.0%;32 cases were effective, 22 cases were markedly effective, 24 cases were ineffective within one month after treatment, the effective rate was 69.2%. The short-term clinical effect of nerve root canal injection under X-ray radiography in the treatment of sciatica is good and it is an effective method to relieve sciatica.

A Case of Lumbar Disc Herniation Penetrating the Ventral and Dorsal Dura Mater with Notable Osteophytes

Introduction : The most common symptoms of lumbar disc herniation are low back and lower limb pain, but emergency surgery is generally only required in cases with severe lower limb muscle weakness and bladder and rectal disorder. A herniated disc that penetrates the dura mater can trigger an intradural herniation (IDH). Although there are no specific symptoms of IDH, it often causes acute and severe neuropathy. Here, we report a case with residual postoperative dysuria due to IDH.

Risk Factors and Scoring System of Cage Retropulsion after Posterior Lumbar Interbody Fusion: A Retrospective Observational Study.

ObjectiveTo investigate risk factors of cage retropulsion after posterior lumbar interbody fusion (PLIF) in China and to establish a scoring system of cage retropulsion.MethodsThe retrospective analysis was based on two hospital databases. The medical data records of posterior lumbar interbody fusion with cage retropulsion were selected from August 2009 to August 2019. Inclusion and exclusion criteria were set in advance. Risk factors including patients' baseline demographics (age, gender, operation diagnosis time difference), preoperative neurological symptoms, whether the fusion involves single or double segments, screw type, intraoperative compression, preoperative bone mineral density, whether there are neurological symptoms before surgery, whether there is urine dysfunction before surgery, disease type, complete removal of the endplate, and patient's education level. The research endpoint was the retropulsion of fusion cages. The Kaplan–Meier (K‐M) method was used to analyze potential risk factors, and multivariate Cox regression was used to identify independent risk factors (P < 0.05). The Statistical Package for the Social Sciences (version 22.0; SPSS, IBM, Chicago, IL, USA) software was used for statistical analysis, and univariate analysis was used to screen out the factors related to cage retropulsion. All independent risk factors were included to predict the survival time of the retropulsion of cage.ResultsThis study included a total of 32 patients with PLIF between 2009 to 2019. All patients were residents of China. Univariate analysis showed that there were 13 patients over 60 years old and 19 patients under 60 years old. There were 20 male patients and 12 female patients. The surgical diagnosis time was seven patients within 1 month, 17 patients within 1 to 3 months, and eight patients over 3 months. The disease type was 18 cases of lumbar disc herniation, 10 cases of lumbar spinal stenosis, four cases of lumbar spondylolisthesis. The fusion segment was 18 cases of single segment, 14 cases of double segment. The intraoperative compression was seven cases of compression, 25 cases of no compression. The preoperative bone mineral density was 10 cases of low density, 18 cases of normal, four cases of osteoporosis. The screw type was 27 cases of universal screw, five cases of one‐way screw. Preoperative neurological symptoms were found in 25 cases and not in seven cases. Preoperative urination dysfunction occurred in 8 cases, whereas 24 cases did not have this dysfunction. The endplate was completely removed in 10 cases and not in 22 cases. Education level was nine cases of primary school education, 10 cases of secondary school, 13 cases of university level. Cox regression analysis showed that intraoperative pressure (hazard ratio [HR] = 4.604, P = 0.015) and complete removal of the endplate (HR = 0.205, P = 0.027) are associated with the time of cage retropulsion. According to the HR of each factor, the scoring rules were formulated, and the patients were divided into the low‐risk group, moderate‐risk group, and high‐risk group according to the final score. The three median survival times of the three groups were 66 days in the low‐risk group, 55 days in the moderate‐risk group, and 45 days in the high‐risk group, with statistical significance (P < 0.05).ConclusionIntraoperative pressure and complete removal of the intraoperative endplate can be helpful to evaluating the expected time of cage retropulsion in patients with PLIF, and this clinical model guided the selection of postoperative prevention and follow‐up treatment.

Comparison of surgical and nonsurgical treatment of lumbar disc herniation with motor deficit: A prospective study

INTRODUCTION: Several studies had compared the differences between surgical and nonsurgical modalities of treatment for patients with herniated discs. Some studies announced several modalities for treating motor weakness caused by lumbar disc herniation but few randomized control trials had compared the efficacy of one treatment over the other treatment except cross-over treatment. This study excludes patients underwent cross over treatment. This study aims to assess outcomes of patients of lumbar disc herniation with motor deficit who underwent surgical treatment with a patient group who underwent nonsurgical treatment. Subjects and Methods: We included 75 cases of lumbar disc herniation with the motor deficit in our tertiary healthcare center. Thirty-six patients were treated with a microdiscectomy, and 39 patients were treated conservatively prospectively from June 2018 to June 2019. The minimum follow-up period was 1 year, i.e., at 1, 3, 6, and 12 months, respectively. Visual analog scale compares outcomes for pain evaluation, motor function by Medical Research Council scale and Oswestry Low Back Pain Questionnaire for overall health quality of life. RESULTS: Patients who undertook surgical treatment shown rapid recovery of the motor deficit, as well as rapid alleviation of symptoms in the first 6 months, postoperatively compared to the nonsurgical group. The difference was statistically significant between both groups in the initial period but the difference, was no longer significant during the final follow-up examination at 1 year. CONCLUSION: Early surgical treatment of properly selected patients of severe motor weakness and severe pain from disc herniation could provide a chance for rapid alleviation.

Transforaminal Endoscopic Surgery: Outside-In Technique

Transforaminal endoscopic lumbar discectomy (TELD) with the outside-in technique can be applied to nearly all cases of lumbar disc herniation (LDH), and transpedicular endoscopic lumbar discectomy can be used to treat highly migrated LDHs. The purpose of this study was to outline these 2 outside-in surgical techniques and to present their clinical outcomes. Between January 2018 and January 2019, a total of 137 patients underwent either transforaminal or transpedicular endoscopic lumbar discectomy. We performed TELD in 124 patients and transpedicular endoscopic lumbar discectomy in 13 cases. All surgical procedures were performed under conscious sedation. The patients’ mean age was 51.3 years; 51 were women and 86 were men. The overall disc recurrence rate was 5.12%. Visual analogue scale scores decreased significantly in both groups. According to the MacNab criteria, good and excellent results were obtained in 92.74% of patients after transforaminal and in 92.30% of patients after transpedicular endoscopic LDH treatment. The results suggest that TELD with the outside-in technique can be effective for the treatment of most cases of LDH. Transpedicular endoscopic lumbar discectomy can be considered as an alternative treatment for highly migrated LDH.

Preoperative radiographic clues for transdural disc herniation: could it be predictable?

Transdural disc herniation (TDH) is a rare event accounting for 0.3-1.5% of all disc herniation cases. Considering the risk of leakage of the cerebrospinal fluid from the dural defect after removal of TDH or incomplete removal, it is very important to recognize TDH before surgery. This study is a retrospective case analysis to analyze the imaging findings of seven cases and to construct a preoperative prediction model for TDH. Retrospective radiographic examination was performed among patients operated for TDH in two institutions from 2008 to 2018. The radiographic images were analyzed according to the following eight signs: including absence of dural tent, complete block of spinal canal, hawk-beak sign, double-layered lesion, increased distance between the dura and cauda equina, rim enhancement, dural tent enhancement, and epidural gas. To clarify the predictive ability of these radiographic signs, consecutive 131 surgically confirmed epidural disc herniation (EDH) patients for the last 2years were set as a control group for TDH. The sum of radiographic findings was compared between TDH and EDH patients to determine the cutoff value. There were 1 thoracic and 6 lumbar TDHs among 75 thoracic and 6674 lumbar disc herniation cases with an incidence of 1.33% and 0.09%, respectively. Dural tent (p = 0.000, odds ratio = 106.67), double-layered lesion (p = 0.000, odds ratio = 22.69), and distance between the dura and cauda equina (p = 0.007, odds ratio = 52.00) were statistically significantly different between TDH and EDH. According to the receiver operating characteristic curve, the cutoff value of 1.5 had 85.7% sensitivity and 90.8% specificity. Preoperative imaging can be useful for TDH diagnosis. It is safe to consider the possibility of TDH in patients with more than two findings in the preoperative images.

Complications, reoperations, readmissions, and length of hospital stay in 34 639 surgical cases of lumbar disc herniation.

The aims of this study were to determine the rates of surgical complications, reoperations, and readmissions following herniated lumbar disc surgery, and to investigate the impact of sociodemographic factors and comorbidity on the rate of such unfavourable events. This was a longitudinal observation study. Data from herniated lumbar disc operations were retrieved from a large medical database using a combination of procedure and diagnosis codes from all public hospitals in Norway from 1999 to 2013. The impact of age, gender, geographical affiliation, education, civil status, income, and comorbidity on unfavourable events were analyzed by logistic regression. Of 34 639 operations, 2.7% (95% confidence interval (CI) 2.6 to 2.9) had a surgical complication, 2.1% (95% CI 2.0 to 2.3) had repeat surgery within 90 days, 2.4% (95% CI 2.2 to 2.5) had a non-surgical readmission within 90 days, and 6.7% (95% CI 6.4 to 6.9) experienced at least one of these unfavourable events. Unfavourable events were found to be associated with advanced age and comorbidity. The results suggest that surgical complications are less frequent than previously suggested. There are limited associations between sociodemographic patient characteristics and unfavourable events. Cite this article: Bone Joint J 2019;101-B:470-477.

Clinical outcomes of allograft Cages in transforaminal lumbar interbody fusion

To explore the fusion effect of allograft Cages on transforaminal lumbar interbody fusion (TLIF). The clinical data of 30 patients (38 vertebral segments) who underwent TLIF with allograft interbody fusion Cages between January 2015 and January 2017 were retrospectively analysed. There were 25 males and 5 females with an average age of 56.9 years (range, 44-72 years). The lesions included 20 cases of lumbar disc herniation, 7 cases of lumbar spondylolisthesis, and 3 cases of lumbar spinal stenosis. The operation section included 4 cases of L 3, 4, 13 cases of L 4, 5, 5 cases of L 5, S 1, 6 cases of L 4, 5-L 5, S 1, and 2 cases of L 3, 4-L 4, 5. The disease duration was 6-36 months (mean, 12 months). The clinical effectiveness was evaluated by visual analogue scale (VAS) score, Oswestry disability index (ODI), and Japanese Orthopaedic Association (JOA) score at preoperation, 3 months and 6 months after operation, and last follow-up. The fusion rate was evaluated by anteroposterior and lateral X-ray films and CT three-dimensional reconstruction at 3 and 6 months after operation. The intervertebral space height was measured on anteroposterior and lateral X-ray films at preoperation, 3 days, 3 months, and 6 months after operation. The operation time was 2.1-4.3 hours (mean, 3.1 hours), and the intraoperative blood loss was 150-820 mL (mean, 407.5 mL). The follow-up time was 8-25 months (mean, 16.4 months). One Cage split at 6 months after operation without Cage movement and neurologic symptoms; none of the other patients had Cage prolapse, displacement, and fragmentation. No local or systemic allergy or infection signs was found in all patients. No nerve compression or symptoms was observed during the follow-up. The postoperative VAS score, ODI score, and JOA score improved significantly when compared with preoperative scores ( P<0.05); and the scores at 6 months and at last follow-up were significantly improved when compared with those at 3 months after operation ( P<0.05); but no significant difference was found between at 6 months and at last follow-up ( P>0.05). The fusion rate was 55.3% (21/38), 92.1% (35/38), and 100% (38/38) at 3 months, 6 months, and last follow-up postoperatively. The intervertebral space height was increased significantly at 3 days, 3 months, 6 months, and last follow-up postoperatively when compared with preoperative ones ( P<0.05); and the loss of intervertebral space height was significant at last follow-up when compared with postoperative at 3 days ( P<0.05). The allograft interbody fusion Cage contributes to the spine interbody fusion by providing an earlier stability and higher fusion rate.

Influence of post-discharge telephone follow-up on rehabilitation effect of lumbar disc herniation with the application of Wallis elastic internal fixation for postoperative patients

Objective To discuss about the influence of post-discharge telephone follow-up on rehabilitation effect of lumbar disc herniation with the application of Wallis elastic internal fixation for postoperative patients. Methods Postoperative 3-month and postoperative 6-month telephone follow-ups were conducted to 75 cases of lumbar disc herniation with the application of Wallis elastic internal fixation.The preoperative and postoperative 3-month, postoperative 6-month JOA score and ODI score, lumbago and backache VAS score and lower limb pain VAS score of patients were compared.In addition, preoperative, postoperative 3-month, postoperative 6-month functional exercise accuracy rate, compliance rate and satisfaction rate of patients were compared. Results After 3 months and 6 months after surgery, the VAS score, lower limb pain VAS score, JOA score and ODI score were statistically significant (P<0.05). The accuracy rate, compliance rate and patient satisfaction rate of the patients after 3 months and 6 months after surgery were higher than those before surgery, and the difference was statistically significant(P<0.05). Conclusion Telephone follow-up can help improve the symptoms of patients, improve accuracy rate and compliance rate of rehabilitation training, improve the satisfaction of patients, which is worth having clinical popularization and application. Key words: The telephone follow-up; Lumbar disc; Wallis elastic internal fixation; Rehabilitation

Association of decision-making in spinal surgery with specialty and emotional involvement-the Indications in Spinal Surgery (INDIANA) survey.

Although recent trials provided level I evidence for the most common degenerative lumbar spinal disorders, treatment still varies widely. Thus, the Indications in Spinal Surgery (INDIANA) survey explores whether decision-making is influenced by specialty or personal emotional involvement of the treating specialist. Nationwide, neurosurgeons and orthopedic surgeons specialized in spine surgery were asked to answer an Internet-based questionnaire with typical clinical patient cases of lumbar disc herniation (DH), lumbar spinal stenosis (SS), and lumbar degenerative spondylolisthesis (SL). The surgeons were assigned to counsel a patient or a close relative, thus creating emotional involvement. This was achieved by randomly allocating the surgeons to a patient group (PG) and relative group (RG). We then compared neurosurgeons to orthopedic surgeons and the PG to the RG regarding treatment decision-making. One hundred twenty-two spine surgeons completed the questionnaire (response rate 78.7%). Regarding DH and SS, more conservative treatment among orthopedic surgeons was shown (DH: odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-9.7, p = 0.001; SS: OR 3.9, CI 1.8-8.2, p < 0.001). However, emotional involvement (PG vs. RG) did not affect these results for any of the three cases (DH: p = 0.213; SS: p = 0.097; SL: p = 0.924). The high response rate indicates how important the issues raised by this study actually are for dedicated spine surgeons. Moreover, there are considerable variations in decision-making for the most common degenerative lumbar spinal disorders, although there is high-quality data from large multicenter trials available. Emotional involvement, though, did not influence treatment recommendations.

Primary Leptomeningeal Lymphoma Presenting as Low Back Pain and Dementia: A Case Report

Primary leptomeningeal lymphoma (PLL) is an extremely rare condition, with only a handful of cases reported in literature. Most often, these are misdiagnosed as other disease entities that are more commonly observed in practice. Currently, there are no clinical algorithms that may guide clinicians to clinching a diagnosis of PLL. This paper discusses a remarkable case of PLL presenting with atypical symptoms namely dementia and low back pain. This is a case of an apparently well adult male who initially presented with low back pain that was treated for two years as a case of lumbar disc herniation. This developed into lower extremity weakness and was subsequently followed by dementia and seizures. The patient was initially treated for tuberculous meningitis after CSF findings showed lymphocytic predominance. However, lack of clinical improvement prompted further work up revealing a malignant process in the lumbosacral meninges. Dural biopsy showed atypical mononuclear infiltrates consistent with a B-cell non-Hodgkin lymphoma with immunohistochemistry showing CD20 positive, CD79a positive, CD3 negative. Being MUM1 positive and BCL2 positive suggests it being a diffuse large B cell lymphoma. A primary malignancy of the leptomeninges was ruled in after PET CT showed no other sites of high metabolic activity. The patient was able to complete 6 cycles of high dose Methotrexate and three Rituximab doses. Remarkably, after more than two years after his initial presentation, he still has mild signs of dementia but is able to carry out most activities of daily living with minimal assistance. The patient has survived beyond the expected life expectancy for PLL.

Zhang’s bone-setting Caiqiao massage therapy for the treatment of 80 pain-dominant non-acute lumbar disc herniation cases

Zhang’s bone-setting Caiqiao massage therapy for the treatment of 80 pain-dominant non-acute lumbar disc herniation cases