Treatment Of Disc Herniation Research Articles

Correction to Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Correction to Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Evolution of Thoracic Disc Herniation Surgery: Future Perspectives from a Systematic Review and Meta-Analysis

Background: The neurosurgical treatment of thoracic disc herniation (TDH) has undergone dramatic changes over the years in terms of surgical approaches and intraoperative technological tools. There is still no unanimous consent on the criteria for approach selection, and the choice varies among Institutions. The aim of this study is to compare anterior and posterolateral approaches for TDH in terms of functional and surgical outcomes. Methods: A systematic literature review and meta-analysis according to PRISMA guidelines from EMBASE, PubMed, Cochrane Library, Web of Science, and Google Scholar online databases up to May 2024 incorporated studies that reported outcomes of thoracic disc herniation surgeries. Analyzed factors included major peri- and postoperative complications, intraoperative blood loss, hospital stay, neurological improvement, and complete hernia resection. Random-effect models were used to calculate pooled odds ratios and mean differences. Results: The posterolateral approach was associated with significantly lower rates of major medical (OR 0.14, 95% CI: 0.07 to 0.27) and surgical complications (OR 0.61, 95% CI: 0.38 to 0.99) compared to the anterior approach. Additionally, posterolateral approaches reduced intraoperative blood loss and shorter hospital stays. Posterolateral techniques were linked to higher odds of neurological improvement (OR 0.65, 95% CI: 0.43 to 0.99) and higher rates of complete hernia resection (OR 0.38, 95% CI: 0.21 to 0.71). Conclusions: Posterolateral approaches offer advantages in terms of safety, recovery, neurological improvement, and complete hernia resection. More extensive prospective studies are needed to confirm these findings and refine surgical strategies. Emerging technologies, such as the exoscope and 45° endoscopy, may further enhance surgical outcomes.

Brain plasticity following lumbar disc herniation treatment with spinal manipulation therapy based on resting-state functional magnetic resonance imaging

As a prevalent spine disorder, Lumbar disc herniation (LDH) has been affecting more than 2 % of the worldwide population and is characterised by uncertain causes and recurring episodes. Studying the brain activity of patients could potentially provide insights into its pathogenesis and significantly enhance therapy. Therefore, we here examined brain function in patients under Spinal Manipulative Therapy (SMT). By analysing regional homogeneity (ReHo) at different frequency bands, we identified the discrepancies in brain activity between LDH patients and healthy people, highlighting the frequency dependence of spontaneous low-frequency oscillations among patients with LDH. Choosing seeds based on the peak ReHo differences helped to elucidate the functional connectivity alterations in the brain regions of LDH. Overall, this study showed that SMT significantly reduced pain, improved dysfunction, and partially rectified aberrant local consistency and functional connection in patients with LDH, not only offering insights into the pathophysiology of LDH from a neurological standpoint, but also providing inspiration for the development of new therapies based on neurobiology.

Posterior Biportal Endoscopic Discectomy for the Treatment of Central Cervical Disc Herniation: Technical Note and Preliminary Results

To evaluate the preliminary outcomes and clinical efficacy of a novel posterior biportal endoscopic technique in the treatment of central cervical disc herniation (CCDH). A total of 11 patients with symptomatic CCDH who met the inclusion criteria underwent posterior biportal endoscopic discectomy between December 2021 and May 2023. The surgical procedure involved flavectomy, foraminotomy, pediculoplasty, and discectomy using 30° and 45° arthroscopes and specialized minimally invasive tools. Functional outcomes were assessed using the Japanese Orthopedic Association scoring system, Neck Disability Index, and visual analog scale for axial neck pain. Clinical efficacy was evaluated at the final follow-up using the modified Macnab criteria. All 11 patients successfully underwent posterior biportal endoscopic discectomy with a mean operative time of 82.7±10.1minutes and mean estimated blood loss of 31.8±9.8ml. The mean hospital stay was 5.2±1.1days, and the mean follow-up period was 13.8±2.4months. Significant improvements were observed in Neck Disability Index, Japanese Orthopedic Association, and visual analog scale scores. Clinical efficacy was rated as excellent in 3 patients, good in 6 patients, and fair in 2 patients according to the modified Macnab criteria. No cases of cervical instability or kyphosis were observed during postoperative follow-up. The novel posterior biportal endoscopic technique demonstrated significant clinical efficacy and safety in treating CCDH, with marked improvements in clinical outcomes, rapid postoperative recovery, and a low incidence of complications.

UBE as a modern approach to the surgical treatment of intervertebral disc herniations with lumbar spinal stenosis

Aim. To improve the results of surgical treatment of lumbar disc herniation using biportal endoscopy.Material and Methods. We analysed the diagnostic data and surgical results of 23 patients diagnosed with disc herniation and stenosis in the lumbar spine. The study period covers the years 2021 to 2023. During the study, all 23 patients underwent a series of diagnostic procedures: clinical neurological examination, CT, MRI and functional radiography. The patients were divided into 2 groups according to the method of surgical intervention: the main group (n=23), where unilateral biportal endoscopy was used, and the control group (n=20), where endoscopic discectomy was used.Results. Long-term outcomes were assessed using the MacNab scale at 9 months after surgery. 82.6% of patients had excellent outcomes. In 2 (8.8%) cases, the results were good; these patients had moderate pain that had completely disappeared by the time they were discharged from hospital. One patient (4.3%) had a satisfactory result, but continued to have moderate nagging pain, which disappeared in the first seven days after discharge from the medical facility. Poor outcome was reported in 1 case (4.3%); this patient had persistent radicular pain due to the development of postoperative neuritis. There were no cases of recurrent disc herniation.Conclusion. The unilateral biportal endoscopic discectomy (UBE) is a minimally invasive and promising technique that can be used as an alternative to the traditional open surgical approach.

P203. Influence of preoperative disability on outcomes following primary surgical treatment of cervical disc herniation

P203. Influence of preoperative disability on outcomes following primary surgical treatment of cervical disc herniation

Clinical effects of endoscope-assisted anterior cervical discectomy, fusion, internal fixation, and conventional surgery on treatment of cervical disc herniation

Clinical effects of endoscope-assisted anterior cervical discectomy, fusion, internal fixation, and conventional surgery on treatment of cervical disc herniation

Research Status and Prospects of Traditional Chinese Medicine in the Treatment of Lumbar Intervertebral Disc Herniation

Research Status and Prospects of Traditional Chinese Medicine in the Treatment of Lumbar Intervertebral Disc Herniation

Histopathologic degenerative score as a predictor of minimal clinically important difference in pain and functionality following surgical treatment for disc herniation.

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 magnetic resonance imaging (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, HDS ≥ 7 was predictive (OR = 6.25, 95%CI: 2.56-15.23) of disability outcomes measured with MCID-ODI (AUC: 0.692, 95%CI: 0.609-0.767, P < 0.001), and HDS ≥ 8 was predictive (OR = 1.72, 95%CI: 1.04-2.77) of persistent pain measured with MCID-VAS (AUC: 0.628, 95%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.

Research Progress in the Treatment of Lumbar Intervertebral Disc Herniation Based on the Theory of "the Liver Is in Charge of Tendons and the Kidney Is in Charge of Bones"

"Liver is the master of tendon and kidney is the master of bone" is an important theoretical source for the treatment of lumbar disc herniation (LDH) in traditional Chinese medicine (TCM). Most of the patients with LDH are in liver and kidney deficiency, and the treatment of LDH is often based on traditional Chinese medicines that tonify the liver and kidneys. With the development of modern medicine, some progress has been made in recent years on the pathogenesis, diagnostic imaging and therapeutic mechanism of LDH based on the theory of "the liver is in charge of the tendons and the kidney is in charge of the bones", and this article will briefly review these aspects to provide a reference for the better utilization of this theory in the treatment of LDH.

Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis.

Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH. PubMed, MEDLINE, EMBASE, and Scopus were systematically searched for the term "thoracic disc herniation" up to March 2023 and study quality appraised with a subsequent meta-analysis. Primary outcomes were perioperative complications, need for instrumentation, and reoperations. Simultaneously, we performed a multicenter retrospective evaluation of outcomes in patients undergoing full endoscopic thoracic discectomy. We identified 3190 patients from 108 studies for the traditional thoracic discectomy meta-analysis. Pooled incidence rates of complications were 25% (95% CI 0.22-0.29) for perioperative complications and 7% (95% CI 0.05-0.09) for reoperation. In this cohort, 37% (95% CI 0.26-0.49) of patients underwent instrumentation. The pooled mean for estimated blood loss for traditional approaches was 570 mL (95% CI 477.3-664.1) and 7.0 days (95% CI 5.91-8.14) for length of stay. For FESS, 41 patients from multiple institutions were retrospectively reviewed, perioperative complications were reported in 4 patients (9.7%), 4 (9.7%) required revision surgery, and 6 (14.6%) required instrumentation. Median blood loss was 5 mL (IQR 5-10), and length of stay was 0.43 days (IQR 0-1.23). The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic TDH. When compared with open surgical approaches, FESS dramatically diminishes invasiveness, the rate of complications, and need for prolonged hospitalizations. Full endoscopic spine surgery has the capacity to alter the standard of care for TDH treatment toward an elective outpatient surgery.

Clinical Outcomes of Percutaneous Endoscopic Transforaminal Discectomy for the Treatment of Disc Herniation: A 3-Year Retrospective Study.

Percutaneous endoscopic transforaminal discectomy (PELD) is a new minimally invasive spine surgery for patients with lumbar disc herniation (LDH). Based on the 3-year follow-up data, the effect of PELD on the clinical outcomes of patients with LDH through a retrospective cohort study was analyzed in this article, so as to provide guidance for clinical selection of surgical options. The clinical data of 150 patients with LDH admitted to our hospital from January 2019 to October 2020 were retrospectively analyzed. According to the surgical methods recorded in the medical record system, the patients were divided into the open lumbar microdiscectomy (OLM) group (n = 50) and the PELD group (n = 100). The surgical and postoperative recovery indicators of the two groups were compared after matching. These included incision length, intraoperative blood loss, operation time, postoperative ambulation time and hospital stays, recovery rate, short-term complication rate, Lumbar visual analogue scale (VAS) score, and Oswestry Disability Index (ODI) score. Compared with the OLM group, the PELD group had shorter incision length, shorter operation time, shorter postoperative ambulation time, shorter hospital stays, less intraoperative blood loss, lower short-term complication rate, lower lumbar pain and dysfunction scores at 3 months, 6 months, and 1 year after operation, higher short-term excellent-and-good recovery rate, and higher quality-of-life scores at 3 years after operation (p < 0.05). Compared with OLM, PELD in the treatment of LDH patients can reduce the operation time, blood loss, and length of hospital stays, suggesting a short-term postoperative recovery effect. Compared with OLM, PELD can also reduce the incidence of short-term complications, enhance the effect of pain control and improvement of dysfunction in the medium term, and improve the long-term quality of life.

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

Treatment of lumbar intervertebral disc herniation using open spinal endoscopy: Techniques and clinical outcomes

The use of acupuncture in the treatment of lumbar intervertebral disc herniation (сlinical case)

Abstract. The effectiveness of acupuncture in the treatment of discogenic compression radiculopathy has been proven in many scientific works. Acupuncture has a positive effect not only on the course of radiculopathy, but also on the size of the hernias and protrusions of the intervertebral discs themselves. Purpose. To study the effectiveness of acupuncture in the treatment of intervertebral disc herniation in the lumbar region. Material and methods. Before and after treatment (after 3 and 6 months), the patient was assessed: neurological status, results of an electrokymographic study of peripheral nerves of the lower extremities, MRI of the spine. Acupuncture was carried out at acupuncture points of the meridian of the stomach, bladder, gallbladder, colon, for a course of 40 procedures. Results. A 40‑year-old patient suffered from prolonged pain for 8 months. Conservative treatment with drug therapy and physical therapy did not provide satisfactory improvement in symptoms. On MRI of the PC department, the IVD herniation at the L4 — L5 level was 12 mm. When using acupuncture, the pain syndrome decreased clearly after the first sessions. Sensory disturbances and motor deficits gradually regressed. After 40 sessions over 3 months, electromyographic indicators of the affected right peroneal nerve improved. An unexpected result was a reduction in the size of the IVD hernia by 50 % to 6 mm.

Letter to the Editor Regarding “Anterior Percutaneous Full-Endoscopic Transcorporeal with Single-Incision Treatment for Noncontiguous 2-Level Cervical Disc Herniation: Technical Report and Early Follow-Up”

Letter to the Editor Regarding “Anterior Percutaneous Full-Endoscopic Transcorporeal with Single-Incision Treatment for Noncontiguous 2-Level Cervical Disc Herniation: Technical Report and Early Follow-Up”

Dynamics of outcomes of thoracoscopic microdiscectomy

Object of the study. Thoracoscopic microdiscectomy (TM) is used for surgical treatment of thoracic disc herniations (TDH). The purpose of this study was to analyze the factors influencing the dynamics of outcomes in the early and late postoperative period Materials and methods/ The study had a retrospective, single-center, observational cohort design. The series included all patients without exception who underwent TM from January 2018 to December 2022. Outcomes were assessed according to the Macnab scale adapted for the thoracic spine. Postoperative complications were classified according to the Clavien-Dindo Classification. Statistical univariate analysis of the data was carried out using the Fisher»s method and the Mann-Whitney U test. Multivariate analysis was performed using multiple linear regression with stepwise elimination. Results/ A total of 36 patients were operated on using the TM technique. These included 22 (61 %) women and 14 (39 %) men. The median age was 45±15 years. Early outcomes were assessed 2 months after the patients» surgery. The median duration of long-term outcomes was 22±12 months. The statistical analysis of early outcomes revealed a connection between the localization of a disc herniation in the lower thoracic spine (Th8 — Th12) with simultaneous surgery at two levels and less favorable outcomes. The analysis of long-term outcomes showed that the only prognostic factor was the patient»s condition when assessing the early outcome. Thus, complete recovery was registered at the first control in 13 out of 15 (86 %) patients and at the last control in 13 out of 16 (81 %) patients (p &lt;0.001). Conclusions. The analysis of early and long-term outcomes made it possible to identify factors that determine the dynamics of recovery after thoracoscopic microdiscectomy. The data obtained can be used in planning postoperative management of this group of patients.

Comparison of the Clinical Effects of Unilateral Biportal Endoscopic and Microscopic Lumbar Discectomy

Introduction : Micro discectomy is the surgical procedure of choice for treating lumbar disc herniations. A laminectomy can cause instability, significant epidural fibrosis, continued radiated pain, and surgical site infection, although there is still concern about the dangers of muscle damage, such as to the multifidus, and excessive articular facet resection. Unilateral biportal endoscopic discectomy has been suggested as a less invasive therapeutic approach.Objective: To compare the clinical effects in terms of pain, impairment, and complications associated with percutaneous endoscopic lumbar discectomy with standard micro discectomy for the treatment of disc herniations. Materials and methods: A study of 60 people with disc herniations who were treated with either microdiscectomy or unilateral biportal endoscopic lumbar discectomy. The Oswestry Disability Index and visual analogue score for back and leg pain was evaluated after three, six, and twelve months. Results: In comparison to Group E, Group M's mean operating time was substantially lower (p&lt;0.05). In addition, it took group M more time on average to get back to work. (p&lt;0.05), and the VAS score at 3 showed a statistically significant change (p&lt;0.05). At three months, group M's Oswestry Low Back Pain Disability score was considerably greater than group E's. (p&lt;0.001). Conclusion: In terms of a three-month return to work and wound infections, endoscopic surgery has a little advantage over microscopic surgery. Both techniques are efficient and safe for lumbar discectomy. However, after 6 months of follow-up, the results seem to be comparable. Keywords: Intervertebral Disc Prolapse, Discectomy, Endoscopy, Intervertebral Disc, Micro Discectomy, Visual Analog Scale, Oswestry Low Back Pain Disability Score

Clinical Outcome for Lumbar Disc Herniation Treatment with Intradiscal Oxygen-ozone Therapy.

Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical treatment has been the mainstay of treatment when indicated but is associated with anesthetic and surgical complications. Intradiscal oxygen-ozone chemonucleolysis is a minimally invasive procedure done under local anesthesia and has promising role in shrinking the bulged disc and reducing nerve root compression and related symptoms. This retrospective study was done to see how intradiscal oxygen-ozone chemonucleolysis reduces pain severity in patients with discogenic low back pain. Retrospective data were retrieved of those patients who underwent fluoroscopy guided intradiscal oxygen-ozone chemonucleolysis with 5-6 ml of an O2-O3 mixture (concentration of 30 microgram/ml) during a period of two years in Nepal pain care and research center. Numerical pain scale (NRS) at various follow ups were compared to preprocedural NRS. Preprocedural NRS was 8± 13. NRS at three hours, one week, one month, three months and six months were 2± 13 (73 percent reduction), 2± 53 (68 percent reduction), 2± 27 (72 percent reduction), 1± 08 (77 percent reduction) and 1± 67 (79 percent reduction) respectively. Intradiscal oxygen-ozone chemonucleolysis can be a useful modality of treatment for discogenic low back pain in patients who fail to respond to conservative management and in whom surgery is not indicated.

Anterior transcorporeal approach combined with posterior translaminar approach in percutaneous endoscopic cervical discectomy for two-segment cervical disc herniation treatment: a technical report and early follow-up

ObjectiveFull endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable full endoscopic treatment for mixed-type two-segment cervical disc herniation (MTCDH) in which one segment herniates in front of the spinal cord and the other segment herniates behind the spinal cord. Therefore, we introduce a new full endoscopic technique by combining an anterior transcorporeal approach and a posterior translaminar approach. In addition, we provide a brief description of its safety, efficacy, feasibility, and surgical points.MethodsThirty patients with MTCDH were given full endoscopic surgical treatment by a combined transcorporeal and transforaminal approach and were followed up for at least 12 months.ResultsClinical assessment scales showed that the patient’s symptoms and pain were significantly reduced postoperatively. Imaging results showed bony repair of the surgically induced bone defect and the cervical Cobb angle was increased. No serious complications occurred.ConclusionThis technique enables minimally invasive surgery to relieve the compression of the spinal cord by MTCDH. It avoids the fusion of the vertebral body for internal fixation, preserves the vertebral motion segments, avoids medical destruction of the cervical disc to the greatest extent possible, and expands the scope of adaptation of full endoscopic technology in cervical surgery.

Clinical Efficacy of Shuagnhetang Combined with Meridian Elimination and Massage in the Treatment of Lumbar Intervertebral Disc Herniation Observed

Clinical Efficacy of Shuagnhetang Combined with Meridian Elimination and Massage in the Treatment of Lumbar Intervertebral Disc Herniation Observed