Herniated Disc Research Articles

Transdural approach for giant calcified herniated thoracic disc: a case report

Transdural approach for giant calcified herniated thoracic disc: a case report

The meningovertebral ligaments as a barrier to a herniated intervertebral disc – an anatomical study

The meningovertebral ligaments as a barrier to a herniated intervertebral disc – an anatomical study

Surgical treatment of herniated thoracic discs using transthoracic extrapleural approach

To analyze the results of herniated thoracic disc resection via transthoracic extrapleural approach. The study included 16 patients with 18 symptomatic herniated thoracic discs wo underwent transthoracic extrapleural surgery. In 11 cases, clinical pattern of disease was represented by myelopathy with radicular or axial pain syndrome. Five patients had radiculopathy alone. Median localization of hernias was observed in 8 (44.4%) cases, paramedian hernias - in 10 (55.6%) cases. There were 10 (55.6%) ossified hernias, 5 (27.7%) giant, 10 (55.5%) large and 3 (16.6%) medium hernias. In most patients, VAS score of pain syndrome decreased by 2-6 points (mean 3.6). In 4 patients, this value remained the same. Among 11 patients with myelopathy, regression of conduction disorders in 1 year after surgery was achieved in 9 (82%) cases including complete recovery in 6 (55%) patients (Frankel E, Nurick - 0-I). In 2 patients, neurological status was equal to preoperative one. In all cases, the follow-up examination confirmed total removal of compressive substrate and found no signs of spine instability. Surgery time varied from 80 to 210 min (mean 161), blood loss - from 300 to 800 ml (mean 378 ml). Two patients had transient neurological deterioration. There was damage to dura mater in 4 cases. Intercostal neuralgia was observed in 3 patients. While retaining the advantages of open thoracotomy, transthoracic extrapleural approach is less traumatic, allows complete spinal cord decompression, minimizes the risk of iatrogenic spinal cord injury and avoids certain postoperative complications.

Factors Associated with Treatment Success After Interlaminar Epidural Steroid Injection for Cervical Radicular Pain.

To investigate the demographic, clinical and radiological findings associated with treatment success after interlaminar epidural steroid injection (ILESI) in radicular pain induced by cervical disc herniation. In this retrospective study, the data of patients who received cervical ILESI between January 2017 and June 2021 were screened. Of 223 patients, 92 with unilateral radicular neck pain due to cervical disc herniation were included. Demographic data, symptom duration, and numerical rating scale scores at baseline, at three weeks, three months, and six months after treatment were collected from the medical records of the patients. Disc herniation level, cervical axis, disc height, presence and degree of spinal canal and neural foraminal stenosis, vertebral endplate signal change, and definitive presence of uncovertebral and facet osteoarthritis were evaluated using cervical spine magnetic resonance imaging. Treatment success was determined as ?50% reduction in pain scores at six months compared to baseline. Data of 92 patients (27 men, 65 women) were included. The mean age was 50.82 ± 10.22 years, and the median symptom duration was 12 (4.25 to 20) months. At six months after ILESI, treatment was successful in 58 (58.7%) patients and unsuccessful in 34 (41.3%) patients. Multivariable logistic regression analysis was performed to identify the factors associated with treatment success at six months post-injection. In the final model, neural foraminal stenosis (non-severe vs. severe) and spinal canal stenosis (non-severe vs. severe) were significantly associated with the treatment success (OR=3.02, 95% CI=1.40?10.95, p=0.009; OR=5.31, 95% CI=1.77?15.85, p=0.003). Treatment success of cervical ILESI at six months is favorable. However, the presence of severe neural foraminal and spinal canal stenosis is associated with a reduced likelihood of treatment success.

Spontaneous clinical and radiological resolution of a large extruded disc in the lumbar spine

Low back ache arising due to a herniated lumbar disk with radicular pain to the lower limbs is a commonly occurring problem evaluated by spine surgeons. Conservative treatment has usually been proposed for an acute disk prolapse in cases without significant motor or sensory deficit. Spontaneous radiological regression of an extruded herniated disk with complete symptomatic recovery has occasionally been reported. A case of conservatively treated large extruded lumbar disk is described who showed complete radiological resolution, along with regression of the clinical symptoms.

Minimally-invasive percutaneous treatments for low back pain and leg pain: a randomized controlled study of thermal disc decompression versus mechanical percutaneous disc decompression

BACKGROUND CONTEXTMinimally invasive techniques have recently been developed as alternative treatments to surgical interventions, especially for small or contained herniated disc. PURPOSEAim of our study is to assess the efficacy of the mechanical percutaneous disc decompression (PDD) in comparison with the percutaneous radiofrequency targeted disc decompression (TDD). STUDY DESIGNWe conducted a single-center noninferiority trial in which patients who had low back pain with radicular leg pain (RLP) from a contained herniated disc were randomly assigned in a 1:1 ratio to undergo either PDD or TDD. PATIENT SAMPLEFrom January 2016 to January 2017 a total of 327 patients were assessed for eligibility of whom 200 underwent randomization in the trial; 100 patients underwent the PDD and 100 underwent the TDD. OUTCOME MEASURESThe primary outcome measure was the proportion of patients who reported >50% reduction in Numeric Rating Scale (NRS) leg pain score. Secondary outcome measure included the proportion of patients who reported >30% improvement in Oswestry Disability Index (ODI) score. METHODSOutcomes of this trial were measured with the use of patient-reported data obtained from validated questionnaires to assess the low back pain with RLP before intervention and at 6 and 12 months after interventions. MRI was performed before intervention and at 6 and 12 months after interventions. In addition to NRS and ODI scores, we collected the following data: age, gender, length of hospitalizations and return to work rate. RESULTSWhen using an intention to treat analysis with those lost to follow-up and requiring a second procedure counting as failures, there were no statistically significant difference between the two treatment groups in the primary and secondary outcomes at 6 months: >50% reduction in NRS leg pain (PDD vs. TDD)=67% versus 65%; >30% ODI improvement (PDD vs. TDD)=57% versus 55%. Similarly, there were no statistically significant differences between groups in outcomes at 12 months: >50% reduction in NRS leg pain (PDD vs. TDD)=51% (95% CI 41%–60%) versus 40% (95% CI: 30%–49%); >30% ODI improvement (PDD vs. TDD)=42% (95% CI 32%–51%) versus 30% (95% CI: 21%–39%). A nonintention to treat analysis which discounted those lost to follow-up showed the only statistically significant finding was the percentage of those reporting >30% ODI at the 12 month follow-up time, favoring the PDD group: (PDD vs. TDD)=58% (95% CI 46%–69%) versus 42% (95% CI: 22%–43%). CONCLUSIONSPDD and TDD are comparable treatments for patients presenting with low back pain with RLP unresponsive to medical therapy caused by contained disc herniations.

An Economic Evaluation of Thread Embedding Acupuncture for the Treatment of Lumbar Herniated Intervertebral Disc in a Randomized Controlled Clinical Trial

Background: Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA).Methods: This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed.Results: The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant.Conclusion: In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1<sup>st</sup> to conduct an economic evaluation of TEA for LHIVD.

Buckling of the Ligamentum Flavum as a Rare Complication of Anterior Cervical Corpectomy and Fusion: A Case Report

Abstract Introduction and Importance Neurological deterioration due to buckling of the ligamentum flavum (LF) is an uncommon complication after anterior cervical corpectomy or discectomy with fusion. Case Presentation In this report, we present the case of a 66-year-old male who underwent anterior cervical partial corpectomy of C5 and discectomy of prolapsed C5-C6 with fusion. Postsurgery, the patient displayed signs of neurological deterioration. Upon immediate cervical magnetic resonance imaging (MRI), posterior canal stenosis and severe compression with cord signal due to LF buckling were detected. A posterior laminectomy procedure and canal decompression at the C5-C6 level with bone fusion were performed. Clinical Discussion Patient presented with walking difficulty, then walking disability, followed by bilateral upper and lower limb paresthesia with burning sensation. Examination showed ⅘ muscle strength in both handgrips. Further investigation showed brisk deep tendon reflexes, positive Hoffman sign unilaterally, equivocal Babinski sign, and progressive quadriparesis. Magnetic resonance imaging showed mild and diffuse building of some cervical discs, with spinal cord progression. We performed an anterior cervical corpectomy and fusion (ACCF) and anterior cervical discectomy and fusion (ACDF); a titanium mesh with plates and screws was used for fusion, with removal of a calcified and herniated subligamentous disc. Postoperatively, upper and lower limb strength deteriorated; immediate cervical and thoracic MRI showed LF buckling, which caused canal stenosis and severe compression. Urgent posterior laminectomy and canal decompression with bone fusion was scheduled on the same day. The patient underwent physiotherapy and regained upper and lower limb strength and his ability to walk. Conclusion This indicates the possibility of neurological deterioration as a result of LF buckling, which may be a result of LF thickening accompanied by hyperextension in the cervical region. In this regard, immediate imaging following signs of neurological complications after anterior cervical corpectomy or discectomy warrants early detection, which results in a better prognosis.

Clinical and Radiologic Analysis of Disc Heights Change in Conservatively Treated Lumbar Herniated Disc Patients

Objective: The main purpose of this study was to evaluate the clinical and radiologic factors of disc height loss in spontaneous resolution of herniated lumbar disc patients.Methods: From January 2017 to December 2018, a total of 56 symptomatic herniated lumbar disc patients (36 men and 20 women) were investigated retrospectively in this study. Clinical findings including age, sex, pain, and smoking history were examined in each group (group A, patients with not-changed disc heights; group B, patients with decreased disc heights). Radiologically, the level, severity, laterality, modic change, and disc degeneration of lumbar disc herniation were investigated between groups. We compared demographic and radiologic findings between groups.Results: A total of 56 patients were enrolled (group A, 30 patients; group B, 26 patients). There were no significant statistical differences in age, sex, visual analog scale (VAS) scores, level of disc herniation, and laterality of disc herniation between groups. Group A had more protrusion cases (14/30 cases) and group B had more Sequestration (11/26 cases). About Modic change and disc degeneration classification, group B had more modic change cases and more disc degeneration cases than group B.Conclusion: In this study, there were no significant differences in demographic findings, level of disc herniation, the status of disc herniation, laterality of disc herniation, VAS of back pain between group A and group B.

Endoscopic Spinal Decompression: A Retrospective Review of Pain Outcomes at an Academic Medical Center.

Introduction: Spinal stenosis is a chronic, debilitating condition that is expected to affect an increasing number of people as the population ages. Symptomatic spinal stenosis, like other spine pathologies, including disc herniation and degenerative disc disease, traditionally required an open decompressive surgical approach if more conservative approaches failed. An emerging alternative has been developed to address the needs of this population of patients in the form of endoscopic spine surgery (ESS). Advantages of ESS include minimal tissue trauma, decreased risk of damage to the neurovascular structures, minimal epidural fibrosis/scarring, reduced hospital stay, early functional recovery, and improved cosmetic outcomes. The purpose of this study was to review the outcomes of patients undergoing transforaminal endoscopic spinal decompression at an academic pain program.Methods: We conducted a retrospective review of electronic medical records with approval from the University of Florida Institutional Review Board (IRB #202001529). Twenty patients underwent successful transforaminal endoscopic lumbar spinal decompression surgery at UF Health Pain Medicine from July 1, 2019, to June 1, 2020. The majority of cases were performed at L4-5 (n = 14), followed by an equal number (n = 3) of cases at L3-4 and L5-S1. Preoperative and postoperative visual analog scale (VAS) pain scores from patients' pain clinic appointments were obtained from the electronic health records system to assess the intervention as a pain relief strategy.Results: Patients had an average pain reduction of 82% (SD = 31%), resulting in an average postoperative pain score of 1.8 (SD = 2.8) on a 10-point VAS.Conclusion: This study highlights the benefits of endoscopic spine surgery for patients, including pain reduction and reduced scarring.

Lumbar Microdiscectomy. Retrospective Analysis of the Results of Treatment of 54 Patients

Summary. Although the microdiscectomy techniques for surgical treatment of a herniated disk are improved, the share of poor outcomes after the lumbar pain syndrome treatment remains high. Objective: to improve the outcomes of patients with lumbar spine osteochondrosis complicated with a herniated disk. Materials and Methods. The retrospective analysis of 54 patients with a lumbar herniated disk, who underwent surgical treatment from 2019 till 2020 at the Spine Surgery Department of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine”. The age of patients varied from 23 to 78 years (mean age – 41.1±11.7 years). Results. We assessed the outcomes using VAS, Oswestry, and Nurick scales on the first day after the surgery, one month, and six months after it. VAS of the lower back pain syndrome declined on average from 5.9±1.59 to 3.4±1.55 on the first day after the surgery, to 1.7±1.1 in a month, and to 2.5±2.1 six months after the surgical treatment. The surgery eliminates radiculopathy and reduces radicular pain according to VAS on average from 8.5±1.17 to 1.3±1.04 on the first day after the surgery, to 1.5±1.0 in a month, and to 1.4±1.6 six months after it. The quality of life according to ODI improved on average from 74.4±5.12 before the surgery to 29.7±9.6 in a month and to 9.6±9.2 six months postoperatively. As of the discharge, 55.6% of patients demonstrated their nervous system's function recovered to the stage I and 38.9% – to the stage II. The long-term follow-up has shown positive dynamics in all the patients: the complete regress of neurologic symptoms in 74.4% and improved conditions – in 25.6% of patients. Conclusions. Surgical treatment of a herniated lumbar disk with the microdiscectomy method ensures the fulfillment of the fundamental nerve rootlet decompression by fenestrotomy, disctomy, or discectomy, and excision of the hernia, including sequestrated one. The positive dynamics of the pain syndrome scores, life quality, and neurological disorders is significant (р<0.05) and substantiates the efficiency of the treatment.

Monitoring of motor deficits dynamics in patients after lumbar herniated disk removal

According to the current literature, the neurological deficit after the removal of a disc herniation at the lumbar level in the postoperative period ranges from 22% to 39%. The aim. Objective evaluation of motor deficits in the distal lower extremities in patients operated on lumbar herniated disk using isokinetic dynamometry.

Study protocol: effect of infection, Modic and inflammation on clinical outcomes in surgery for radiculopathy (EIMICOR)

BackgroundEvidence indicates that inflammatory processes are involved in radicular pain as well as in resorption of herniated disc tissue. Furthermore there are indications that the presence of vertebral end plate pathology (Modic changes; MC) is associated with a negative effect on inflammation. It is hypothesized that in patients with MC, the (possibly bacterial induced) inflammation will be accompanied by pro inflammatory cytokines that worsen the outcome, and that in patients without MC, the inflammation is accompanied by cytokines that induce a resorption process to accelerate recovery.MethodsThis prospective cohort study will include 160 lumbar and 160 cervical patients (total of 320), which are scheduled for surgery for either a lumbar or cervical herniated disc with ages between 18 and 75. The main and interaction effects of local bacterial infection (culture), inflammatory cells in disc material (immunohistology), MC (MRI), and blood biomarkers indicating inflammation or infection (blood sample evaluation) will be evaluated. Clinical parameters to be evaluated are leg pain on the 11 point NRS pain scale, Oswestry (lumbar spine) or Neck (cervical spine) Disability Index, Global Perceived Recovery, Womac Questionnaire, and medication status, at baseline, and after 6, 16, 26 and 52 weeks.DiscussionGaining insight in the aetiology of pain and discomfort in radiculopathy caused by a herniated disc could lead to more effective management of patients. If the type of inflammatory cells shows to be of major influence on the rate of recovery, new immunomodulating treatment strategies can be developed to decrease the duration and intensity of symptoms. Moreover, identifying a beneficial inflammatory response in the disc through a biomarker in blood could lead to early identification of patients whose herniations will resorb spontaneously versus those that require surgery.Trial registrationprospectively enrolled at trialregister.nl, ID:NL8464.

Effectiveness and safety of motion style acupuncture treatment of the pelvic joint for herniated lumbar disc with radiating pain: A prospective, observational pilot study

ContextConservative treatment is effective for treating and managing herniated lumbar disc with radiating leg pain. ObjectivesTo investigate the effects of motion style acupuncture treatment (MSAT) on the pelvic joint for this condition. DesignThis prospective observational study was a pilot study for a future randomized, controlled trial (RCT). Setting[masked for review]. Patients/InterventionsWe enroled 40 patients and allocated them to two groups (both n = 20). Groups 1 and 2 received integrative Korean medicine treatment (KMT) and integrative KMT with MSAT for pelvic joint, respectively. Primary outcome was the Numeric Rating Scale (NRS) score for low back pain. Secondary outcomes were the Oswestry Disability Index (ODI), Visual analogue Scale (VAS), and EuroQol 5-Dimension-5-level (EQ-5D-5 L) scores. Efficacy was assessed by comparing the baseline and Day 4 results. Safety was assessed based on the frequency and severity of all adverse events. ResultsOn Day 14, except for ODI in Group 1, the NRS, VAS, and EQ-5D-5 L scores showed significant improvements in both groups. On Day 90, both groups showed significant improvements in the NRS, ODI, and EQ-5D-5 L scores. There was a significant between-group difference in the NRS score on Day 7. On Day 14, Group 2 had a significantly lower VAS score for radiating leg pain than Group 1. Twelve patients reported adverse events associated with integrative KMT; however, there was no association with pelvic joint MSAT. ConclusionAdding MSAT for pelvic joint to conventional integrative KMT may ameliorate radiating leg pain and improve the quality of life.

Next-generation sequencing (NGS) to determine microbiome of herniated intervertebral disc

BACKGROUND CONTEXTThere is apparent causality between chronic infection of the intervertebral disc and its degenerative process. Although disc is considered a sterile tissue, collected samples of uninfected patients sent to culture testing resulted positive. PURPOSEThe purpose of this study was to analyze the microbiome of the intervertebral disc by using and validating the next-generation sequencing (NGS) molecular test, controlled with tissue culture and clinical presentation of patients. STUDY DESIGN/SETTINGProspective study of consecutive patients in a hospital. PATIENT SAMPLEPatients with lumbar disc herniation undergoing open microdiscectomy aging 18 to 65 years. OUTCOME MEASURESNGS, tissue culture METHODSSubjects undergoing open decompression surgery for lumbar disc herniation were consecutively included and clinically followed for one year. Three samples of the excised herniated disc fragment were sent to tissue culture and another sample of the disc was sent to NGS test for microbiome analysis. Control samples of the ligamentum flavum and deep muscle were collected and sent to culture. RESULTSA total of 17 patients were included. All patients presented negative cultures of the removed disc samples, as well as negative cultures of muscle and yellow ligament. None of the patients evolved to clinical infection one year after surgery, nor presented significant alteration of laboratory markers. NGS mapped a mean of 14,645 (range 6,540 to 27,176) DNA sequences for each disc sample of each patient. There were a total of 45 different bacteria genera remnants with different amount of DNA sequences detected. There was a mean of 8 (range 3-17) different bacterial elements in each sample of intervertebral disc. Three bacteria were present in all disc samples (Herbaspirillum, Ralstonia, and Burkolderia). Although there were a considerable mean number of bacterial sequences mapped in each disc sample, the amount of sequences related to bacteria was low. Cutibacterium acnes elements was not found in any disc microbiome analysis. CONCLUSIONSNGS has been proven to adequately determine bacterial DNA presence within the intervertebral disc. C. acnes was not isolated in culture neither in microbiome analysis of patients with lumbar disc herniation. We cannot confirm disc sterility since, even if it does not cause infection, there is bacterial or remnant DNA in herniated discs.

Complete Resorption of Large Cervical Disc Protrusion Compressing Spinal Cord

In this report, we describe a case of 32-year-old woman who experienced spontaneous resolution of a large herniated disc with cord compression at C5-6. While the need for a surgical procedure is commonly accepted in case of symptomatic myelopathy, the medical management of cases with no or mild symptomatic lesion may be debated [1]. The following manuscript describes a case of spontaneous regression of herniated cervical disc and suggests that, even in patient with acute cervical disc herniation accompanied with cervical myelopathy, non-surgical, conservative treatment could be an option.

Case of neuropathic itch‐associated prurigo nodules on the bilateral upper arms after unilateral herpes zoster in a patient with cervical herniated discs: Successful treatment with mirogabalin

The Journal of DermatologyVolume 48, Issue 12 p. e585-e586 LETTER TO THE EDITOR Case of neuropathic itch-associated prurigo nodules on the bilateral upper arms after unilateral herpes zoster in a patient with cervical herniated discs: Successful treatment with mirogabalin Satoshi Okuno, Satoshi Okuno orcid.org/0000-0003-0456-1852 Department of Dermatology, National Defense Medical College, Tokorozawa, JapanSearch for more papers by this authorTakashi Hashimoto, Corresponding Author Takashi Hashimoto hashderm@ndmc.ac.jp orcid.org/0000-0001-6779-5598 Department of Dermatology, National Defense Medical College, Tokorozawa, Japan Correspondence Takashi Hashimoto, Department of Dermatology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan. Email: hashderm@ndmc.ac.jpSearch for more papers by this authorTakahiro Satoh, Takahiro Satoh orcid.org/0000-0002-2244-6332 Department of Dermatology, National Defense Medical College, Tokorozawa, JapanSearch for more papers by this author Satoshi Okuno, Satoshi Okuno orcid.org/0000-0003-0456-1852 Department of Dermatology, National Defense Medical College, Tokorozawa, JapanSearch for more papers by this authorTakashi Hashimoto, Corresponding Author Takashi Hashimoto hashderm@ndmc.ac.jp orcid.org/0000-0001-6779-5598 Department of Dermatology, National Defense Medical College, Tokorozawa, Japan Correspondence Takashi Hashimoto, Department of Dermatology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan. Email: hashderm@ndmc.ac.jpSearch for more papers by this authorTakahiro Satoh, Takahiro Satoh orcid.org/0000-0002-2244-6332 Department of Dermatology, National Defense Medical College, Tokorozawa, JapanSearch for more papers by this author First published: 05 September 2021 https://doi.org/10.1111/1346-8138.16147Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume48, Issue12December 2021Pages e585-e586 RelatedInformation

Effect of Traditional Korean Medicine Treatment Including Acupotomy on the Level of Pain and Quality of Life of Patients with Cervical Herniated Intervertebral Disc: A Retrospective Observational Study

Background: The purpose of this study was to statistically analyze the treatment effect and patient satisfaction of traditional Korean medicine, including acupotomy treatment of cervical herniated intervertebral disc. Methods: This was a retrospective study of 22 patients who received traditional Korean medicine including acupotomy treatment amongst all patients diagnosed with cervical herniated intervertebral discs at the Korean Medicine hospital in Daejeon, Korean, from January 01, 2020 to April 30, 2021. The clinical data from patient medical records were statistically analyzed. Results: The Numeric Rating Scale, the European Quality of Life 5 Dimensions, and the European Quality of Life Visual Analogue Scale questionnaire scores were each compared before and after traditional Korean medicine treatment, including acupotomy, showed significantly improved scores after treatment (p < 0.001). Out of a total of 22 patients, 11 rated the treatment “very satisfactory” (50%), 5 “satisfactory” (22.7%), 5 “indifferent” (22.7%), 1 “unsatisfactory” (4.5%), and 0 “very unsatisfactory” (0%). Of the total 22 patients, 17 patients (77.3%) were willing to have further treatment, and 5 patients (22.7%) were not willing. Conclusion: Traditional Korean medicine treatment including acupotomy was an effective treatment for cervical herniated intervertebral discs. To determine the effect of an individual application (e.g., acupotomy) of traditional Korean medicine treatment for cervical herniated intervertebral disc, a prospective, controlled study is needed.

61. Percutaneous lumbar discal nucleoplasty (PLN): Initial experience in 51 patients affected by small/contained herniated disc

<h3>BACKGROUND CONTEXT</h3> Percutaneous lumbar nucleoplasty (PLN) is a nonoperative, fluoroscopy-guided method for the treatment of nonsequestrated herniated discs in patients with discogenic low back pain (LBP). PLN with controlled ablation ("Coblation") of the disc consists of a combination of tissue removal through plasma molecular dissociation (ablation) and thermal treatment via radiofrequency (RF) heating (coagulation). <h3>PURPOSE</h3> To estimate the effectiveness of PLN in patients with LBP. <h3>STUDY DESIGN/SETTING</h3> Retrospective/day hospital/orthopedic institution. <h3>PATIENT SAMPLE</h3> Inclusion criteria were axial LBP with or without radiating pain, MRI visualization of a contained disc protrusion and/or small contained herniated disc that was concordant with pain's characteristics (side and level), disc height ≥50% and failed conservative therapy for ≥3 months. Exclusion criteria were complete annular derangement, migrated or sequestrated disc, moderate to severe spinal stenosis. <h3>OUTCOME MEASURES</h3> 1) rate of pain reduction one-month postprocedure on a visual analog 1-to-10 scale (VAS); 2) rate of reduction in the protruded disc size at MRI between preoperative and post procedure. <h3>METHODS</h3> From October 2020 to January 2021, 51 patients were treated at our Institution for LBP. All fluoroscopy-guided PLN were performed by one experienced interventional radiologist. A contralateral approach technique permitted precise localization of the intradiscal target navigating inside the nucleus with a curved tip that can rotate 360° within a 5 cm range. All patients underwent MRI before and 3, 6 months after treatment, using axial and sagittal planes T2-weighted images. The PLN treatment was considered successful when the VAS decreased of at least 3 points. The VAS distribution was given as median and interquartile interval. <h3>RESULTS</h3> Out of 51 patients, 35 (70%) experienced a successful outcome after PLN, 13 patients reported a VAS unchanged or a 1-2 points reduction, while the remaining 3 patients reported a worsening of the pain. The overall distribution of VAS was 8 (7–9) before treatment and 4.5 (2–8) after treatment (VAS reduction of 46%). MRI showed reduction in herniated disc dimension in 40 patients (80%), strongly associated with VAS reduction. No serious complications related to PLN occurred. <h3>CONCLUSIONS</h3> PLN with coblation is a minimally invasive method that achieve mostly sudden pain relief as well as MRI-documented volumetric reduction of the herniated disc. No damage or necrosis were reported inside nucleus and surrounding discal structures (annulus, vertebral endplate, nerve root). In this preliminary study, effectiveness was estimated to be 70% and the VAS reduction after treatment was nearly 50%. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Risk Factors for Recurrence of Disc Herniation After Single-Level Lumbar Discectomy

Objective: Herniated nucleus pulposus is a common disease of the lumbar spine. Recurrence of disc herniation and subsequent disc degeneration are the most common problems following discectomy. Many first-time lumbar discectomy patients experience favorable outcomes; however, same-level recurrent discectomy can occasionally induce unfavorable results. Therefore, in this study, we retrospectively analyzed the risk factors for recurrence of lumbar disc herniation after discectomy.Methods: From January 2013 to December 2015, 226 patients underwent one-level discectomy in our department. We excluded patients with less than two years of follow-up, a previous spine deformity with a compression fracture, foraminal or extraforaminal discs, or a history of previous lumbar operation history, leaving 71 selected patients. Patients were divided into recurrent and non-recurrent groups and various factors were retrospectively compared between the groups.Results: Patients with preoperative disc space narrowing experienced recurrence less commonly; however, this was not statistically significant (10.0% and 25.5%, respectively; p=0.150). A disc height decrease of more than 20% during the follow-up period was a statistically significant risk factor for recurrence (36.4% and 14.3%, respectively; p=0.035), and grades 3 and 4, compared to grades 1 and 2, facet joint degeneration were also statistically significant risk factors for recurrence of disc herniation (41.2% and 14.8%, respectively; p=0.020).Conclusion: Patients who underwent more than a moderate degree of preoperative facet joint degeneration on the operated side and for whom the progression of disc space height decreased during the follow-up period may require closer observation for recurrence of disc herniation.