Intervertebral Disc Herniation Research Articles

Traumatic C2-C3 Coronal Dislocation with Vertebral Artery Injury: Case Report and Literature Review

Introduction: The coronal subluxation of C2-C3 (lateral leisthesis or non-hangman fracture) is extremely rare and difficult to manage. In this paper, we report a case of a 21-year-old male who came to the ER after a motor vehicle accident (MVA) with C2-C3 lateral leisthesis and, surprisingly, mild neurological symptoms.
 Method: This systematic review was conducted following the recommendations of the preferred reporting items for systematic reviews and meta‐analyses (PRISMA) checklist. On January 1, 2022, a comprehensive electronic search was conducted through Scopus, PubMed, and Web of Science databases to retrieve original studies.
 Results: Seven articles were found reporting on non-hangman traumatic C2/C3 subluxation, with only two cases reporting coronal subluxation or lateral listhesis of C2 over C3. The first case was reported by Rajasekaran et al. Singh reported the second case. Both cases were unilateral facet dislocations with no radiological evidence of intervertebral disc disruption or herniation. We will report the third case in the literature of a non-hangman C2/C3 coronal dislocation. The patient underwent intraoperative manual traction under continuous neurophysiology monitoring. After the satisfactory reduction, fixation was carried out using lateral mass and pars screws from C1 to C3. Postoperatively, the patient recovered well, showed no signs of motor impairment during examination, and was discharged on the fifth day.
 Conclusion The impact of cervical spine injury is tremendous at every level. Management of cervical spine dislocation injury is full of controversies. The C2/C3 traumatic coronal translation with no disc involvement and unilateral facet dislocation may have a better outcome.

Tension-activated nanofiber patches delivering an anti-inflammatory drug improve repair in a goat intervertebral disc herniation model.

Conventional microdiscectomy treatment for intervertebral disc herniation alleviates pain but does not repair the annulus fibrosus, resulting in a high incidence of recurrent herniation and persistent dysfunction. The lack of repair and the acute inflammation that arise after injury can further compromise the disc and result in disc-wide degeneration in the long term. To address this clinical need, we developed tension-activated repair patches (TARPs) for annulus fibrosus repair and local delivery of the anti-inflammatory factor anakinra (a recombinant interleukin-1 receptor antagonist). TARPs transmit physiologic strain to mechanically activated microcapsules embedded within the patch, which release encapsulated bioactive molecules in direct response to spinal loading. Mechanically activated microcapsules carrying anakinra were loaded into TARPs, and the effects of TARP-mediated annular repair and anakinra delivery were evaluated in a goat model of annular injury in the cervical spine. TARPs integrated with native tissue and provided structural reinforcement at the injury site that prevented aberrant disc-wide remodeling resulting from detensioning of the annular fibrosus. The delivery of anakinra by TARP implantation increased matrix deposition and retention at the injury site and improved maintenance of disc extracellular matrix. Anakinra delivery additionally attenuated the inflammatory response associated with TARP implantation, decreasing osteolysis in adjacent vertebrae and preserving disc cellularity and matrix organization throughout the annulus fibrosus. These results demonstrate the therapeutic potential of TARPs for the treatment of intervertebral disc herniation.

Biomechanical properties of polyvinyl alcohol hydrogel as a nucleus pulposus replacement in intervertebral disc herniation: A systematic review

Biomechanical properties of polyvinyl alcohol hydrogel as a nucleus pulposus replacement in intervertebral disc herniation: A systematic review

Novel Modic grading scoring system and its clinical validation: a preliminary investigation.

To propose a novel Modic grading scoring system and explore the relationship between the Modic grading score and disc degeneration, disc herniation, disc height, and clinical symptom scores. In total, 194 patients were included in the study. The new Modic grading scoring system included four indicators: invaded vertebral height, invaded endplate length, endplate morphology, and grade of endplate defects. The severity of Modic changes was visually quantified by numerical scores, and the kappa value was used to verify the interobserver and intraobserver reliability. Spearman correlation analysis was used to explore the relationship between the Modic grading score and intervertebral disc degeneration, disc herniation, disc height, and clinical symptom scores. The interobserver and intraobserver reliability showed substantial to almost perfect agreement in the new Modic grading scoring system. The Modic grading score was positively correlated with intervertebral disc degeneration (r = 0.757, p < 0.001) and negatively correlated with the intervertebral disc height index (r = - 0.231, p < 0.001). There was no significant correlation between the Modic grading scoring system and disc herniation (r = 0.369, p = 0.249). Additionally, there was no significant correlation between the Modic grading score and the Japanese Orthopaedic Association score (r = - 0.349, p = 0.25), Oswestry Disability Index score (r = 0.246, p = 0.11), or visual analogue scale score (r = 0.315, p = 0.35). The new Modic grading scoring system had good interobserver and intraobserver reliability. The Modic grading score was positively correlated with intervertebral disc degeneration and negatively correlated with the intervertebral disc height.

Study on early efficacy of UBED and PEID in the treatment of L5/S1 intervertebral disc herniation

Introduction This study aimed to compare early efficacy of UBED and PEID in the treatment of L5/S1 IDH. Material and methods Forty-two patients who underwent surgical treatment for L5/S1 IDH were divided into two groups: UBED and PEID. Operation time, complications, VAS/ODI score were recorded. MacNab evaluation was completed one and three months postoperatively. Results All patients were successfully operated without infection, nerve injury, or huge hematoma in the spinal canal. There were no significant differences in operation time and hospitalization days between the two groups (p > 0.05). All patients were followed up after the operation and low back/leg pain was significantly reduced. VAS for low back pain, VAS for leg pain, ODI scores in both groups one and three months after the operation were significantly lower than pre-operation (p < 0.05). There were no significant differences between one and three months after the operation in both groups (p > 0.05). There were no significant differences in VAS for low back pain, leg pain, ODI score, and overall efficacy between the two groups one and three months post-operation (p > 0.05). Conclusion UBED and PEID have very good early efficacy in treating L5/S1 IDH. Because UBED has a wider vision field and more flexible operation, it can be used as a useful complement to PEID.

Accuracy of low-field magnetic resonance imaging for differentiating intervertebral disc extrusions and protrusions at the lumbosacral disc space in dogs.

MRI features differentiating extrusion from protrusion in thoracolumbar discs have been published, however little specifically evaluates the lumbosacral disc. The high prevalence of degenerative changes in apparently normal animals complicates assessment of this region and features relevant elsewhere in the spine may not apply. The aims of this study were to determine the accuracy of MRI in differentiating IVDE and IVDP at the lumbosacral disc space in dogs and determine which MRI characteristics discriminate between IVDE and IVDP. MRI examinations from dogs with surgically confirmed IVDE or IVDP at the lumbosacral disc space were collected retrospectively (2011-2019). Two radiologists independently recorded a diagnosis of IVDE or IVDP, gave a confidence rating, and evaluated specific MRI features. Univariable statistical analysis was performed to identify which MRI characteristics might help distinguish IVDE from IVDP. 117 dogs with lumbosacral IVDE (n = 16) or IVDP (n = 101) were included. Features associated with IVDE were in concordance with previous studies and included interruption of the dorsal annulus, suspected epidural hemorrhage, dispersed (rather than confined) intervertebral disc herniation on T2W sagittal images, lateralized intervertebral disc herniation and displacement of the cauda equina. Overall diagnostic accuracy was 68.8% and interobserver agreement was fair (κ = 0.37), which is lower than has been reported in thoracolumbar disc herniation, but accuracy increased to 85.3% with substantially improved agreement (κ = 0.87) in "confident" diagnoses. MRI characteristics used in differentiating thoracolumbar IVDE and IVDP can be extrapolated to the lumbosacral intervertebral disc space, but diagnostic accuracy in low-field MRI is lower than previously reported in herniations involving the thoracolumbar spine.

What factors influence surgical decision-making in anterior versus posterior surgery for cervical myelopathy? A QOD analysis.

The aim of this study was to explore the preoperative patient characteristics that affect surgical decision-making when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM). This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected. Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean 64.8 ± 10.6 vs 58.5 ± 11.1 years, p < 0.001) and those with a higher American Society of Anesthesiologists class (class III or IV: 52.4% vs 46.3%, p = 0.003), a higher rate of motor deficit (67.0% vs 58.7%, p = 0.014), worse myelopathy (mean modified Japanese Orthopaedic Association score 11.4 ± 3.1 vs 12.4 ± 2.6, p < 0.001), and more levels treated (4.3 ± 1.3 vs 2.4 ± 0.6, p < 0.001). On the other hand, surgeons more frequently performed an anterior surgical approach when patients were employed (47.2% vs 23.2%, p < 0.001) and had intervertebral disc herniation as an underlying pathology (30.7% vs 9.2%, p < 0.001). The selection of approach for patients with CSM depends on patient demographics and symptomology. Posterior surgery was performed in patients who were older and had worse systemic disease, increased myelopathy, and greater levels of stenosis. Anterior surgery was more often performed in patients who were employed and had intervertebral disc herniation.

A Case of Cold Hypersensitivity of Hands and Feet Treated with Korean Medicine Including &lt;italic&gt;Gyejifabuja-tang-gmibang&lt;/italic&gt; and Acupuncture in a Patient with Lumbar Spinal Herniated Intervertebral Disc - A Case Report

Objective: The purpose of this study is to report the efficacy of using Korean medicine treatment with cold hypersensitivity of the hands and feet with lumbar spinal herniated intervertebral disc.Case presentation: We used Korean medicine treatment (&lt;i&gt;Gyejigabuja-tang&lt;/i&gt;, acupuncture) to treat a hospitalized patient with cold hypersensitivity of the hands and feet with lumbar spinal herniated intervertebral disc. To evaluate the treatment, we used the Numerical Rating Scale (NRS). The degree of cold hypersensitivity of the hands and feet was also evaluated using evaluation paper. The generic health status was measured using the European Quality of Life-5 Dimensions (EQ-5D) scale. The 31-year-old female underwent 13 days of inpatient treatment. Her pattern identification was that both hands and feet are cold (BiYangHeo) types. The treatments were herbal medicine and acupuncture. She took &lt;i&gt;Gyejigabuja-tang&lt;/i&gt; for 13 days. She also received acupuncture for 20 minutes twice a day at LI11 (曲池), L14 (合谷), TE5 (外關) on her hands, LR3 (太衝), SP6 (三陰交), SP9 (陰陵泉) ST36 (足三里), GB41 (足臨泣) on Feet, GV4 (命門), GV3 (腰陽關), BL23 (腎兪), BL24 (氣海兪), BL25 (大腸兪), and BL26 (關元兪) on the low back. After 2 weeks of treatment, the NRS scale of her cold hypersensitivity of hands and feet symptoms dropped from NRS 7 to NRS 3, and her low back pain dropped from NRS 6 to NRS 3. Her cold hypersensitivity of hands and feet evaluation paper score decreased from 64 to 32, and her EQ-5D increased from 0.487 to 0.681. After the end of treatment, continued symptom improvements and no significant side effects were confirmed.Results: These findings suggest that Korean medical treatment (&lt;i&gt;Gyejigabuja-tang&lt;/i&gt;, acupuncture) may be effective for treating cold hypersensitivity of hands and feet with lumbar spinal herniated intervertebral disc. The NRS, evaluation paper, and EQ-5D scores improved after treatment, with no side effects.

Understanding the etiopathogenesis of lumbar intervertebral disc herniation: From clinical evidence to basic scientific research.

Lumbar intervertebral disc herniation, as a leading cause of low back pain, productivity loss, and disability, is a common musculoskeletal disorder that results in significant socioeconomic burdens. Despite extensive clinical and basic scientific research efforts, herniation etiopathogenesis, particularly its initiation and progression, is not well understood. Understanding herniation etiopathogenesis is essential for developing effective preventive measures and therapeutic interventions. Thus, this review seeks to provide a thorough overview of the advances in herniation-oriented research, with a discussion on ongoing challenges and potential future directions for clinical, translational, and basic scientific investigations to facilitate innovative interdisciplinary research aimed at understanding herniation etiopathogenesis. Specifically, risk factors for herniation are identified and summarized, including familial predisposition, obesity, diabetes mellitus, smoking tobacco, selected cardiovascular diseases, disc degeneration, and occupational risks. Basic scientific experimental and computational research that aims to understand the link between excessive mechanical load, catabolic tissue remodeling due to inflammation or insufficient nutrient supply, and herniation, are also reviewed. Potential future directions to address the current challenges in herniation-oriented research are explored by combining known progressive development in existing research techniques with ongoing technological advances. More research on the relationship between occupational risk factors and herniation, as well as the relationship between degeneration and herniation, is needed to develop preventive measures for working-age individuals. Notably, researchers should explore using or modifying existing degeneration animal models to study herniation etiopathogenesis, as such models may allow for a better understanding of how to prevent mild-to-moderately degenerated discs from herniating.

An innovative method of interosseous lumbar spine stabilization surgery using the dynamic implant in a professional athlete as a way to return to competitive activity as quickly as possible

Objective: surgical intervention for spinal pathologies in professional athletes represents a pertinent topic in contemporary sports medicine and neurosurgery, given the extended rehabilitation period and potential decline in competitive activity following spinal surgeries. In this clinical case we describe an innovative technique for stabilizing the lumbar spine in an elite adult professional athlete which enables rapid return to regular competitive activities without restrictions.Materials and methods: a clinical case involving the surgical treatment of lumbar spine instability with compression of neural structures caused by an intervertebral disc herniation is presented. An innovative method for spinal stabilization employing an interbody dynamic implant is outlined.Results: the implementation of this spinal stabilization method allowed an adult professional elite futsal player to resume active physical sport-specific activities without any limitations just three weeks post-surgery.Conclusion: this clinical observation illustrates that spinal fixation using this novel and original method ensures the stability of the operated segment during physical exertion of any intensity.

Risk Factors for Short-Term and Long-Term Low Back Pain After Transforaminal Endoscopic Lumbar Discectomy.

Low back pain following transforaminal endoscopic lumbar discectomy (TELD) is prevalent (15-25% incidence). Modifying TELD techniques to avoid excessive disc removal has been suggested to reduce such pain. Facet injury, re-herniation, and disc space collapse might contribute. This retrospective study aimed to explore factors linked to post-TELD low back pain. A total of 351 patients with L3/4, L4/5, and L5/S1 intervertebral lumbar disc herniations, who underwent TELD at two spine centers, were included. Patients were followed for one year. Low back and leg pain visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Pfirrmann grade, and disc height were measured at 3 months and 1 year. Correlation analyses examined links between postoperative low back pain VAS scores, age, sex, disc/vertebrae height ratio (D/V H ratio), Pfirrmann grade, cannula position grade, re-herniation grade, high-intensity zone (HIZ), disc calcification, surgical grade, and other factors. Significant variables were identified using partial least square tests, with variable importance in projection (VIP) values quantifying their impact on low back pain. Univariate analysis indicated that surgical grade correlated with long-term postoperative low back pain (P = 0.023), while re-herniation (P = 0.008, P = 0.000), disc height (P = 0.001, P = 0.034), and sex (P = 0.025, P = 0.003) correlated with both short- and long-term postoperative low back pain. Trephine/cannula position is correlated with short-term low back pain (P = 0.036). Worsening low back pain was associated with female sex, improper trephine/cannula position, re-herniation, and post-surgical disc space collapse. Intradiscal irrigation was linked to decreased low back pain. This study highlights factors influencing low back pain after TELD. Loss of disc height, extent of re-herniation, quality of trephine/cannula position, and sex were associated with low back pain at both 3 months and 1-year post-TELD. Proper techniques, like minimizing disc height loss and re-herniation, may help mitigate postoperative low back pain.

Video telescope operating monitor-assisted surgery is equivalent to conventional surgery in treatment of cervical intervertebral disc herniation in dogs.

To compare the use of the video telescope operating monitor (VITOM) and use of a conventional unassisted surgical method for treatment of cervical intervertebral disc herniation in dogs. 39 dogs with cervical intervertebral disc disease. Prospective study. Dogs were prospectively nonrandomly assigned to either the VITOM (n = 19) or conventional surgery (20) group depending on VITOM system availability. Signalment and preoperative neurologic status were recorded for all dogs. Preoperative and postoperative CT myelography was performed to compare intervertebral space location, spinal cord dimensions at the decompression level, ventral slot dimensions, and residual disc material. Surgical complications and postoperative neurologic outcomes were recorded. Data were compared between the 2 groups using fixed-effects or mixed-effects models to consider double reading of CT myelography images. No significant differences were noted between the 2 groups regarding the decompression ratio (P = .85), vertebral length body ratio (P = .13), ventral slot width ratio (P = .39), residual disc material (P = .30), and sinus bleeding (P = .12). No significant differences were found between the 2 groups regarding postoperative neurologic grade (P = .17). VITOM-assisted ventral slot decompression is equivalent to conventional surgery in treatment of cervical intervertebral disc herniation in dogs. The use of VITOM remains a good alternative to the conventional surgical method.

Vertebral fixation does not affect recovery or recurrence of cervical intervertebral disc herniation in small dogs (< 15 kg).

To compare the prognosis of small dogs with cervical intervertebral disc herniation (C-IVDH) when treated with ventral slot decompression (VSD) alone or with concomitant vertebral fixation (VF). Small dogs (n = 303) weighing < 15 kg diagnosed with C-IVDH and treated with VSD. We recorded signalment, cervical myelopathy grade, surgical site, use of VF, degree of adjacent disc degeneration, recovery, recurrence, recurrence site, and postoperative course, including the time elapsed from recovery to recurrence. We examined factors associated with recovery and recurrence during the 30-month postoperative period using multivariate logistic regression analysis. VF did not affect recovery (P = .79). However, nonchondrodystrophic breeds had poorer recovery (OR, 5.89; P = .023) than chondrodystrophic breeds, and a higher preoperative cervical myelopathy grade (grade 3 or 4) was associated with poorer recovery (OR, 7.09 or 3.46, respectively; P = .019 or .042, respectively), compared with grade 1. VF did not affect recurrence (P = .79); however, increasing age was associated with recurrence (OR, 1.79; P = .001). In small dogs weighing < 15 kg, there was no difference in postoperative recovery and recurrence rates after VSD with or without concomitant VF. Therefore, in small dogs with C-IVDH, even if the slot volume is increased to remove sufficient disc material during VSD, a good prognosis can be achieved with or without VF.

COMPARISON OF ENDOSCOPIC AND MINIMALLY INVASIVE SURGICAL INTERVENTIONS FOR INTERVERTEBRAL DISC HERNIATIONS IN THE LUMBAR SPINE

Introduction. Intervertebral disc herniations are a common condition that is often associated with painful sensations and restricted spinal mobility. Since this condition can significantly deteriorate a patient's quality of life, it is essential to seek effective and safe methods for its treatment. Therefore, evaluating the effectiveness and safety of treating patients with pain caused by intervertebral disc herniation, which includes performing surgical interventions for hernia removal using endoscopic and minimally invasive techniques, is a relevant task today. In this context, comparing endoscopic and minimally invasive surgical interventions becomes a pertinent topic for research, as it can help determine the optimal treatment method for each patient.&#x0D; The aim of the study is to compare endoscopic and minimally invasive surgical procedures for intervertebral disc herniations in the lumbar spine.&#x0D; Materials and Methods. The study involved 100 patients diagnosed with lumbar intervertebral disc herniation. Of these, 50 patients underwent endoscopic surgery, while the remaining 50 underwent minimally invasive surgery. The effectiveness and safety of both methods were compared using several criteria, including the duration of surgery, blood loss, length of hospital stay, pain level, overall health status, the incidence of complications, and patient satisfaction with the procedure.&#x0D; Results. Compared to minimally invasive surgery, endoscopic surgery resulted in lower blood loss, shorter treatment duration, reduced pain levels, and fewer complications. All patients in both groups returned to normal activity according to their health status.&#x0D; Conclusions. Endoscopic surgery is more effective and safer compared to minimally invasive surgery in the treatment of herniated intervertebral discs in the lumbar spine. The endoscopic technique allows for better visualization and more precise manipulation in hernia removal, which positively affects treatment outcomes, reduces the risk of complications, shortens hospitalization, and leads to faster patient recovery. The results of this study can be valuable for physicians and patients when choosing the method of treatment for herniated intervertebral discs in the lumbar spine.

The Effects of Scapular Stabilization Exercise Program on the Neck Disability Index, Range of Motion and Myofunction for Patients with Cervical Herniation of Intervertebral Disc

The Effects of Scapular Stabilization Exercise Program on the Neck Disability Index, Range of Motion and Myofunction for Patients with Cervical Herniation of Intervertebral Disc

Percutaneous endoscopic lumbar endoscopic discectomy in L5-S1 calcified disc herniation

Introduction: Calcified lumbar intervertebral disc herniation is a special type of herniated disc, the cause of which is still poorly understood. Chronic inflammation is proposed as a possible cause of calcification. Calcification can occur in the herniated nucleus pulposus when the course of the lumbar herniated disc has been&gt; 6 months. A hard disk increases the stenosis of the nerve root canal and therefore causes compressive symptoms giving dysesthesia in the lower extremities. Most patients will need open surgery as well as subsequent decompression and instrumentation. Percutaneous Endoscopic Lumbar Discectomy, using minimally invasive techniques, is a safe alternative treatment for calcified herniated discs. Case Presentation: We present the case of a 34-year-old male patient, Police on active duty, with severe low back pain according to the Pain Scale (VAS) of 8 and Oswestry Index of Disability also disabled (56%), in addition to radiculopathy of the long lower left limb evolution, without apparent cause and exacerbated 6 months ago. Magnetic resonance imaging shows a left foraminal paracentral paracentral protrusion hernia with morphological changes like calcification and with L5-S1 caudal migration, in addition to a severe narrowing of the canal. Conclusions: Percutaneous Endoscopic Lumbar Discectomy is a safe procedure that allows, with minimal invasion techniques, to decompress the medullary canal despite having significant narrowing. It also does not destroy healthy tissue unnecessarily or sacrifice stability. Lastly, a lower incidence of complications is reported.

Melatonin-loaded self-healing hydrogel targets mitochondrial energy metabolism and promotes annulus fibrosus regeneration

Intervertebral disc (IVD) herniation is a major cause of chronic low back pain and disability. The current nucleus pulposus (NP) discectomy effectively relieves pain symptoms, but the annulus fibrosus (AF) defects are left unrepaired. Tissue engineering approaches show promise in treating AF injury and IVD degeneration; however, the presence of an inflammatory milieu at the injury site hinders the mitochondrial energy metabolism of AF cells, resulting in a lack of AF regeneration. In this study, we fabricated a dynamic self-healing hydrogel loaded with melatonin (an endocrine hormone well-known for its antioxidant and anti-inflammatory properties) and investigate whether melatonin-loaded hydrogel could promote AF defect repair by rescuing the matrix synthesis and energy metabolism of AF cells. The protective effects of melatonin on matrix components (e.g. type I and II collagen and aggrecan) in AF cells were observed in the presence of interleukin (IL)-1β. Additionally, melatonin was found to activate the nuclear factor erythroid 2-related factor signaling pathway, thereby safeguarding the mitochondrial function of AF cells from IL-1β, as evidenced by the increased level of adenosine triphosphate, mitochondrial membrane potential, and respiratory chain factor expression. The incorporation of melatonin into a self-healing hydrogel based on thiolated gelatin and β-cyclodextrin was proposed as a means of promoting AF regeneration. The successful implantation of melatonin-loaded hydrogel has been shown to facilitate in situ regeneration of AF tissue, thereby impeding IVD degeneration by preserving the hydration of nucleus pulposus in a rat box-cut IVD defect model. These findings offer compelling evidence that the development of a melatonin-loaded dynamic self-healing hydrogel can promote the mitochondrial functions of AF cells and represents a promising strategy for IVD regeneration.

The effects of Q angle and Hamstring Length on Balance Performance in Patients with Lumbar Disc Hernia

Aim: Patellafemoral angle (Q angle) and Hamstring length are important measurements to evaluate balance. This study aims to examine the effects of Q angle and Hamstring length on balance performance in patients with lumbar intervertebral disc herniation (LDH). Material and Methods: LDH (n=32) and control group (CG)(n=30) were included in the study. Q angles and hamstring muscle lengths of the participants were measured. Balance was evaluated with Y balance test. Results: As a result of our study, no difference was found between LDH patients and CG groups in terms of hamstring muscle length; Q angle decreased in LDH patients and there was a negative high correlation between Q angle and R -Anterior, R-Posteromedial, R-Posterolateral values on the right and between Q angle and L-Anterior, L-Posteriolmedial, L-Posterolateral values on the left. Conclusion: It was found that Q angle measurements decreased in LDH patients, causing genu varum and leading to impairment in balance, especially in the left anterior, anteromedial and anterolateral.

Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation

To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05). For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.

Forecast of pain degree of lumbar disc herniation based on back propagation neural network.

To further explore the pathogenic mechanism of lumbar disc herniation (LDH) pain, this study screens important imaging features that are significantly correlated with the pain score of LDH. The features with significant correlation imaging were included into a back propagation (BP) neural network model for training, including Pfirrmann classification, Michigan State University (MSU) regional localization (MSU protrusion size classification and MSU protrusion location classification), sagittal diameter index, sagittal diameter/transverse diameter index, transverse diameter index, and AN angle (angle between nerve root and protrusion). The BP neural network training model results showed that the specificity was 95 ± 2%, sensitivity was 91 ± 2%, and accuracy was 91 ± 2% of the model. The results show that the degree of intraspinal occupation of the intervertebral disc herniation and the degree of intervertebral disc degeneration are related to LDH pain. The innovation of this study is that the BP neural network model constructed in this study shows good performance in the accuracy experiment and receiver operating characteristic experiment, which completes the prediction task of lumbar Magnetic Resonance Imaging features for the pain degree of LDH for the first time, and provides a basis for subsequent clinical diagnosis.