Lumbar Disc Herniation Patients Research Articles

Comparison of Needle-Warming Moxibustion and Other Physical Therapies for Lumbar Disc Herniation: A Meta-analysis

Background Needle-warming moxibustion (NWM) demonstrates a controversial effect on lumbar disc herniation (LDH). This study is aimed at comparing the efficacy of NWM and conventional acupuncture or other physical therapies on LDH through a meta-analysis. Methods Potentially eligible literatures were retrieved and screened from electronic databases. The subject of the literature was a comparison of NWM and conventional acupuncture or other physical therapies for LDH. The methodological quality was evaluated by the Jadad scale. The chi-square test was used for the heterogeneity test. Subgroup analysis was used to explore the source of heterogeneity. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used to describe the effect size. The publication bias was evaluated by Egger's test. Results The effective rate of NWM in the treatment of LDH was significantly higher than that of conventional acupuncture (RR = 1.27, 95%CI [1.18, 1.36], P < 0.00001) and lumbar traction (RR = 1.12, 95%CI [1.06, 1.18], P < 0.0001) There was no significant difference in the effective rate between NWM and electric acupuncture for LDH (RR = 1.06, 95%CI [0.98, 1.14], P = 0.17). VAS of LDH patients treated with NWM was lower than conventional acupuncture (MD = −1.51, 95%CI [−1.70, −1.31], P < 0.00001) and lumbar traction (MD = −2.64, 95%CI [−2.79, −2.49], P < 0.00001) but statistically insignificant with electric acupuncture (MD = −0.31, 95%CI [−0.72, 0.09], P = 0.13). JOA scores of LDH patients treated with NWM were higher than those with conventional acupuncture (MD = 2.24, 95%CI [1.04, 3.45], P = 0.0003) and lumbar traction (MD = 10.76, 95%CI [10.45, 11.07], P < 0.00001) but statistically insignificant with electric acupuncture (MD = 0.25, 95%CI [−0.95, 1.45], P = 0.69). The long-term effective rate of NWM on LDH was higher than that of conventional acupuncture (MD = 3.13, 95%CI[2.12, 4.61], P < 0.00001). In this study, no heterogeneity (P > 0.10, I2 < 50%) and publication bias (P > 0.05) among the literature were noted. Conclusion The effect of NWM on LDH was superior to traction therapy and conventional acupuncture therapy, but similar to electric acupuncture for LDH. High-quality randomized controlled trials were still needed to confirm the results.

Gait asymmetry of lower extremities reduced immediately after minimally invasive surgery among patients with lumbar disc herniation

BackgroundLumbar disc herniation patients with increased pain exhibit greater gait asymmetry in stance time, swing time and single support time. Percutaneous endoscopic lumbar discectomy, as a minimally invasive surgical procedure has been used to treat patients with lumbar disc herniation. The objective of this study was to evaluate the immediate impact of the percutaneous endoscopic lumbar discectomy on gait asymmetry in spatiotemporal and kinetic parameters among lumbar disc herniation patients. MethodsMarker trajectories and ground reaction forces were measured during walking among 67 lumbar disc herniation patients and 15 healthy controls. Spatiotemporal gait parameters were analyzed via Visual3D. Muscle force and joint contact force were calculated with OpenSim. Gait asymmetry of those parameters were assessed with asymmetry index. FindingsAfter surgery, gait asymmetry in gait cycle time, step length, peak biceps femoris long head, tensor fasciae latae and rectus femoris muscle forces, and peak hip and knee joint contact forces reduced immediately. Postoperatively, increased gait cycle time and decreased step length were found in the affected side. Moreover, decreased peak biceps femoris long head, tensor fasciae latae and rectus femoris muscle forces, and peak hip joint contact force were observed in the contralateral side. InterpretationThese results suggested compensation strategy that biceps femoris long head, tensor fasciae latae and rectus femoris in the contralateral side were mainly used to compensate the affected side preoperatively in lumbar disc herniation patients, with less compensation between lower limbs after surgery, which may provide an insight into postoperative rehabilitation.

Clinical Efficacy Analysis of Fast Rehabilitation Nursing on Pain Mitigation after Lumbar Discectomy and Bone Graft Fusion and Internal Fixation.

Objective To investigate clinical efficacy analysis of fast rehabilitation nursing on pain mitigation after lumbar discectomy and bone graft fusion and internal fixation. Methods A total of 60 patients with lumbar disc herniation who underwent lumbar discectomy and bone graft fusion and internal fixation in our hospital from January 2021 to December 2021 were randomized either into routine group (n = 30) or rehabilitation group (n = 30) via the random number table method. The patients in the routine group were intervened with the routine postoperative nursing mode, and the patients in the rehabilitation group were intervened with the fast rehabilitation nursing mode on the basis of the nursing of the patients in the routine group. The rehabilitation effect, self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores, postoperative pain improvement, and nursing satisfaction were compared between the two groups. Results The postoperative rehabilitation effect of the rehabilitation group was significantly better than that of the routine group (P < 0.05). The fast rehabilitation nursing resulted in a notably lower postoperative SAS and SDS scores versus the routine nursing (P < 0.001). The postoperative pain was significantly mitigated in the rehabilitation group when compared with the routine group (P < 0.001). The fast rehabilitation nursing implemented in the rehabilitation group led to a remarkably higher nursing satisfaction of the patients (P < 0.001). Conclusion The fast rehabilitation nursing mode intervention for lumbar disc herniation patients undergoing lumbar discectomy and bone graft fusion and internal fixation is a promising approach to improve the postoperative rehabilitation, mitigate postoperative pain, and relieve anxiety, depression, and other negative emotions, with higher clinical nursing satisfaction.

Neoepitope fragments as biomarkers for different phenotypes of intervertebral disc degeneration.

BackgroundDuring the intervertebral disc (IVD) degeneration process, initial degenerative events occur at the extracellular matrix level, with the appearance of neoepitope peptides formed by the cleavage of aggrecan and collagen. This study aims to elucidate the spatial and temporal alterations of aggrecan and collagen neoepitope level during IVD degeneration.MethodsBovine caudal IVDs were cultured under four different conditions to mimic different degenerative situations. Samples cultured after 1‐ or 8‐days were collected for analysis. Human IVD samples were obtained from patients diagnosed with lumbar disc herniation (LDH) or adolescent idiopathic scoliosis (AIS). After immunohistochemical (IHC) staining of Aggrecanase Cleaved C‐terminus Aggrecan Neoepitope (NB100), MMP Cleaved C‐terminus Aggrecan Neoepitope (MMPCC), Collagen Type 1α1 1/4 fragment (C1α1) and Collagenase Cleaved Type I and II Collagen Neoepitope (C1,2C), staining optical density (OD)/area in extracellular matrix (OECM) and pericellular zone (OPCZ) were analyzed. Conditioned media of the bovine IVD was collected to measure protein level of inflammatory cytokines and C1,2C.ResultsFor the bovine IVD sections, the aggrecan MMPCC neoepitope was accumulated in nucleus pulposus (NP) and cartilage endplate (EP) regions following mechanical overload in the one strike model after long‐term culture; as for the TNF‐α induced degeneration, the OECM and OPCZ of collagen C1,2C neoepitope was significantly increased in the outer AF region after long‐term culture; moreover, the C1,2C was only detected in conditioned medium from TNF‐α injection + Degenerative loading group after 8 days of culture. LDH patients showed higher MMPCC OECM in NP and higher C1,2C OECM in AF region compared with AIS patients.ConclusionsIn summary, aggrecan and collagen neoepitope profiles showed degeneration induction trigger‐ and region‐specific differences in the IVD organ culture models. Different IVD degeneration types are correlated with specific neoepitope expression profiles. These neoepitopes may be helpful as biomarkers of ECM degradation in early IVD degeneration and indicators of different degeneration phenotypes.

Efficacy of side lying traction versus supine lying traction in treatment of lumbar disc herniation

Objective: To investigate the effect of side lying lumbar traction and Supine lumbar traction in treatment of Lumbar disc herniation (LDH). Design: Two Experimental design Pretest – Posttest control group. Subjects: Forty-seven patients of LDH with unilateral sciatica randomly assigned into side lying traction group, supine lying traction group, and control group. Intervention: control group received conventional physical therapy (hot pack- lumbar strengthening exercise and stretching exercise). Side lying group received side lying traction beside conventional physical therapy and supine lying traction group received supine lying traction beside conventional physical therapy. The treatment was 3 sessions per week for 12 weeks. Outcome measurement: The patients were evaluated by Visual Analogue Scale (VAS) for (back – leg) pain, Oswestry Disability Index (ODI), H reflex Latency, L4/L5, L5/S1 herniated disc index. The evaluation was before and after intervention. Results: There was statistically significant difference for side lying traction in VAS (back-leg), ODI score and L5/S1 disc index after 12 weeks of treatment (p &gt; 0.05). There was statistically significant difference for both traction groups in L4/L5 disc index. There wasn’t statistically significant among three groups in H reflex latency.

Analysis of the resilience level and associated factors among patients with lumbar disc herniation

This study aims to determine the resilience level and its influence on anxiety among Chinese lumbar disc herniation (LDH) patients, and to determine the critical psychological and non-psychological predictors of resilience among LDH patients. Twenty hundred and fifty LDH patients from a tertiary hospital in Jinzhou, China were included in this survey to answer the Resilience Scale-14 (RS-14), Zung Self-Rating Anxiety Scale (SAS), Herth Hope Index (HHI), Revised Life Orientation Test (LOT-R), Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Stress Scale-10 (PSS-10). The mean resilience level of LDH patients was 61.96 ± 12.37. Resilience was negatively correlated with anxiety (χ2 = 32.603, p < 0.001), accompanied by a significant linear trend (χ2 = 28.567, p < 0.001). Hope, stress, social support, and medical payment type accounted for 48.7% resilience variance. This study reveals that Chinese LDH patients had low resilience level, and that lower level of resilience was closely associated with higher anxiety level. The predictors for resilience among LDH patients include hope, stress, social support, as well as medical payment types. These findings provide local government and related health-care professionals with a basis for development of targeted mental health management of Chinese LDH patients, and will also help to devise appropriate health intervention strategies for promoting the mental health status of LDH patients.

Transforaminal injection of autologous platelet-rich plasma for lumbar disc herniation: A single-center prospective study in Vietnam

ObjectiveLumbar radiculopathy is a major health problem, which often treated by neurosurgery or guided lumbar epidural steroids for pain relief. We used autologous Platelet Rich Plasma (PRP) as a novel pharmaceutical agent that has strongly emerged in recent years to treat patients of lumbar disc herniation. From that, we evaluated the efficacy of PRP via transforaminal route in treatment of radicular pain in patients with lumbar disc herniation. MethodsTwenty-five patients were enrolled and injected with 4 ml of autologous platelet rich plasma under fluoroscopic guidance via transforaminal epidural injection into area of affected nerve root. They were followed using Visual Analogue Scale (VAS), Modified Oswestry Disability Index (ODI) and Straight Leg Raising Test (SLRT) for clinical assessment. ResultsPatients who received transforaminal injections with autologous PRP showed statistically significant improvements on all three evaluation tools (VAS, ODI, SLRT). The improvements were sustained over twelve-month follow-up and there were no associated complications. ConclusionTransforaminal injection with autologous PRP helps patients relieve chronic pains and be able return to work. Besides, autologous PRP can be considered as a good alternative to epidural steroids in management of lumbar disc herniation.

A one-step foraminoplasty via a large trephine in percutaneous endoscopic transforaminal discectomy for the treatment of lumbar disc herniation.

Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a widely used basic technique for lumbar disc herniation (LDH) with advantages including causing less trauma and fast recovery. The secure, efficient, and rapid enlargement of the intervertebral foramen is a key step in PELD procedures. However, the conventional multi-step trephine system for foraminoplasty involves complicated surgical procedures. In this study, we reported an improved one-step foraminoplasty via a large trephine with simplified surgical procedures, reduced radiation exposure, and shortened operative time. 70 LDH patients who underwent PELD were retrospectively reviewed in this study. The conventional multi-step trephine system was used for foraminoplasty in 35 patients in the multi-step (MS) group, and the single large trephine was used in the other 35 patients in the one-step (OS) group. Indicators including the operative time, the time to establish the working cannula, intraoperative fluoroscopy times, the radiation dose, and postoperative complications were compared between the MS and OS group. The operative time and the time to establish the working cannula in the OS group was significantly shorter than that in the MS group (P < 0.01); intraoperative fluoroscopy times and the radiation dose in the OS group were significantly smaller than those in the MS group (P < 0.01). There was no statistical difference in the incidence of postoperative complications between the two groups (P > 0.05). The postoperative VAS scores and ODI scores (2 days and 3 months after the surgery) were significantly lower than the preoperative scores in both groups (P < 0.01), and there was no statistical difference in VAS scores or ODI scores between the two groups at the same time points (P > 0.05). The one-step foraminoplasty via a single large trephine is an optimized technique evolving from the conventional multi-step foraminoplasty, showing significant superiority in simplified operation, shorted operative time, and reduced radiation exposure.

Medical Data Analysis of Lumbar Disc Herniation Patients after Traditional Chinese Medicine Rehabilitation Intervention Lumbar Function Recovery

In order to study the efficacy of TCM rehabilitation for lumbar disc herniation, it is suggested to compare the effects of hot compress, ordinary sandbag, or hot compress with traditional Chinese medicine. A total of 79 patients with Qi stagnation and blood stasis syndrome in a traditional Chinese medicine hospital who met the diagnostic criteria of LDH and the syndrome classification in the diagnostic efficacy criteria of traditional Chinese medicine were selected. The subjects were randomly divided into groups A, B, and C: group A (26 cases) was the sandbag hot compress dry pregroup and received the simple sandbag hot compress scheme; group B (26 cases) was a simple traditional Chinese medicine hot compress intervention group, which received traditional Chinese medicine hot compress scheme; group C (27 cases) was the intervention group of traditional Chinese medicine sandbag combined with hot compress and received the scheme of traditional Chinese medicine sandbag combined with hot compress. In addition to the different hot compress media used, other aspects remained the same among the three groups. The treatment time of each hot compress was 40 min, twice a day for 2 weeks. A total of 14 cases fell out during the intervention process, and 65 subjects completed the intervention process. The experiment showed that there was no significant difference among the three groups (P > 0.05). The test results were confirmed.

Brain Network Changes in Lumbar Disc Herniation Induced Chronic Nerve Roots Compression Syndromes.

Lumbar disc herniation (LDH) induced nerve compression syndromes have been a prevalent problem with complex neural mechanisms. Changes in distributed brain areas are involved in the occurrence and persistence of syndromes. The present study aimed to investigate the changes of brain functional network in LDH patients with chronic sciatica using graph theory analysis. A total of thirty LDH adults presenting L4 and/or L5 root (s) compression syndromes (LDH group) and thirty age-, sex-, BMI- and education-matched healthy control (HC group) were recruited for functional MRI scan. Whole-brain functional network was constructed for each participant using Pearson's correlation. Global and nodal properties were calculated and compared between two groups, including small-worldness index, clustering coefficient, characteristic path length, degree centrality (DC), betweenness centrality (BC) and nodal efficiency. Both LDH and HC groups showed small-world architecture in the functional network of brain. However, LDH group showed that nodal centralities (DC, BC and nodal efficiency) increased in opercular part of inferior frontal gyrus; and decreased in orbital part of inferior frontal gyrus, lingual cortex and inferior occipital gyrus. The DC and efficiency in the right inferior occipital gyrus were negatively related with the Oswestry Disability Index in LDH group. In conclusion, the LDH-related chronic sciatica syndromes may induce regional brain alterations involving self-referential, emotional responses and pain regulation functions. But the whole-brain small-world architecture was not significantly disturbed. It may provide new insights into LDH patients with radicular symptoms from new perspectives.

A retrospective comparative study of local anesthesia only and local anesthesia with sedation for percutaneous endoscopic lumbar discectomy.

It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under local anesthesia for lumbar disk herniation (LDH) patients. Herein, we compared the analgesic and sedative effects of local anesthesia alone and local anesthesia with conscious sedation in LDH patients during percutaneous endoscopic lumbar discectomy. Ninety-two LDH patients were enrolled and divided into the following groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Various signs, including mean arterial pressure (MAP), heart rate (HR), pulse oximeter oxygen saturation (SpO2) and Ramsay score, were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperation (T4). Clinical outcomes, including VAS score, operation time, hospitalization period, Macnab criteria, and SF-36 score, were also evaluated. The Dex + Oxy Group showed the most stable MAP and HR at T2 and T3 in all groups. The clinical outcomes, such as VAS, hospitalization period, Macnab criteria, and SF-36 score, have no significant differences among groups (p > 0.05). Local anesthesia combined with conscious sedation is a safe and effective method to improve the surgical experience and achieve satisfying clinical outcomes for LDH patients during percutaneous endoscopic lumbar discectomy.

Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation With Type II Modic Changes

Percutaneous endoscopic lumbar discectomy (PELD) has become a favorable surgical approach for lumbar radiculopathy caused by intervertebral disc herniation. Studies have revealed patients with type II Modic change may suffer from unrelieved low back pain and higher lumbar disc herniation (LDH) recurrence after herniated nucleus pulposus removal. Therefore, in this study, we aim to evaluate how PELD performed in management of LDH patients with type II Modic change. We collected 267 single-level LDH cases aged 20-50 yearswho underwent PELD from December 2016 to December 2019. The mean follow-up time was 26.3 months (range: 12-48 months). The visual analog scale (VAS), Oswestry Disability Index (ODI), and MacNab scores, as well as the recurrence rate, were analyzed pre- and post-surgery, as well as at the time points of 3 months, 12 months, and the final follow-up time after surgery. The clinical outcomes in LDH patients with or without type II Modic change who underwent PELD were thoroughly analyzed. Within the 267 LDH patients enrolled, 145 cases present Modic signals, among which 3 are type I and 142 are type II. The VAS and ODI scores of the patients in the 2 groups at different follow-up times were significantly lower than those before surgery. The excellent and good MacNab scores in the control group and Modic type II change group were 87.0% and 82.1%, respectively. However, with the extension of follow-up time, the VAS and ODI scores, as well as the recurrence rate, were found to be higher in the type II Modic change group when compared with those in the non-Modic change group. PELD performed well in management of LDH patients. However, we need to pay more attention to the continuous low back pain and the recurrence possibility in the cases with type II Modic change. In these cases, longer brace support or other interventions could be applied.

The association between changes in multifidus muscle morphology and back pain scores following discectomy surgery for lumbar disc herniation: a systematic review and meta-analysis.

To evaluate the impact of discectomy on back muscles (e.g. multifidus muscle (MM)) morphology in patients with lumbar disc herniation (LDH) following discectomy surgery, address the association of back muscles morphology with pain score preoperatively and post-operatively, and investigate the relationships between the changes from pre- to post-operative back muscles measurements and pain score (primary outcome) and disability score (secondary outcome) change following discectomy if any. We searched three online databases for randomized controlled trials (RCTs) and observational studies. In LDH patients, eligible for discectomy surgery, pre- and post-operative and the changes from pre- to post-operative of back and/or leg pain with Visual Analogue Scale (VAS) and multifidus muscle morphology, were considered as primary outcomes. Cochrane Risk-of-Bias 2 tool and Newcastle-Ottawa Scale (NOS) were used to assess the methodological quality of RCTs and observational studies, respectively. Standardize mean difference (SMD) with 95% confidence intervals (CI) was evaluated. A meta-regression analysis was conducted. GRADE approach was used to summarize the strength of evidence. One RCT and five observational studies were included in the analysis of 489 patients with LDH undergoing discectomy surgery. The mean overall follow-up was 64.9weeks (6 to 148.7weeks). There was a significant negative relationship between the change from pre- to post-operative cross-sectional area (CSA) in MM and change in VAS back pain [regression coefficient = -0.01, (95% CI = -0.02, -0.01), p = 0.044] after discectomy surgery. No significant relationship between preoperative CSA in MM and preoperative/post-operative clinical (any of the follow-up periods) scores could be established. The results of this study found very low-quality grade evidence for an association between higher reduction of CSA in MM and less reductions of back pain scores following discectomy surgery for patients with LDH. Due to the heterogeneity and methodological limitations, further studies will improve understanding and aid preoperative counselling.

Increased local miR-21 expressions are linked with clinical severity in lumbar disc herniation patients with sciatic pain.

The miR-21 has been implicated in the process of neuroinflammation as well as neuropathic pain. To explore the relationship between the plasma and local expression of miR-21 with disease severity of lumbar disc herniation (LDH) patients with sciatic pain. Ninety-two LDH patients with sciatic pain and 25 scoliosis patients as painless controls were enrolled in the current study. Samples from nucleus pulposus (NP), annulus fibrosus (AF) and soft tissues around nerve root (STANR) were obtained. The plasma and local expressions of miR-21 were detected with quantitative reverse transcription polymerase chain reaction (qRT-PCR). The visual analogue scale (VAS) for lumbar pain and leg pain, and Japanese Orthopedic Association (JOA) score were selected to evaluate the clinical severity. The degree of disc compression on nerve was evaluated using the Pfirrmann grade based on the magnetic resonance imaging (MRI) findings. For the convenience of analysis, LDH patients with sciatic pain were classified into a severe pain (SP) group (VAS ≥ 6) and a mild-moderate pain (MP) group (VAS < 6). Receiver operating characteristic (ROC) curve analysis was performed to detect the potential diagnostic power of miR-21 with regard to the Pfirrmann grade. There were no significant differences in serum miR-21 expressions among SP LDH patients, MP LDH patients and scoliosis painless controls. Local expressions of miR-21 in STANR, AF and NP were all drastically upregulated in the SP group in comparison with the MP group and scoliosis painless group. Local NP and STANR miR-21 expressions were positively associated with the Pfirrmann grade. Local miR-21 expressions in STANR and AF were positively associated with VAS score and negatively related to JOA score. The ROC curve analysis indicated that both STANR and AF miR-21 expressions may serve as significant diagnostic factors for the Pfirrmann grade. Increased local miR-21 expressions are linked with clinical severity of LDH in patients with sciatic pain.

Clinical outcomes and satisfaction in patients after lumbar microdiscectomy

Introduction: Lumbar disc herniation is a common cause of low back and radicular pain. Microdiscectomy is the recommended surgical technique for herniated lumbar discs at the moment. It has great success rates and little postoperative morbidity. We aimed to assess the clinical result and patient satisfaction of micro-discectomy in lumbar disc herniation patients. Methodology: This is a prospective observational hospital-based research of 26 patients who had micro-discectomy at the Regional Clinical Center of Neurosurgery and Neurology in Uzhhorod, Ukraine, during August and September 2021. The research excluded patients with recurrent prolapsed intervertebral discs, multiple level herniated discs, and disc surgery requiring stability. During surgery, the kind of prolapsed intervertebral disc, its level, and the duration of the procedure were recorded. Additionally, we recorded the duration of the patient's hospital stay and any complications. The visual analogue scale (VAS), the Oswestry Disability Index (ODI), and the MacNab score questionnaires were used to measure pain, disability, and patient satisfaction, respectively. Result: All procedures were performed on a single level using micro-discectomy. The mean age of the study population was 45.69 years. Micro-discectomy surgeries were performed in less than an hour in 69.2% of cases. The most often seen lumbar prolapsed intervertebral disc occurred at the L4-L5 level (57.7%). The most often seen kinds of prolapse were disc extrusion (30.8%) and disc sequestration (26.9%). The mean length of stay in the hospital was 3.96 days. After surgery, 57.7% of patients received an excellent rating on the Macnab's scale. There was a statistically significant difference between pre- and postoperative VAS and ODI scores (p&lt;0.05). Conclusion: Overall 65.4% of patients had no postoperative complications. In these instances, a proper surgical technique might help avoid problems. Our findings demand additional investigation with bigger sample sizes and longer follow-up periods.

The substantial clinical benefit of comprehensively considering low back pain and radiating pain caused by lumbar intervertebral disc herniation.

Patients with lumbar disc herniation (LDH) may experience low back pain (LBP) and radiating pain (RP). Currently, there is no substantial clinical benefit (SCB) of assessing both LBP and RP due to LDH. To determine enhanced SCB values by simultaneously assessing LBP and RP. We retrospectively evaluated hospitalized LDH patients with concomitant LBP and RP between June 1, 2012, and May 31, 2013, and determined the numeric rating scale (NRS) and Oswestry Disability Index (ODI) scores at admission and discharge. Furthermore, the area under the receiver operating characteristic curve (AUC) was computed to assess diagnostic accuracy. SCB as per NRS for both LBP and RP was -2.50 in the 186 enrolled patients (AUC: 0.699 and 0.704, respectively). SCB as per ODI was -18.78 (AUC: 0.771). SCB for the mean of the two NRS scores for LBP and RP was -2.75 (AUC: 0.757). SCB for NRS score with a larger change in LBP and RP was -3.50 (AUC: 0.767). SCB may be determined by comprehensively considering LBP and RP and choosing the mean NRS or NRS score with a large change.

161 Return to Work Following Surgery for Lumbar Disc Herniation: Comparison of a Universal and Multitier Health Care System

INTRODUCTION: Canada has a universal health care system that is funded by the government. In contrast, the United States utilizes a combined public and private payer system where patients may directly access specialists. METHODS: Surgical lumbar disc herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective multicenter registry and were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study.Patient reported outcomes (PROs) and return to work were compared at 3 months and 1 year post-operatively were analyzed. RESULTS: The CSORN cohort consisted of 157 patients and the SPORT cohort was made up of 397 patients that were actively working at the time of surgery. The rate of depression (9.1% vs. 16.5%, p = 0.016) and symptom duration greater than 6 months were higher in the CSORN cohort (23.4% vs. 73.2%, p &lt; 0.0001). 100% of the CSORN cohort had public insurance compared to 1% in the SPORT cohort (p &lt; 0.001) and patients in the CSORN group were more likely to have compensation claims (17.8% vs. 9.1%, p = 0.0049). CSORN patients had better baseline ODI and SF36/12-PCS scores (ODI: 50.9 ± 19.7 vs. 45.8 ± 14.9, p = 0.0031; SF36/12 PCS: 29.9 ± 7.9 vs. 35.7 ± 7.4, p &lt; 0.001). At 3 months post-operatively the rate of patients that had returned to work was significantly lower in the CSORN cohort (47.8% vs. 72.8%, p &lt; 0.0001), but was not different at 12-months post-operatively (86.7% vs. 91.6%, p = 0.11). Membership in the CSORN cohort and compensation claims were significant independent predictors of not returning to work at 3-months post-operatively on multivariable logistic regression (OR 0.16, 95% CI 0.09-0.29, p &lt; 0.001; OR 0.47, 95% CI 0.26-0.85, p = 0.012). CONCLUSION: Patients undergoing surgical treatment for lumbar disc herniation in Canada (CSORN cohort) had a lower rate of return to work at 3 months but not 1 year post-operatively compared to the United States cohort (SPORT) despite better disability scores prior to surgery.

Differential item functioning analysis using the SF-36 in patients with lumbar disc herniation: A quality of life research

&#x0D; Background: Differential item functioning (DIF) presents when individuals from different groups perceive the meaning of items differently in health-related quality of life (HRQoL) questionnaires. The aim of this study is to distinguish DIF in the SF-36 questionnaire and to determine its effect on comparison of HRQoL scores of lumbar disc herniation (LHD) patients and a healthy population.&#x0D; Methods: A total of 137 patients with LHD and 691 healthy individuals filled out the Persian version of the SF-36 questionnaire. The Rasch model was used to assess DIF for patients with LDH and a healthy population.&#x0D; Results: The presence of DIF was determined in 6 of 8 (75%) domain scores between patients with LDH and healthy individuals. Although half of the DIF was categorized as either negligible (3 out of 8; 37.5%), high DIF was observed in 3 out of 8 domains (37.5%). Gender was not flagged as important to DIF, with only 3 of 8 (37.5%) categorized as negligible.&#x0D; Conclusion: Because the use of the SF-36 questionnaire in HRQoL assessment between groups may not be invariant, caution should be used during comparison of HRQoL scores between heterogeneous groups.&#x0D;

Clinical application of enhanced recovery after surgery in lumbar disk herniation patients undergoing dynamic stabilization and discectomy

Enhanced recovery after surgery (ERAS) has been demonstrated to improve early postoperative outcomes and is becoming a crucial component of any perioperative management paradigm. To investigate the effect of an ERAS protocol on lumbar disk herniation (LDH) patients undergoing dynamic stabilization and discectomy. A total of 119 lumbar disk herniation (LDH) patients undergoing Dynesys dynamic stabilization and discectomy were divided into the ERAS (n1 = 56) and control group (n2 = 63). ERAS group received an enhanced recovery after surgery (ERAS) protocol, and control group received a traditional care protocol. Both the ERAS and control groups had significantly decreased visual analog scale (VAS) score and Oswestry Disability Index (ODI) and increased Japanese Orthopaedic Association (JOA) score at postoperative 1 week, 1 month and 3months compared with preoperative scores. Moreover, the ERAS group had lower postoperative VAS score and ODI and higher postoperative JOA score and rate of improved JOA score compared with the control group. Intraoperative blood loss, operation time, ambulation time and length of stay were all lower in the ERAS group than in the control group. The ERAS protocol designed was feasible for LDH patients undergoing dynamic stabilization and discectomy with significantly improved perioperative outcomes.

Pain, disability, and MRI changes in lumbar disc herniation patients treated with integrative medicine: Ten-year results of an observational study

Background: To date, a 10-year follow-up study on complementary and alternative medical treatment of lumbar intervertebral disc herniation (LDH) has never been conducted. Therefore, we aimed to perform a prospective 10-year follow-up study on the integrated treatment of LDH in Korea.Methods: One hundred and fifty patients from the baseline study, who initially met the LDH diagnostic criteria with a chief complaint of radiating pain and received integrated treatment, were recruited for this follow-up study. The 10-year follow-up was conducted from February 2018 to March 2018 on pain, disability, satisfaction, quality of life, and changes in herniated disc, muscles, and fat through magnetic resonance imaging.Results: Sixty-five patients were included in this follow-up study. Visual analogue scale score for lower back pain and radiating leg pain were maintained at a significantly lower level than the baseline level. Significant improvements in Oswestry disability index and quality of life were consistently present. MRI confirmed that disc herniation size was reduced over the 10-year follow-up. In total, 95.38% of the patients were either “satisfied” or “extremely satisfied” with the treatment outcomes and 89.23% of the patients claimed their condition “improved” or “highly improved” at the 10-year follow-up.Conclusions: The reduced pain and improved disability was maintained over 10 years in patients with LDH who were treated with nonsurgical Korean medical treatment 10 years ago. Nonsurgical traditional Korean medical treatment for LDH produced beneficial long-term effects, but future large-scale randomized controlled trials for LDH are needed.Study registration: ClinicalTrials.gov, NCT03426215.