Surgery For Lumbar Disc Herniation Research Articles

Efficacy of Epidural Steroid Injections and Evaluation of Surgical and Anesthetic Approaches in Far-Lateral Disc Herniations

Aim: To observe the long-term effect of epidural steroid injections (ESI) and describe surgical outcomes in patients with far-lateral lumbar disc herniations. Materials & methods: The medical records of 30 patients who underwent surgery for far-lateral lumbar disc herniations were reviewed. Results: ESI outcomes: pain scores decreased significantly after ESI (p=0.004). The surgery was delayed for 13.78±8.59 months in patients who received ESI. Surgical outcomes: the improvement in the leg pain was considerably more significant than the back pain (p<0.001). While motor deficit improved substantially (p<0.001), there was persistent sensory dysesthesia. Conclusion: ESI does not preventbut may delay the surgery up to 28 months. Although postoperative pain scores were significantly decreased, there was persistent back pain and sensory paresthesia.

Physical capability and patient-reported well-being after spinal surgery: a 20-year cohort from the Kuopio Osteoporosis Risk Factor and Prevention study combined with the Finnish Care Register for Health Care.

Studies investigating the effect of spinal surgery on both physical capability (PC) and subjective well-being (SW) are scarce. We aimed to investigate self-reported PC and SW up to 20 years after lumbar spine surgery. 6,612 postmenopausal Finnish women (47-56 years at baseline [BL]), from the Osteoporosis Risk Factor and Prevention (OSTPRE) study, were followed-up (FU) for 20 years. The Finnish Care Register for Healthcare (CRFH) provided data on surgery in the OSTPRE population on lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). PC and SW of women with lumbar surgery was compared with that of women without lumbar surgery. A chi-square analysis was conducted to analyze the statistical differences in the distribution of PC and SW. A propensity score-matched control analysis was also performed in addition to analysis of the total populationbased control group. In women without lumbar surgery 94% reported good PC at BL, which decreased to 79% at the 20-year FU. For those with LSS/LDH surgery, 84%/(37/50) reported good PC at BL and 80%/(33/50) at 20-year FU, respectively. Good SW was reported by 48% of the control group at BL, 50% at 10-year FU, and 42% at 20-year FU. Women with LSS/LDH surgery before the 10-year FU reported good SW as follows: (6/50)/38% at BL, (12/48)/39% at 10-year FU, and (9/50)/37% at 20-year FU. Patients with LSS and LDH report lower PC and SW. Lumbar spinal surgery improves PC and SW in the short term, with early LDH surgery showing the greatest benefits whereas late surgery did not. Overall, PC and SW are lower both initially and during the 20-year FU when compared with the age-matched controls except for early LDH surgery.

Retracted: Clinical Efficacy and Safety of Percutaneous Spinal Endoscopy versus Traditional Open Surgery for Lumbar Disc Herniation: Systematic Review and Meta-Analysis.

[This retracts the article DOI: 10.1155/2022/6033989.].

Predictive value of the five-repetition sit-to-stand test for outcomes after surgery for lumbar disc herniation: prospective study

Predictive value of the five-repetition sit-to-stand test for outcomes after surgery for lumbar disc herniation: prospective study

Evaluation of a mobile-application educational intervention on the knowledge, attitude, and practice of patients in postoperative care for lumbar disk herniation surgery: A randomized control trial.

We aimed to evaluate the impact of a mobile-based educational program on patients' postoperative care for lumbar disk herniation surgery. A randomized controlled trial was conducted at Fayaz-Bakhsh Hospital, Tehran, Iran. Patients with lumbar disc herniation surgery experience were randomized to the intervention and control groups (learning with the LUmbar CAring Training-app). Participants' knowledge, attitudes, and practices of postoperative care for lumbar disc herniation surgery were assessed using a validated questionnaire at three-time points: pre-test (baseline), post-test one (immediately after program completion), and post-test two (8 weeks after program completion). The primary outcome measures were knowledge, attitudes, and practices scores variations. Secondary outcomes were not considered in our study. In total, 150 patients were enrolled, with 75 patients in each group. Patients in the intervention group demonstrated increased knowledge, modified attitudes, and practice than those in the control group (p < 0.05). The post-test knowledge, attitudes, and practices scores in the intervention group were significantly higher than those in the control group (p < 0.05). Mobile-application-based education was a practical and feasible approach to improve patients' postoperative care for lumbar disc herniation surgery in Iran.

Application of three-dimensional (3D) magnetic resonance (MR) Multi-Echo iN Steady-state Acquisition sequences in preoperative evaluation of lumbar disc herniation: a prospective study.

Conventional spinal magnetic resonance imaging (MRI) cannot provide accurate diagnosis and surgical planning; thin-layer scanning can enhance the diagnostic efficacy. This study aimed to investigate the value of 3-dimensional (3D) magnetic resonance (MR) in preoperative evaluation of lumbar disc herniation, with a focus on the application of Multi-Echo iN Steady-state Acquisition (MENSA) sequence. A total of 51 patients who underwent lumbar disc herniation surgery in West China Hospital of Sichuan University from June 2021 to December 2021 were prospectively enrolled. A cross-sectional study was conducted on those patients. The Cube group was scanned using 3D-FSE-Cube sequence, the Cube stir group was scanned using 3D-FSE-Cube Short Tau Inversion Recovery (STIR) sequence, and the MENSA group was scanned using MENSA sequence. Signal and noise values of nerve, herniated disc, ligamentum flavum (LF), and soft tissue were measured on the 3 groups. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Objective scores were calculated by analysis of variance (ANOVA). Image quality was scored by a 5-point method. Friedman test was used to compare subjective scores, and Kappa test was used to evaluate the consistency of 2 readers' scores. The nerve root SNRs in the MENSA and Cube stir groups were higher than that in the Cube group (P<0.01), but there was no substantial statistical difference between the 2 groups. The herniated disc and LF SNRs of the MENSA group were greater than those of the Cube stir and Cube groups (P<0.01). Soft tissue SNR was greater in the MENSA group compared with the Cube stir group (P<0.01), which was greater than the SNR in the Cube group (P<0.01). The nerve root CNR of the Cube group (102.88±73.19) was greater than that of the MENSA group (55.98±25.26, P<0.01), which was higher than the CNR in the Cube Stir group (29.42±16.22, P<0.01). The herniated disc CNR was higher in the MENSA and Cube groups than that in the Cube Stir group. The CNR of LF was greater in the MENSA group (37.71±16.87) compared to the Cube group (29.76±25.73, P=0.03), which was greater than that in the Cube stir group (10.50±7.75, P<0.01). Among the subjective ratings of 2 reviewers, MENSA sequence scored highest in the qualitative measures of image quality. In the consistency test, the Kappa values of 2 readers for 3 groups of images were all greater than 0.73, indicating good consistency. The differences of subjective scores among all groups were statistically significant (P<0.05). Overall, it was indicated that the consistency test results of the 2 readers were statistically significant and consistent. The MENSA group had the highest accuracy in diagnosing nerve compression. In addition, MENSA sequence ranked highest among the 3 sequences with 94.1% diagnostic accuracy. The preoperative 3D MRI MENSA sequence can clearly depict the nerve roots and offer desirable contrast between the nerve roots, LF, bone, and intervertebral discs (IVDs). Patients with lumbar degeneration can effectively benefit from MENSA sequence since it provides useful imaging information to help understand disc herniation and compression of adjacent tissues when developing preoperative surgical strategies.

A 9-year retrospective cohort of patients with lumbar disc herniation: Comparison of patient characteristics and recurrence frequency by smoking status

To evaluate the association between smoking status and patient characteristics and to identify risk factors associated with recurrence in patients who underwent surgery for lumbar disc herniation (LDH). This retrospective study was carried out at Lokman Hekim University, Ankara, Turkey between January 1, 2021 and January 1, 2022. The medical data of patients who underwent microsurgical discectomy for LDH were retrospectively recorded. Patients with any reemergence of LDH within a 6-month period after surgery were defined as having recurrent LDH. A total of 1109 patients were included in the study and mean age was 50.7 ± 14.3 years. The frequency of hernia at L2-L3 and L3-L4 levels was higher in the nonsmoker group (P < .001). The frequency of cases with Pfirrmann Grade 4 degeneration was higher in the nonsmoker group than in smokers and ex-smokers (P < .001). Protrusion-type hernias were more common in nonsmokers (P = .014), whereas paracentral hernias were more common in smokers (P < .001). The overall frequency of recurrence was 20.4%, and was higher in smokers than in non-smokers and ex-smokers (P < .001). Multivariable logistic regression revealed that current smoking (OR: 2.778, 95% CI [confidence interval]: 1.939-3.980, P < .001), presence of Pfirrmann Grade 4&5 disc degeneration (OR: 4.217, 95% CI: 2.966-5.996, P < .001), and paracentral herniation (OR: 5.040, 95% CI: 2.266-11,207, P < .001) were associated with higher risk of recurrence, whereas presence of sequestrated disc was associated with lower risk of recurrence (OR: 2.262, 95% CI:0.272-0.717, P = .001). Taken together, our data show that smoking, increased degree of degeneration and paracentral hernia increase the risk of LDH recurrence, while sequestrated disc appears to decrease risk. Taking steps to combat smoking in individuals followed for LDH may reduce the risk of recurrence in LDH patients.

The efficacy of ultrasound-guided anterior quadratus lumborum block for pain management following lumbar spinal surgery: a randomized controlled trial

BackgroundQuadratus lumborum block (QLB) is a fascial plane block. There is no randomized study on the efficacy of QLB for lumbar surgery. We evaluated the efficacy of QLB for postoperative pain management and patient satisfaction after lumbar disc herniation surgery (LDHS).MethodsSixty patients with ASA score I-II planned for LDHS under general anesthesia were included. We allocated the patients into two groups: the QLB group (n = 30) or the control group (n = 30). QLB was performed with 30 ml 0.25% bupivacaine in the QLB group. Paracetamol 1 g IV 3 × 1 was ordered to the patients at the postoperative period. If the NRS score was ≥ 4, 1 mg/ kg tramadol IV was administered as rescue analgesia.ResultsThere was a reduction in the median static NRS at 0 h and 2 h with QLB compared to the control group (p < 0.05). There was no difference in the resting NRS at any other time point up to 24 h. The median dynamic NRS was significantly lower at 0, 2, 4, 8, and 16 h in the QLB group (p < 0.05). The need for rescue analgesia was significantly lower in the QLB group. The incidence of nausea was significantly higher in the control group. The postoperative patient satisfaction was significantly higher in the QLB group (p < 0.05).ConclusionWe found that the QLB is effective for pain control following LDHS.

Local anesthesia, epidural anesthesia and general anesthesia comparison in lumbar disc herniation: a network meta-analysis.

There were 3 major anesthesia methods for discectomy: local, epidural and general. A lot of studies has been established to compare these three methods in different aspects, however, the result is still controversial. We conducted this network meta-analysis to evaluate these methods. Electronic databases including PubMed, EMBASE, Cochrane Library, were searched to identify clinical trials that reported the effects of local anesthesia general anesthesia and epidural anesthesia in lumbar disc herniation. Three indicators were included for evaluation: post-operative VAS score, complication, operation duration. In total, 12 studies and 2287 patients were included for this study. For complication, epidural anesthesia shows significantly lower rate compare to general anesthesia (OR: 0.45, 95% CI [0.24, 0.45], P=0.015), but local anesthesia didn't show significant result, no significant heterogeneity was observed between designs. For VAS score, epidural anesthesia showed a better effect (MD: -1.61, 95%CI [-2.24, -0.98]) compare to general anesthesia, and local anesthesia has a similar effect (MD: -0.91, 95%CI [-1.54, -0.27]). However this result showed a very high heterogeneity (I2=95%). For operation duration, local anesthesia showed a significant lesser time compare to general anesthesia (MD: -46.31(minutes), 95%CI [-73.73, -19.19]) but epidural anesthesia didn't have one, this result also showed a very high heterogeneity (I2=98%). Epidural anesthesia showed lesser post- operative complication compare to general anesthesia in lumbar disc herniation surgery.

Early Postoperative Iatrogenic Neuropraxia After Lumbar Disc Herniation Surgery: Analysis of 87 Cases

Postoperative early neuropraxia after lumbar disc herniation surgery is common. The emergence of new paresthesia findings with increased sensory and motor deficits in the postoperative period suggests iatrogenic neuropraxia. This study aimed to discuss the causes and prognosis of iatrogenic neuropraxia detected in the early postoperative period in patients who have been operated on for lumbar disc herniation. Cases with postoperative iatrogenic neuropraxia were determined retrospectively. Deficits were evaluated at intervals of 0-2hours, 2-12hours, 12-24hours, and 24-48hours. The cases were evaluated in 2 groups as those who underwent aggressive discectomy and simple discectomy. In addition, the treatment results were compared between the 2 groups as the cases that were treated and not treated with methylprednisolone. The iatrogenic neuropraxia rate was significantly higher in patients who underwent aggressive discectomy. Although it was observed that paresthesia findings improved more rapidly in cases treated with methylprednisolone, no difference was found between the 2 groups in terms of its effects on the motor deficit. Iatrogenic neuropraxia is a finding whose cause cannot be determined by quantitative criteria. It is common in patients who underwent aggressive discectomy. Methylprednisolone treatment is effective in recovering the paresthesia finding faster and may show that the radicular injury is in the neuropraxia stage in the early period.

Investigation of clinical efficacy and safety of a new herbal “Algan Hemostatic AgentTM” in lumbar disc herniation operations

Aim. ALGAN Hemostatic Agent (AHA) is obtained with a standard mixture of 6 different herbs. It is a polysaccharide based hemostatic agent. The purpose of this study is to determine the clinical efficacy and reliability of AHA as a local hemostatic agent in lumbar disc herniation operations. Materials and Methods. In the study, the hemostatic efficacy of the product was observed on 28 volunteers underwent lumbar disc herniation surgery. In the treatment and control groups (14 patients each), operation times, bleeding stop times, pre- and postoperative hematocrit values (amount of blood loss), duration of hospital stay, and need for cautery use were compared. Traditional methods (cautery, ligation, etc.), which are used as a hemostatic in the operation, were always ready to be used effectively. The AHA application took 120 seconds. Results. While there was no difference between the groups in terms of preoperative hemoglobin and hematocrit values, postoperative hemoglobin and hematocrit values were statistically significant (p=0.033, 0.043). The amount of cautery use decreased significantly in the treatment group and the result was found to be statistically significant (p=.0.001). There was no significant difference in blood transfusion and mean operation times. Conclusions. AHA has been shown to be both effective in controlling bleeding and safe, so it can be used as an auxiliary product in capillary bleeding control in lumbar disc operations.

Comparative study of two elastic fixation systems in single-segment lumbar disc herniation surgery for nucleus pulposus extraction

To investigate the clinical application of two elastic pedicle internal fixation systems in single-segment lumbar disc herniation fenestration. A retrospective analysis of 64 patients with lumbar intervertebral disc herniation treated by surgery from June 2019 to March 2021. According to the different elastic fixation systems placed during the operation, the patients were divided into ordinary pedicle screw elastic rod link group (elastic rod group) and a special elastic pedicle screw rigid rod fixed connection group (elastic screw group). There were 33 cases in the elastic rod group, including 18 males and 15 females, aged from 30 to 69 years old with an average of(49.18±10.23) years old;and 31 cases in the elastic screw group, including 16 males and 15 females, aged from 32 to 68 with an average of (49.81±9.24) years old. The operation time, intraoperative blood loss, postoperative wound drainage, and postoperative landing time of the two groups were recorded separately. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and Oswestry Disability Index (ODI) were compared before and 3, 12 months after operation. The height of the adjacent vertebral space on the lateral DR film before and 12 months after the operation was measured. The clinical efficacy was evaluated by Macnab standard. All the patients successfully completed the operation, and were followed up. The operation time, intraoperative blood loss, postoperative wound drainage and postoperative landing time in the elastic rod group were(63.73±12.01) min, (89.55±16.07) ml, (81.67±16.00) ml, (3.45±0.75) d , while in the elastic nail group was (62.96±11.54) min, (88.35±17.14) ml, (82.29±15.40) ml, (3.29±0.78) d, the difference was not statistically significant. The symptoms of low back pain and lower extremity numbness were significantly improved in all patients after operation. There was no significant difference in VAS, JOA score and ODI between the two groups before and after surgery (P>0.05). At 12 months after operation, there was no significant difference in the height of the adjacent vertebral space between the upper adjacent vertebral body and the same segment before operation(P>0.05), and there was no significant difference between the groups before and after the operation. According to Macnab criteria, the elastic rod group was excellent in 30 cases, good in 2 cases, fair in 1 case, while the elastic nail group was excellent in 29 cases, good in 2 cases, fair in 0 cases, and there was no significant difference(Z=-0.42, P=0.68). In fenestrated nucleus pulposus extraction for lumbar disc herniation, the two elastic pedicle internal fixation systems are equally effective and can be used. The elastic screw internal fixation system has certain advantages when the distance between the two vertebral bodies is short, and the elastic rod cannot be placed or is difficult to be placed, and it is more widely used.

A study comparing outcomes between obese and nonobese patients with lumbar disc herniation undergoing surgery: a study of the Swedish National Quality Registry of 9979 patients

BackgroundThis study aimed to evaluate whether an increasing grade of obesity is associated with inferior outcomes after lumbar disc herniation (LDH) surgery.MethodsWe retrieved data from the Swedish register for spine surgery regarding patients aged 20–64 who underwent LDH surgery from 2006–2016 and had preoperative and one-year postoperative data. A total of 4156 patients were normal weight, 4063 were overweight, 1384 had class I obesity, 317 had class II obesity and 59 had class III obesity (“morbid obesity”). Data included patient satisfaction, improvement in leg pain (assessed using the National Rating Scale; NRS; rating 0–10), disability (assessed using the Oswestry Disability Index; ODI; rating 0–100) and complications.ResultsAt one year postsurgery, 80% of normal-weight patients, 77% of overweight patients and 74% of obese patients (class I-III evaluated together) were satisfied (p < 0.001) [75%, 71%, 75% in obesity classes I, II, and III, respectively (p = 0.43)]. On average, all groups improved by more than the minimal clinically important difference (MCID) in both NRS leg pain (> 3.5) and ODI (> 20). NRS leg pain improved by 4.8 in normal weight patients (95% CI 4.7–4.9), by 4.5 in overweight patients (4.5–4.6) and by 4.3 in obese patients (4.2–4.4) (p < 0.001) [4.4 (4.3–4.6), 3.8 (3.5–4.1) and 4.6 (3.9–5.3) in obesity classes I, II, and III, respectively (p < 0.001)]. The ODI improved by 30 in normal weight patients (30–31), by 29 in overweight patients (28–29) and by 26 in obese patients (25–27) (p < 0.001) [29 (28–29), 25 (22–27) and 27 (22–32) in obesity classes I, II, and III, respectively (p < 0.01)]. A total of 3.0% of normal-weight patients, 3.9% of overweight patients and 3.9% of obese patients suffered complications (p = 0.047) [3.8%, 4.4%, 3.5% in obesity classes I, II, and III, respectively (p = 0.90)].ConclusionsLDH surgery is also generally associated with favourable outcomes and few complications in patients with morbid obesity.

Preoperative anxiety as an independent predictor of postoperative delirium in older patients undergoing elective surgery for lumbar disc herniation.

Anxiety is common in older patients suffering from lumbar disc herniation. Postoperative delirium is related to poor prognosis. But the relationship between preoperative anxiety and postoperative delirium among older patients undergoing elective surgery for lumbar disc herniation is not clear. The study aimed to investigate if preoperative anxiety is an independent risk factor of postoperative delirium among older patients undergoing elective surgery for lumbar disc herniation. The medical records of 1290 patients undergoing elective surgery for lumbar disc herniation at a single institution from 2016 through 2021 were reviewed. Of 863 eligible patients, 225 (26.1%) patients had been diagnosed with anxiety by a board-certified psychiatrist and constituted the Anxiety group; the remaining 638 patients constituted the no-anxiety group. The demographics, baseline, operative variable and postoperative complications were collected and compared between the two groups. The primary outcome of this study was the incidence of delirium, according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, during a hospital stay after surgery for lumbar disc herniation. The relationship between anxiety and postoperative delirium was determined through multivariate logistic regression analysis. The demographics and comorbidity were similar between the two groups, except for age, sex, alcohol use and cerebrovascular disease. The operative variables were different between the two groups. The incidence of postoperative complications other than postoperative delirium was also similar between the two groups. In total, 86 patients (9.97%) had an episode of postoperative delirium, with anxiety group patients experiencing approximately a twofold higher rate (15.6% vs 7.99%). In a multivariate logistic regression analysis, anxiety was an independent predictor of postoperative delirium in older patients undergoing elective surgery for lumbar disc herniation (OR 2.228, 95% CI 1.494-3.416, p = 0.009). This study suggests that anxiety is an independent risk factor of postoperative delirium among older patients undergoing elective surgery for lumbar disc herniation. Preoperative anxiety assessment can help to identify older patients at high risk of postoperative delirium and facilitate perioperative management of older patients undergoing elective surgery for lumbar disc herniation.

Favorable long-term outcome in young adults undergoing surgery for lumbar disc herniation

PurposeThe purpose of the study was to evaluate the long-term outcome after surgery for lumbar disc herniation in a young adult population.MethodsA total of 526 consecutive patients between 18 and 40 years of age who underwent surgery for lumbar disc between 1990 and 2005 were included in the study. The primary outcomes were the need for new lumbar spine surgery during the follow-up and secondary outcomes were short-term subjective outcome, the Oswestry Disability Index (ODI) score, and the ability to carry out employment at the end of the long-term follow-up.ResultsA total of 96% of the patients had a reduction in their symptoms at the clinical follow-up (median of 50 days post-surgery). Twenty-one patients (4.0%) had a reoperation within 28 days. Excluding these early reoperations, 136 patients (26%) had additional lumbar spine surgery and 18 patients (3.4%) underwent lumbar fusion during the follow-up of median 18 years. The annual risk for new surgery was 1.4%. In total, 316 patients (60%) returned the ODI questionnaire, and their mean score was 8.1. Patients with a higher number of additional lumbar spine surgeries (p < 0.001) reported deteriorating ODI scores.ConclusionPatients showed excellent short-term recovery from their symptoms. In the long term, the mean ODI score for the patients was comparable to the normative population. However, a notable proportion of the patients required additional lumbar surgery during the follow-up period, and a higher number of lumbar surgeries was associated with poor ODI scores.

Percutaneous endoscopic interlaminar discectomy for L5-S1 calcified lumbar disc herniation: A retrospective study.

BackgroundCalcified lumbar disc herniation (CLDH) is considered to be a special type of lumbar disc herniation (LDH). Percutaneous endoscopic interlaminar discectomy (PEID), with safety and efficacy, has been proved to be a minimally invasive surgery for LDH. However, there are few studies on PEID in the treatment of CLDH at the L5-S1 level. This study aimed to analyze the clinical efficacy of PEID for L5-S1 CLDH.MethodsFrom August 2016 to April 2020, we retrospectively analyzed 28 consecutive patients (17 males and 11 females) with L5-S1 CLDH treated with PEID at our institution. All the patients were monitored for more than 1 year postoperatively. The demographic characteristics, surgical results, and clinical outcomes estimated by the visual analog scale (VAS) for leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria were collected.ResultsAll patients successfully underwent PEID. The mean operative time and intraoperative blood loss were 65.36 ± 5.26 min and 13.21 ± 4.35 ml, respectively. The VAS for leg pain and ODI scores improved remarkably from 7.54 ± 0.96 to 1.50 ± 0.51 (P < 0.05) and from 69.29 ± 9.91 to 17.43 ± 3.69 (P < 0.05) a year after operation, respectively. According to the modified MacNab criteria of the last follow-up, the excellent and good rates are 92.86%. Two of the patients had complications, one had nerve root injury and the other had postoperative dysesthesia.ConclusionsPEID achieved good clinical outcomes in the treatment of L5-S1 CLDH, and it was a safe and effective minimally invasive surgery for L5-S1 CLDH.

The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial

ABSTRACT Background Valuable impact of postoperative exercises on the clinical outcomes of patients with lumbar discectomy has been demonstrated. However, there is a lack of consensus on the best kind of postoperative exercises. This study aimed to evaluate the impact of the early postoperative flexion-based and extension-based exercises on the clinical outcomes of patients with lumbar discectomy. Methods In this single-blind randomized clinical trial (RCT), 90 subjects with lumbar discectomy were randomly assigned to three groups. The flexion-based and extension-based exercises were planned for the first and the second groups, respectively. The third group was considered as the control group. Subjects in the experimental groups started their exercise program at the end of the 6th postoperative week and continued exercises for 8 weeks. We used Visual analogue scale (VAS), Oswestry Disability Index (ODI), modified Biering-Sorensen test (mBST), and Trunk Flexion Endurance Test (TFET) to evaluate back pain, disability, back and abdominal muscle endurance, respectively. The outcomes were investigated before starting the exercises program as well as at the end of the study. Moreover, return to work was evaluated at the end of the study. Data were analyzed using descriptive and inferential statistics by SPSS-24 software. Results Our results showed that the VAS pain diminished in all the groups. However, this reduction was most in the McKenzie group (P < 0.001). Moreover, extension-based exercises reduced ODI more than other groups (P < 0.001). We found that extension-based and flexion-based exercises had more efficacy in increasing the back and trunk flexion endurance, respectively (P < 0.001). There was not a significant difference between the three groups in the term of returning to work (P = 0.06). Conclusions Both flexion-based and extension-based exercises could reduce postoperative back pain and disability. However, the impact of the extension-based program was more dominant. Moreover, these exercises could increase back and abdominal muscle endurance. Therefore, prescribing such low-cost home-based exercises could be very helpful for patients with lumbar discectomy.

47. Economic consequences of waiting for lumbar disc herniation surgery

<h3>BACKGROUND CONTEXT</h3> Despite the well-established benefits of lumbar discectomy, many patients wait for their surgery which delays their return to work and potentially increases health care costs. The economic repercussions of such delays have not been well studied. <h3>PURPOSE</h3> This study aims to provide meaningful comparisons of costs to decisions-makers who plan health care services. The main goal of this study was to quantify the cost differences in terms of direct and indirect costs of early surgery for symptomatic disc herniation compared to late surgery. In other words, this study aimed to unveil what is the cost of being on a surgical waitlist for a lumbar discectomy. Secondarily, we report PROS and compared the proportions of patients reaching meaningful patient reported outcomes (PROs) between early and late surgery. <h3>STUDY DESIGN/SETTING</h3> This is a retrospective analysis of prospectively collected data from the CSORN registry. <h3>PATIENT SAMPLE</h3> Comparisons were made between patients receiving surgery less than 60 days after consent (short wait) and 60 days or more after consent (long wait). <h3>OUTCOME MEASURES</h3> The Ontario Health Insurance Plan (OHIP) claims history database was used for direct costs estimates. Canada Income Statistics and the human capital method were used to calculate indirect costs. The primary outcome was defined as the cost difference between short wait and long wait groups to determine the overall cost of waiting for surgery. <h3>METHODS</h3> Continuous data are summarized using means and standard deviations, compared using Student's t-tests. Categorical data are expressed as numbers and percentages, compared using chi-square tests. The minimum clinically important difference (MCID) was defined as 30% improvement in NRS leg and NRS back from baseline to 3 months. The proportion of patients reaching MCID was compared between patients who returned to work at 3 months or not and between short- and long-wait groups. PROs at 3 months were adjusted for baseline score. A p-value <0.05 was considered statistically significant. Analyses were performed with IBM SPSS for Windows release 28. <h3>RESULTS</h3> A total of 493 patients were included in this study with 272 patients (55.2%) in the short-wait group and 221 patients (44.8%) in the long-wait group. Demographics were similar between the two groups. The proportions of patients who returned to work at 3 months and 12 months postoperatively were similar (p <0.596; p <0.798). Time from surgery to return to work was similar between both groups (34.0 vs 34.9 days, p<0.804). Inherently, the longer wait group had significantly longer time from consent to return to work. This extended wait corresponded to an additional $11,753.10 indirect cost due to productivity loss while waiting for surgery. The short-wait group showed increased health care usage with patients more commonly visiting the emergency department (52.6% vs 25.0%, p <0.032), using physiotherapy (84.6% vs 72.0%, p <0.001) and receiving MRI (65.2% vs 41.4%, p <0.043). This corresponded to an additional direct cost of $518.21 per patient. The short wait group had higher baseline NPR leg, ODI, EQ5D, PCS and MCS. A higher proportion of patients reached MCID in terms of NRS leg pain at 3-month follow-up in the short wait group (84.0% vs 75.9%, p <0.040). <h3>CONCLUSIONS</h3> Early surgery is associated with cost saving of $11,234.89 per patient when compared to late surgery for lumbar disc herniation. The higher health care utilization in patients receiving early surgery is counterbalanced by the additional productivity loss of the long waiters. From a societal economic perspective, early surgery seems beneficial and should be promoted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Percutaneous Endoscopic Discectomy Via a Transforaminal Approach for L5/S1 Far-Lateral Disc Herniation Assisted by Intraoperative Computed Tomography

To examine the clinical outcomes of a percutaneous lumbar transforaminal endoscopic discectomy (PTED) with intraoperative computed tomography (iCT) navigation for the treatment of L5-S1 far-lateral lumbar disc herniation (LDH). A total of 30 patients with L5-S1 far-lateral LDH who underwent PTED with iCT navigation from September 2016 to October 2020 were enrolled in this study. Outcomes were assessed using the visual analog scale pain score, the Oswestry Disability Index, the Japanese Orthopedic Association score, the EQ-5D-5L and the modified Macnab criteria. Preoperative and postoperative complications were recorded. The mean visual analog scale score for leg pain improved from 8.1 at baseline to 2.3, 0.9, 0.7 and 0.9 at 1day, 1week, 6months, and 12months postoperatively, respectively (P < 0.01). The mean Oswestry Disability Index improved from 78.1% at baseline to 45.5%, 21.9%, 12.6%, and 11.7% at 1week, 1month, 6months, and 12months postoperatively, respectively (P < 0.01); and the mean Japanese Orthopedic Association score improved from 8.6 at baseline to 14.2, 20.2, 24.4, and 25.6 at 1day, 1week, 6months, and 12months postoperatively, respectively (P < 0.01). At 12months postoperatively, the EQ-5D-5L value significantly increased, from-0.061±0.138 to 0.903±0.064. The rate of a good or excellent modified Macnab result was 93% (26/28) at 12months postoperatively. In the present study, combined L5-S1 foraminal stenosis tended to lead poor outcomes, which required more postsurgical treatments. With iCT navigation, PTED is a feasible and effective minimally invasive surgery for L5-S1 far-lateral LDH.

Hui Medicine Moxibustion Promotes the Absorption of Lumbar Disc Herniation and the Recovery of Motor Function in Rats through Fas/FasL Signaling Pathway.

Objectives To study the resorption of the herniated lumbar disc (RHLD) and its mechanism in the SD rats of lumbar intervertebral disc herniation treated with Hui medicine moxibustion (HMM). Methods Forty SD rats were randomly divided into four groups, normal group, lumbar disc herniation (LDH) group, HMM group, and antagonist (HMM+Met12) group, with 10 rats in each group. The rat model of LDH was prepared with the method of lumbar epidural emplacement of the caudal intervertebral disc. In the HMM group and HMM+Met12 groups, 4 weeks after modeling, HMM therapy was performed in the lumbar spine for 3 months with 1 time per day and 20 min each time, the samples were collected 8 weeks after the treatment. The histological degeneration was observed through HE staining, and the neovascularization of intervertebral disc tissues was detected by the expression of CD34 and vascular endothelial growth factor (VEGF). The apoptosis of nucleus pulpous cells was detected by TUNEL assay, and the activity of caspase-3, -8, and -9 and extracellular matrix enzymes was detected by western blotting. Results HMM treatment significantly improved the behavioral ability of rats with LDH surgery. The morphological structure was obviously destroyed in the LDH group, but disc structure was significantly repaired in the HMM group, and mild structure alterations were observed in the HMM+Met12 group. Higher levels of CD34 and VEGF were detected in the HMM group indicating that neovascularization is formed. The expression level of FasL was significantly increased in the HMM group. The protein expression levels of cleaved-caspase-3, cleaved-caspase-8, and cleaved-caspase-9 in nucleus pulposus (NP) tissues were also elevated when treated with HMM, and the TUNEL staining showed the same results. The protein expression levels of matrix metalloproteinases- (MMP-) 1, MMP-2, MMP-3, MMP-13, and ADAMTS-4 were markedly promoted in the HMM group. Met12, a small peptide antagonist of FasL, significantly reduced the effects of HMM. Conclusion HMM can promote the formation of neovascularization of lumbar intervertebral disc, support the apoptosis of NP cells through Fas/FasL signaling, and regulate the degradation of extracellular matrix enzyme, which then accelerates the absorption of lumbar intervertebral disc herniation and the recovery of motor function in rats.