The annual prevalence of lumbar disc herniation (LDH) in western industrialized countries averages between1% and 2.5% but shows aclear age dependency with apeak between the ages of30 and50 years. The medical history and physical examination are the most important parts of the examination, with attention being paid to so-called red flags that trigger further imaging. Most LDH can be successfully treated conservatively and tend to regress over time. It is not imaging but clinical symptoms that determine whether surgery is indicated. Patients with severe motor deficits (Medical Research Council, MRC < 2) benefit most from early surgical intervention within the first48-72 h. Approximately 1-1.5% of patients develop acute conus/cauda symptoms, representing an absolute spinal surgical emergency. After confirmation of the diagnosis, surgical decompression should be performed without delay; decompression after more than 48 h is associated with poorer functional outcomes. Minimally invasive endoscopic discectomy shows identical results to conventional surgical techniques for LDH in terms of pain relief, functional improvement, safety and recurrence rate.

A nomogram prediction model for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a multicenter retrospective study.

Lumbar disc herniation (LDH) is a prevalent major cause of low back pain and radicular syndromes in the lower extremities. Elevated disc herniation volumes and the subsequent progression of spinal canal compromise are positively correlated with higher severity of radicular symptoms, functional disability, and neurological deficits. To investigate the impact of high-intensity laser therapy (HILT) on disc size and functional outcomes in patients with LDH. This study enrolled 40 patients of both sexes (40% male and 60% female), ages from 30 to 45 years, all presenting with lumbosacral radiculopathy secondary to L4-L5 or L5-S1 disc herniation. Participants were randomly assigned to two equal groups. Group A (study group) received HILT group treated with a combined standard physical therapy exercise program, while Group B (control group) underwent a sham HILT procedure alongside the same physical therapy exercise program. Interventions were conducted three times a week over 6 weeks. The primary outcome was the change in disc herniation size in anteroposterior, transverse, and posterior vertical diameter as measured by magnetic resonance imaging. The secondary outcomes included pain intensity assessed by the visual analogue scale (VAS) and functional disability assessed by the Oswestry Disability Index (ODI). The HILT group demonstrated statistically significant reductions in all disc size parameters compared to the control group (p < 0.05). Additionally, the HILT group showed significantly higher reduction in VAS scores (63.88% vs. 26.04%) and ODI scores (53.5% vs. 24.58%) compared with the control group (p < 0.001). HILT serves as a potent noninvasive modality for reducing the herniated lumbar discs size and providing significant pain relief and improving functional outcomes in individuals with lumbosacral radiculopathy.

Lumbar disc herniation (LDH) is a major cause of chronic low back pain, in which tumor necrosis factor-alpha (TNF-α) plays a central role in inflammation and pain signaling. While biologic TNF-α inhibitors have shown therapeutic benefit, their systemic administration, high cost, and limited penetration into the avascular disc environment restrict their clinical utility. In this study, we present a multiscale computational framework to identify small-molecule TNF-α inhibitor candidates. A curated dataset of experimentally validated TNF-α inhibitors was used to train supervised machine learning models, among which a Random Forest classifier achieved the best performance (ROC-AUC = 0.92). The optimized model was applied to screen 61,534 compounds from the ChemDiv database, yielding high-confidence candidates that were further evaluated through Glide XP docking, ADMET prediction, and molecular dynamics (MD) simulations. Docking protocol validation was performed via redocking of the co-crystallized ligand, achieving an RMSD < 2.0Å. The top-ranked compound (8009-0259) exhibited favorable binding affinity, stable interaction patterns during 100ns MD simulation, and consistent engagement with key residues (Tyr151, Gln61). Binding free energy analysis (MM/GBSA) suggested that hydrophobic interactions are the dominant contributors to ligand stabilization. Density functional theory (DFT) analysis indicated moderate electronic stability of the lead compound, supporting its potential for intermolecular interactions. Overall, this study provides a computational prioritization framework for identifying TNF-α inhibitor candidates and offers mechanistic insights into their binding behavior. The identified compounds warrant further experimental validation for their therapeutic potential in LDH.

To systematically evaluate the clinical efficacy and safety of unilateral biportal endoscopy (UBE) in the treatment of recurrent lumbar disc herniation (rLDH). PubMed, Embase, and the Cochrane Library were systematically searched for clinical studies investigating UBE for rLDH published up to November 29, 2025. Study selection, data extraction, and quality assessment were independently performed by two reviewers. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was conducted using Stata version 18.0. Continuous variables were pooled using standardized mean differences (SMDs) or weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs). Exploratory subgroup analyses were performed to assess potential sources of heterogeneity. Statistical heterogeneity was assessed using the I² statistic. Publication bias was evaluated using Egger's test and the trim-and-fill method. A total of seven high-quality retrospective cohort studies (all with NOS scores ≥ 8) involving 409 patients with rLDH were included. Compared with preoperative values, UBE significantly improved postoperative visual analogue scale scores for back pain (VAS-BP) (immediate postoperative: SMD = - 3.59, 95% CI: -4.81 to - 2.37; final follow-up: SMD = - 5.01, 95% CI: -7.24 to - 2.78), leg pain (VAS-LP) (immediate postoperative: SMD = - 3.76, 95% CI: -5.78 to - 1.75; final follow-up: SMD = - 5.72, 95% CI: -7.65 to - 3.79), and Oswestry Disability Index (ODI) scores (immediate postoperative: SMD = - 4.20, 95% CI: -6.64 to - 1.75; final follow-up: SMD = - 4.44, 95% CI: -6.55 to - 2.34) (all p < 0.001). Perioperative outcomes demonstrated a mean operative time of 99.59min (95% CI: 72.15 to 127.03), a mean intraoperative blood loss of 66.59 mL (95% CI: 44.14 to 89.03), and a mean length of hospital stay of 4.54 days (95% CI: 3.22 to 5.86). The overall complication rate was 4% (risk difference (RD) = 0.04, 95% CI: 0.02 to 0.05). Although substantial heterogeneity was observed across most outcomes (I² > 96%), sensitivity analyses confirmed the robustness of the pooled results. Publication bias was detected in certain outcomes; however, after adjustment using the trim-and-fill method, the primary efficacy outcomes remained statistically significant. This meta-analysis suggests that UBE may provide favorable clinical efficacy and an acceptable safety profile in the treatment of rLDH. Significant postoperative improvements were observed in back and leg pain as well as functional outcomes, with a relatively low rate of complications. These findings support UBE as a promising minimally invasive surgical option for rLDH.

This systematic review synthesizes current evidence on gait analysis as a diagnostic and prognostic tool for degenerative lumbar spine diseases (DLSD), evaluates the clinical utility of specific gait parameters as biomarkers, and identifies emerging technologies enabling scalable, accessible clinical implementation. A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science (2010-2026). Studies evaluating gait parameters in patients with lumbar spinal stenosis (LSS), lumbar disc herniation (LDH), or lumbar spondylolisthesis were included. Data extraction focused on spatiotemporal gait metrics, kinematic parameters, and diagnostic performance measures. A total of 47 studies met the inclusion criteria, comprising 2,847 patients with DLSD and 1,892 healthy controls. Disease-specific gait signatures were identified: LSS demonstrated significant increases in gait asymmetry (+ 131%) and variability (+ 436%), while LDH exhibited marked reductions in gait velocity (-76%) and cadence (-67%). Machine learning classifiers achieved diagnostic accuracy up to 93.18% (AUC 0.97) for differentiating lumbar pathologies. Smartphone-based and wearable sensor technologies showed strong agreement with laboratory-based motion capture systems (ICC > 0.85), offering potential for remote clinical applications. Gait analysis provides objective, quantifiable biomarkers that differentiate DLSD subtypes with high diagnostic accuracy. The emergence of smartphone-based video analysis and wearable sensors represents a paradigm shift toward accessible gait assessment. Integration of artificial intelligence with clinical gait databases offers promising directions for decision support systems in spine care.

Percutaneous endoscopic lumbar discectomy (PELD) is a preferred minimally invasive surgery for lumbar disc herniation (LDH); however, postoperative recurrence, nerve root damage, and hyperesthesia continue to present key clinical challenges. Chitosan represents a novel preventive approach against postoperative complications. This study aimed to assess the clinical efficacy of ultrasound-guided percutaneous endoscopic interlaminar discectomy (PEID) plus medical chitosan in treating lumbar 4-5 disc herniation (L4-5 LDH). Totally, 200 L4-5 LDH patients were prospectively recruited and randomly divided into the control group (ultrasound-guided PEID) and observation group (ultrasound-guided PEID plus medical chitosan). Low back and leg pain and lumbar dysfunction were assessed preoperatively and postoperatively using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA). Efficacy and postoperative complications were evaluated according to the modified MacNab criteria. Logistic regression analyses identified the risk factors. Mann-Whitney U test was used for inter-group comparisons, and the Kruskal-Wallis test for timepoint comparisons. The two groups showed significant differences in pre-treatment Pfirrmann classification and operation time. As time progressed, patients exhibited reduced VAS and ODI scores and increased JOA scores postoperatively. Significant differences were observed in VAS, JOA, and ODI scores in the observation group at 2 weeks postoperatively. The observation group demonstrated superior treatment efficacy and a lower complication incidence than the control group. Age, disease course, and postoperative bleeding were independent risk factors affecting clinical efficacy of ultrasound-guided PEID plus chitosan. Ultrasound-guided PEID plus medical chitosan reduces postoperative pain and perioperative complications, demonstrating superior clinical efficacy.

Aim To compare the effectiveness of Pilates exercises and Back rehabilitation protocol on pain, core strength and functional status in low back pain patients with lumbar disc herniation.  Methodology Thirty-nine subjects were included in the study and allocated in two groups Pilates and Back rehabilitation group. They were given supervised intervention for 2 weeks followed by 2 weeks of home exercise program. Hot fomentation and ergonomic advice were given to patients in both the groups. Outcome measures used were Visual Analogue Scale, Pressure biofeedback unit and Oswestry disability index to assess pain, core strength, and disability respectively pre-treatment at week 0 and post 4-week intervention.  Results Statistical analysis was done using SPSS version 24. There was a significant difference on an intra-group analysis in outcome measures in Pilates and Back rehabilitation group, however, a non-significant difference existed on an inter-group comparison between the two groups.  Conclusion Both the intervention techniques that is Pilates exercises and Back rehabilitation protocol were equally effective in reducing pain, increasing core strength and reducing disability over a period of 4 weeks in low back pain patients with lumbar disc herniation.

Lumbar disc herniation (LDH) is common, often leading to lumbosacral nerve damage in affected patients. This study aims to assess the correlation between nerve root compression and clinical symptoms of LDH using magnetic resonance neurography (MRN) combined with T2 mapping. This prospective study included patients with unilateral LDH-related nerve root compression. All participants underwent 3.0T MRI with 3D SHINKEI and T2 mapping sequences. Clinical symptoms were evaluated using ODI and VAS scores. Measure T2 values of the lumbosacral plexus (LSP) using T2 mapping and calculate the difference in T2 values between the compressed and uncompressed sides. MRN image results and symptoms were analyzed with Fisher's exact test. Paired samples t-test compared T2 values of compressed and uncompressed groups. Correlation between T2 differences and ODI/VAS scores was examined. A two-sample t-test assessed T2 differences in postganglionic segments of MRN high and non-high signal groups. The significance level was set at P < 0.05. There was a significant correlation between MRN image results and clinical symptoms, with MRN visual observation showing 91.7% sensitivity and 50.0% specificity. T2 values of the postganglionic segment on the compressed side and the uncompressed side were 76.04 ± 12.82 ms and 68.91 ± 12.24 ms. The difference in T2 values between compressed nerves and uncompressed segments correlated positively with leg numbness VAS scores (r = 0.35, P = 0.045). T2 values differed significantly between high and non-high signal groups (t = -2.57, P = 0.015). MRN and quantitative data from T2 mapping can help in assessing nerve edema and provide a basis for clinical management.

To compare the clinical efficacy and perioperative outcomes of percutaneous interlaminar endoscopic discectomy (PIED) and unilateral biportal endoscopic discectomy (UBED) in treating L5 to S1 lumbar disc herniation. This prospective comparative study with quasirandom allocation included 59 patients with diagnosed isolated L5 to S1 disc herniation who underwent either PIED (n = 30) or UBED (n = 29) between January 2023 and June 2024. Surgical time, drain placement duration, drainage volume, postoperative hospitalization duration, visual analog scale (VAS) scores for low back and leg pain, and Oswestry Disability Index (ODI) scores were recorded pre- and postoperatively. Clinical outcomes were assessed using the modified MacNab criteria at the final follow-up. Both PIED and UBED groups demonstrated significant postoperative improvements in lumbar and leg pain VAS scores and ODI scores (P < 0.001). The PIED group showed significantly shorter operative time (58.2 ± 3.1 minutes vs 109.6 ± 4.3 minutes, P < 0.001) and hospital stay (1.0 ± 0.2 days vs 3.1 ± 0.8 days, P < 0.001) compared with the UBED group. Additionally, the PIED group had lower lumbar pain VAS scores at final follow-up (0.6 ± 0.6 vs 1.2 ± 0.9, P < 0.05). No postoperative drainage was required in the PIED group, while the UBED group required a mean drain duration of 2.7 ± 0.7 days with a mean output of 71.6 ± 38.3 mL. No significant differences were observed in final ODI scores or overall clinical outcomes based on the modified MacNab criteria (96.6% vs 86.2%, P = 0.297). Both UBED and PIED are safe and effective techniques for treating L5 to S1 disc herniation. However, PIED is associated with shorter operative time, faster postoperative recovery, and less early postoperative lumbar pain. These findings support the preferential use of PIED in selected patients with isolated L5 to S1 disc herniation. This study provides comparative evidence to guide surgical decision-making for L5-S1 disc herniation. The advantages of PIED-including reduced operative duration, accelerated recovery, and decreased early postoperative pain-may translate into improved patient satisfaction, reduced healthcare resource utilization, and earlier return to daily activities or work. Surgeons can consider PIED as a favorable minimally invasive option for appropriately selected patients.

Systematic review and meta-analysis. To compare safety, recovery metrics, and patient-reported outcomes between full endoscopic discectomy (FED) and microscopic discectomy (MSD) for lumbar disc herniation (LDH). Full-endoscopic techniques aim to reduce access-related soft tissue injury compared with conventional MSD but rely on fluoroscopic guidance and constrained working corridors. Prior syntheses frequently pooled heterogeneous minimally invasive approaches or non-randomized studies, limiting interpretability for contemporary practice. PubMed, Embase, and CENTRAL were searched from inception to 16 February 2026 for randomized controlled trials comparing FED with MSD in adults with LDH. Prespecified outcomes included complications, Visual Analog Scale (VAS) back and leg pain, Oswestry Disability Index (ODI), and perioperative/recovery measures. Random-effects meta-analyses were performed throughout. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed. Seventeen trials including 2238 patients (FED 1070; MSD 1168) were analyzed (mean follow-up 14.6-14.7mo). Leg pain trajectories were comparable. Back VAS favored FED at 1 year (MD -0.18; 95% CI: -0.35--0.01) and ODI at 2 years (MD -5.72; 95% CI: -11.24--0.21). FED reduced blood loss (MD -38.62mL; 95% CI: -67.69--9.54) and return-to-work time (MD -22.68d; 95% CI: -32.85--12.50), but increased radiation exposure (MD 0.92; 95% CI: 0.84-1.00). Operative time and length of stay were similar. FED lowered postoperative infection (RR 0.30; 95% CI: 0.12-0.78), poor wound healing (RR 0.25, 95% CI: 0.07-0.96), and hematoma (RR 0.47; 95% CI: 0.23-0.94). Other non-wound-related complications did not differ. Risk of bias was low-to-moderate; certainty of evidence was moderate. FED and MSD provide comparable decompressive efficacy and patient-reported outcomes. FED reduces wound-related morbidity and may accelerate return to work, at the cost of greater fluoroscopic exposure, without consistent long-term superiority in pain or disability.

Lumbar disc herniation (LDH) is rare in juveniles and may present atypically, potentially delaying referral for neurosurgical evaluation. We aimed to assess diagnostic and treatment delays and to evaluate short-term surgical outcomes in pediatric patients undergoing microdiscectomy for LDH at our department over a 10-year period. We retrospectively reviewed consecutive patients under 18years of age who underwent microdiscectomy for LDH at our institution between 2015 and 2025. Clinical presentation, timing of imaging and surgery, and postoperative outcomes were analyzed. Twenty-one patients were included (mean age 14.6 ± 2.1 years, 57% females). Median body mass index (BMI) was 21.2 (range 18.7-36.9). All patients presented with low back pain, and 92.5% had radicular symptoms. The median time from symptom onset to MRI was 6months (range 0-12 months), and to surgery 12months (range 0-36months). Most patients (90.5%) were operated at one level; L4/L5 and L5/S1 were the most commonly affected levels. At 3months after surgery, 95.2% of patients reported improvement of back pain, while all patients experienced relief of radicular symptoms. In our cohort of pediatric patients with LDH, short-term outcomes following microdiscectomy were generally favorable despite substantial delays in diagnosis and referral for surgical treatment. These findings may suggest that, unlike in adults, prolonged symptom duration does not necessarily compromise recovery in children, although this should be interpreted with caution given the limited sample size and follow-up period. Nevertheless, increased awareness of pediatric LDH could facilitate earlier neurosurgical evaluation, streamline care pathways, and potentially further optimize patient management.

Recurrent lumbar disc herniation (rLDH) remains a major cause of treatment failure after percutaneous endoscopic lumbar discectomy (PELD). The roles of spinopelvic parameters and facet joint degeneration in postoperative recurrence have not been fully clarified. To investigate the associations between spinopelvic parameters, facet joint degeneration, and recurrent lumbar disc herniation after PELD. A total of 106 patients who underwent single-level PELD were retrospectively analyzed, including 53 patients with recurrence (rLDH group) and 53 without recurrence (non-rLDH group). Propensity score matching was performed to balance baseline characteristics. Clinical and radiological parameters, including pelvic incidence (PI), lumbar lordosis (LL), PI-LL mismatch, disc height (DH), range of motion (ROM), facet joint degeneration, Pfirrmann grade, and Modic changes, were evaluated. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted. After matching, no significant differences were observed in age, sex, BMI, or surgical level between the two groups (all P > 0.05). The rLDH group exhibited significantly greater PI-LL mismatch, DH, ROM, facet degeneration, Pfirrmann grade, and a higher prevalence of Modic changes (all P < 0.05). Multivariate analysis identified DH (OR = 1.50, 95% CI: 1.14-1.97), facet degeneration (OR = 6.00, 95% CI: 1.74-20.70), Modic changes (OR = 7.35, 95% CI: 1.55-34.86), PI-LL mismatch (OR = 1.08, 95% CI: 1.01-1.14) as independent predictors of recurrence. ROC analysis showed that DH (AUC = 0.785) and ROM (AUC = 0.749) had the highest predictive value. PI-LL mismatch, facet joint degeneration, disc height, and Modic changes are independent risk factors for recurrent lumbar disc herniation after percutaneous endoscopic lumbar discectomy. PI-LL mismatch greater than 10° and facet joint degeneration (Weishaupt grade ≥ 2) are significantly associated with an increased risk of recurrence.

Study DesignInternational Expert Cross-Sectional Survey.ObjectivesTo establish international expert consensus on the definition, diagnostic criteria, imaging requirements, and surgical management of recurrent lumbar disc herniation (RLDH).MethodsA comprehensive survey was developed based on current literature and disseminated globally via professional, academic, and personal networks among clinicians with expertise in spinal disorders. The survey covered core definitions, clinical symptoms, imaging criteria, and surgical preferences. Consensus was predefined as ≥70% agreement. Statistical analysis included descriptive statistics, Chi-square tests, Rasch analysis, and post-hoc analysis using adjusted standardized residuals with Bonferroni correction.ResultsA global cohort of 510 experts participated (62% neurosurgeons, 30% orthopedic surgeons), primarily from Europe (42%), North America (25%), and Asia (19%). Strong consensus was reached for defining RLDH as a new herniation at the same level (83.5%) and same side (72.4%) as the index surgery, following a pain-free interval (77.0%). No consensus was reached on interval duration. MRI confirmation was considered necessary (96.7%), with differentiation from postoperative scar tissue (87.0%). Open microdiscectomy remains the global gold standard (43%), with significant geographic (P < 0.0001) and specialty-based (P < 0.0001) variations. North Americans more often preferred tubular microdiscectomy (25%), Asians full endoscopic techniques (25%), and Europeans open microdiscectomy (56%). Neurosurgeons favored open procedures (55%), while orthopedic surgeons preferred full endoscopic approaches (29%) and fusion (21%).ConclusionsThis study establishes a foundation for an international consensus definition of RLDH as a new herniation at the same level and side as the initial herniation, with a pain-free interval and MRI confirmation differentiating from postoperative scar tissue.

Microplastics (MPs) have been detected in various tissues, yet evidence regarding the relatively isolated nucleus pulposus (NP) remains limited. This study investigated MPs in NP tissues from 51 patients undergoing lumbar disc herniation (LDH) surgery in Wuhan, China. Samples underwent chemical digestion and filtration, followed by candidate-particle screening using an operator-assisted micro-Raman spectroscopy mosaic imaging workflow and targeted Raman spectral assignment. Microplastic-sized polymer particles were Raman-assigned in five patients, including polyurethane foam, poly (propylene glycol), poly (ethylene-co-vinyl acetate), polyacrylate rubber, and poly (ethylene-co-propylene). A graphite particle was also detected in one additional patient. Specifically, nine particles ranging from 37 to 280μm were detected across six patients; notably, most were smaller than 100μm. To reduce false-positive assignments, procedural blanks and five known surgical materials were analyzed, and particles matching these sampled materials were excluded. This study provides preliminary evidence of particulate contaminants in NP tissue, demonstrating the feasibility of detection in this understudied anatomical compartment and establishing a methodological foundation for future investigations.

To compare the clinical outcomes and learning curves of unilateral biportal endoscopy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of far lateral lumbar disc herniation (FLLDH). A retrospective analysis was conducted on 122 patients with FLLDH who underwent spinal endoscopic surgery between January 2022 and July 2024, including 62 cases in the PELD group and 60 cases in the UBE group. All procedures were performed by the same minimally invasive spine surgery team. Perioperative parameters (operative time, intraoperative blood loss, foraminal area, postoperative hospital stay, total cost), visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), and modified Macnab criteria were compared. Learning curves were analyzed using cumulative sum (CUSUM) with operative time as the core variable. All patients were followed for at least 12 months. Both groups achieved significant improvement in pain and functional outcomes after surgery. Operative time was significantly longer in the UBE group than in the PELD group (132.77 ± 27.55min vs. 86.61 ± 24.52min), and total blood loss was also higher (270.43 ± 119.44ml vs. 37.32 ± 13.69ml). The PELD group showed lower postoperative day-1 back pain scores, whereas long-term VAS, ODI, and modified Macnab outcomes were comparable between groups. The excellent/good rates were 91.9% in the PELD group and 93.3% in the UBE group. CUSUM analysis demonstrated learning curve inflection points at 24 cases for UBE and 38 cases for PELD. Both UBE and PELD are safe and effective for treating FLLDH. PELD offers advantages in perioperative minimally invasive characteristics and cost-efficacy, whereas UBE features a shorter learning curve, facilitating more rapid surgical mastery.

To investigate the feasibility and effectiveness of uni-portal non-coaxial spinal endoscopic surgery (UNSES) via a single incision for the treatment of adjacent two-segmental lumbar disc herniation (LDH). A retrospective analysis was performed on 33 adjacent two-segmental LDH patients treated with single-incision UNSES between June 2023 and May 2025, including 18 males and 15 females, with a mean age of 55.7 years (range, 28-74 years) and a mean disease duration of 11.2 months (range, 3-36 months). There were 4 cases of L 3, 4, L 4, 5 herniation and 29 cases of L 4, 5 and L 5, S 1 herniation. Pfirrmann grade of disc degeneration was grade 3 in 24 segments, grade 4 in 39 segments, and grade 5 in 3 segments. Perioperative indicators were recorded. The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) were evaluated preoperatively and at 3 days, 3 and 6 months postoperatively. The modified MacNab criteria were used to assess patient satisfaction at last follow-up. Postoperative lumbar CT or MRI was applied to evaluate nerve root decompression. Lumbar lordosis angle and L 3, 4, L 4, 5, and L 5, S 1 segmental endplate angles on standing lateral X-ray films were measured to compare sagittal balance changes before operation and at last follow-up. The operation time was 70-126 minutes, with an average of 84.8 minutes; the incision length was 1.8-2.4 cm, with an average of 2.1 cm; the fluoroscopy frequency was 1-4 times, with an average of 2.2 times; and the hospital stay was 5-12 days, with an average of 7.6 days. All patients were followed up 6-24 months, with an average of 14.1 months. The incidence of complications was 6.1% (2/33), including 1 case of dural tear (<4 mm) required no suture and presented no cerebrospinal fluid leakage, and 1 case complete inferior articular process resection had no obvious low back pain during follow-up. No myeloid hypertension-like syndrome, nerve root injury, cerebrospinal fluid leakage, or intervertebral space infection occurred in other patients. VAS score of low back and leg pain and ODI at each time point after operation were lower than those before operation, and further decreased with time, and the differences between different time points were significant ( P<0.05). According to the modified MacNab criteria, 19 cases were excellent, 10 cases were good, 4 cases were fair, and the excellent and good rate was 87.9%. Postoperative lumbar MRI showed that the herniated nucleus pulposus tissue had been removed in all patients, the cross-sectional area of the spinal canal was significantly increased, and the nerve root was not significantly compressed. At last follow-up, there was no significant difference in lumbar lordosis angle, L 3, 4 endplate angle, L 4, 5 endplate angle, and L 5, S 1 endplate angle when compared with those before operation ( P>0.05). Single-incision UNSES has the advantages of small trauma, high safety, flexible operation, and extensive decompression, which can effectively complete the removal of two adjacent segments herniated disc, and the effectiveness is satisfactory.

Large language models (LLMs) are increasingly used as clinical information tools; however, their ability to accurately interpret evidence-based spine guidelines remains unclear. This study compared the performance of ChatGPT-5.1, Gemini, and Perplexity in interpreting the North American Spine Society (NASS) guideline for lumbar disc herniation with radiculopathy. Nineteen open-ended clinical questions derived from the NASS guideline were submitted to each LLM under standardized conditions. Responses were evaluated by two blinded clinicians using validated Likert scales for clinical accuracy (1-5), reliability, and usability (1-7). Semantic similarity to guideline-based answers was assessed using the Universal Sentence Encoder, surface-level textual similarity using ROUGE-L F1 scores, and readability using multiple established readability indices. Reference reliability was analyzed using the Reference Hallucination Score. Perplexity demonstrated significantly higher clinical accuracy (3.95 ± 0.70) compared with ChatGPT-5.1 (3.45 ± 0.68) and Gemini (3.50 ± 0.65) (p = 0.018). Reliability and usability scores were also highest for Perplexity (4.85 ± 1.05 and 4.75 ± 0.95, respectively; both p < 0.01). Semantic similarity scores were greater for Perplexity (0.71 ± 0.06) than for ChatGPT-5.1 (0.64 ± 0.07) (p < 0.001), whereas Gemini achieved the highest ROUGE-L F1 scores (0.14 ± 0.04; p < 0.001). Readability indices were comparable across models, indicating similar levels of textual complexity. ChatGPT-5.1 exhibited the highest reference hallucination (8.10 ± 2.85), while Perplexity showed the lowest (4.15 ± 2.70) (p < 0.001). LLMs show significant variability in guideline-based clinical reasoning. Although none should be used as independent decision-making tools, reference-oriented models may provide more reliable adjunctive support for evidence-based spine practice.

Lumbar disc herniation (LDH) is a major cause of low back pain and disability worldwide. Although magnetic resonance imaging (MRI) is the standard modality for diagnosis, interpretation remains subject to interobserver variability. Deep learning (DL)-based approaches have been increasingly applied to improve diagnostic accuracy; however, their overall performance and sources of heterogeneity remain unclear. PubMed, Web of Science, and the Cochrane Library were searched from inception to March 2026. Studies evaluating imaging-based DL models for LDH diagnosis were included if sufficient diagnostic performance data were available. Two reviewers independently performed study selection, data extraction, and quality assessment using QUADAS-2. Pooled sensitivity and specificity were estimated using random-effects models, and summary receiver operating characteristic (SROC), subgroup, and sensitivity analyses were performed. The primary subgroup analysis used one primary standalone DL result per study to reduce non-independence. Ten retrospective studies were included. The pooled sensitivity and specificity were 0.94 (95% CI: 0.90-0.96) and 0.94 (95% CI: 0.90-0.97), respectively, with an area under the SROC curve of 0.99. Substantial heterogeneity was observed (I² > 97%), with no obvious threshold effect (ρ = -0.188, P = 0.603), indicating that the pooled estimates should be interpreted as exploratory. External validation studies showed lower specificity than internal or same-center temporally independent validation studies (0.87 vs. 0.96; P = 0.034), while sensitivity was similar. Sensitivity analyses suggested that differences in model task and output structure contributed to heterogeneity. At a pretest probability of 20%, a positive DL result increased the posttest probability to approximately 80%, whereas a negative result reduced it to approximately 2%. DL-based imaging models show promising diagnostic potential for LDH and may support assisted screening, triage, and lesion localization. However, the evidence is limited by substantial heterogeneity, retrospective study designs, non-patient-level analytical units, variable reference standards, and limited external validation. Future studies should use standardized task definitions, annotation procedures, AI reporting frameworks, and multicenter prospective patient-level validation before routine clinical implementation. Not applicable. This study is a systematic review and meta-analysis based on previously published literature and did not involve any prospective intervention involving human participants. This systematic review and meta-analysis was registered in PROSPERO (CRD420261353452).

Although spontaneous resorption of lumbar disc herniation (LDH) has been documented in the literature, its occurrence specifically in adjacent segments following endoscopic spine surgery remains unreported. This study aimed to investigate whether spontaneous resorption occurs in adjacent segments after endoscopic discectomy and to evaluate the associated clinical and radiological outcomes. A cohort of 91 patients diagnosed with single-segment LDH who underwent endoscopic surgery between 2020 and 2022 was included. Patients were classified into a Herniated group (n = 46) and a Bulging group (n = 45) based on preoperative MRI findings. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA) score and Visual Analog Scale (VAS). Radiological parameters, including disc height, protrusion volume, lumbar lordosis (Cobb angle), and paraspinal muscle morphology, were measured preoperatively and at final follow-up. Logistic regression was performed to identify predictors of resorption. Both groups showed significant improvements in JOA and VAS scores postoperatively (P < 0.05). At final follow-up, reductions in disc height, lumbar curvature, protrusion volume, and protrusion ratio were observed in adjacent segments. Logistic regression analysis identified age (OR = 1.290, p = 0.009), preoperative protrusion volume (OR = 4.511, p = 0.014), and preoperative lumbar lordosis (OR = 0.481, p = 0.015) as independent predictors of spontaneous resorption. Spontaneous resorption of adjacent-segment LDH can occur after endoscopic surgery, particularly in younger patients with smaller protrusions and relatively preserved spinal alignment. These findings support a conservative, expectant management approach for asymptomatic or minimally symptomatic adjacent-segment protrusions, potentially reducing unnecessary surgical intervention. III.