Lumbar Disc Prolapse Research Articles

Unani Integrative Approach for the Management of Sciatica, Employing Pharmacotherapy with Regimenal Therapy: A Case Report

Sciatica, a subtype of low back pain (LBP) is one of the most common clinical complaints in primary care which is characterized by pain that originates in the lower back or buttocks and radiates down one or both legs along the distribution of the sciatic nerve. It commonly results due to nerve root compression by a prolapsed lumbar disc. Sciatica affects both genders equally and has an annual incidence of 1-5%, most common in 30-65 years of age. The management of sciatica includes non-pharmacological, pharmacological and surgical approaches. Combining these management techniques can help in pain reduction and thereby can lead to an overall wellbeing of the individual. In this case report we present the case of a 52 year old male patient with lower back pain radiating to left lower limb who came to Department of Regimenal therapies, National Institute of Unani Medicine, Bengaluru. The patient had taken NSAIDs and other measures for pain management from last 6 months. Despite taking exhaustive measures, no significant improvement was seen. The symptoms have gotten worse over the past two months. After complete clinical examination and diagnosis, the patient underwent treatment for 4 weeks using integrative approach in the form of unani pharmacotherapy, coupled with regimenal therapy. Many objective parameters were used to evaluate the patient both before and after the intervention. The assessment parameters after the intervention reported a significant amelioration of the symptoms. Our study suggested that, management of sciatica with an integrative strategy can be considered. Keywords: Sciatica, LBP, lumbar disc, Integrative therapy, NSAIDs, Regimenal therapy.

Association Between Spinopelvic Parameters and Clinical Outcomes of Patients Treated With Transforaminal Platelet-Rich Plasma Injections for Lumbar Disc Prolapse.

Introduction Lumbar disc prolapse mainly occurs in the regions involving the L4-L5 and L5-S1 vertebrae. In this context, the significance of spinopelvic parameters becomes notably prominent. Non-invasive management of lumbar disc prolapse encompasses medicinal therapy, physical therapy, exercise, and epidural injections. Because of its autologous blood origin, platelet-rich plasma (PRP) therapy has minimal risks associated with immunogenic reactions and side consequences. We evaluated the extent of pain reduction and improvement of functional outcomes in patients having discogenic low back pain with modified spinopelvic parameters before and after undergoing transforaminal autologous PRP injection interventions. Methodology An observational study was conducted between September 2022 and August 2023 on 100 patients with low back pain for six months.The study populationcomprised patients whodid not respond to conservative treatment; they were recruited from the orthopaedicward of the emergency medicine department and outpatient department at the RLJalappa Hospital and Research Centre affiliated with Sri Devaraj Urs Medical College in Kolar, India. Every patient received a thorough evaluation that comprised an extensive medical history, a clinical examination, and imaging of the lumbosacral spine from both the front and side views. After obtaining the patient's consent and confirming their readiness for surgery, a PRPinjection was administered. The injection technique followed the standardized protocol and was performed by an experienced spine surgeon in collaboration with orthopaedic residents. Pain evaluations utilizing the Visual Analog Scale (VAS) and assessment of functional outcomes using the Oswestry Disability Index (ODI) scale were conducted before and after PRPinjections at the one- and six-month follow-ups. Results The average age of the study participants was 41.82 ± 5.0 years, with 55% of them being male. A total of 39% of study samples exhibited an increased angle in spinopelvic parameters. The independent t-test revealed a statistically significant difference in the mean score of back pain, limb pain, and ODI score between patients with increased and decreased angles of spinopelvic parameters before and after injection (p=0.0001). The severity of back pain, leg pain, and functional disability was significantly reduced in patients with increased angles of spinopelvic parameters following PRP injections at the one-month follow-up (p=0.0001). However, at the six-month follow-up, patients encountered recurring symptoms and worsening back pain, leg pain, and functional disability compared to the one-month follow-up. Conversely, the severity of back pain, leg pain, and functional disability has been markedly reduced in the patients with lower spinopelvic parameter angles following PRP injections at one month (p=0.0001) and six months (p=0.0001) compared to pre-injections. Conclusion During the long-term follow-up, subjects with elevated spinopelvic parameter angles reported a lower level of improvement in functional outcome, leg pain, and back pain. The impact of spinopelvic parameterson back pain severity and functional disability is substantial, significantly affecting the functional outcome of patients with lumbar disc prolapse.

Assessment of Obesity as Risk Factor of Lumbar Disc Surgery: Retrospective Analysis of 598 Cases and Simulated Surgery on 3D-Printed Models.

(1) Background: Obesity poses known risks in surgery, including a prolonged operation time and postoperative complications. Given the rising obesity rates and frequent lumbar disc surgeries, understanding these risks is crucial. This study aims to assess the impact of obesity on operation duration and postoperative complications in lumbar disc prolapse surgery. (2) Methods: We retrospectively analyzed 598 patients with monosegmental disc herniation, correlating their body mass index (BMI) as a surrogate parameter for obesity with operation time. Excluding complex cases (multi-segmental herniations or recurrent herniations), complication rates and hospital stays were recorded. Simulated surgeries on 3D-printed models of varying obesity levels examined operation times and instrument suitability. (3) Results: Of these patients, 438 patients had a BMI of <30, and 160 patients had a BMI of ≥30. Complication rates showed no significant differences between groups. Linear regression analysis failed to establish a sole dependency of operation time on BMI, with R2 = 0.039 for the normal-weight group (BMI < 30) and R2 = 0.059 for the obese group (BMI ≥ 30). The simulation operations on the 3D-printed models of varying degrees of obesity showed a significant increase in the simulated operation time with higher levels of obesity. A geometrically inadequate set of surgical instruments was assumed to be a significant factor in the simulated increase in operating time. (4) Conclusions: While various factors influence operation time, obesity alone does not significantly increase it. However, simulated surgeries highlighted the impact of obesity, particularly on instrument limitations. Understanding these complexities is vital for optimizing surgical outcomes in obese patients.

134 How to Spot the Recurring Lumbar Disc? Risk Factors for Recurrent Lumbar Disc Herniation in Adult Patients with Lumbar Disc Prolapse: A Systematic Review and Meta-Analysis

Abstract Aim Despite a fast-growing evidence-base examining the relationship of certain clinical and radiological factors such as smoking, BMI and herniation-type with recurrent lumbar disc herniation (rLDH), there remains much debate around which factors are clinically important. We conducted a systematic review and meta-analysis to identify risk factors for rLDH in adults after primary disc surgery. Method A systematic literature search was performed using Ovid-Medline, EMBASE, Cochrane library and Web of Science databases from inception to 23rd June-2022. Observational studies of adult patients with radiologically confirmed rLDH ≥3 months after the initial surgery were included, and their quality assessed using the Quality-In-Prognostic-Studies (QUIPS) appraisal tool. Meta-analyses of univariate and multivariate data and a sensitivity-analysis for rLDH post-microdiscectomy were carried out. Results Twelve studies (n=4497, mean-age: 47.3; 34.5% female) were included, of which 11 studies were meta-analysed (n=4235). The mean follow-up was 38.4 months. Mean recurrence-rate was 13.1% and mean time-to-recurrence was 24.1 months (range: 6-90 months). Clinically, older age (OR:1.04, 95% CI:1.00-1.08, n=1014), diabetes mellitus (OR:3.82, 95% CI:1.58-9.26, n=2330) and smoking (OR:1.80, 95% CI:1.03-3.14, n=3425) increased likelihood of recurrence. Radiologically, Modic-change type-2 (OR:7.93, 95% CI:5.70-11.05, n=1706) and disc-extrusion (OR:12.23, 95% CI:8.60-17.38, n=1706) increased likelihood of recurrence. The evidence did not support an association between rLDH and sex; BMI; occupational-labour; alcohol-consumption; Pfirmann-grade, or herniation-level. Conclusions Older patients, smokers, patients with diabetes, those with type-2 Modic-changes or disc-extrusion are more likely to experience rLDH. Higher quality studies with robust adjustment of confounders are required to determine the clinical bearing of all other potential risk factors on rLDH.

Comparative study between Transforamenal Lumbar Interbody Fusion (TLIF) and traditional discectomy in treatment of patients with massive lumbar disc prolapse

Comparative study between Transforamenal Lumbar Interbody Fusion (TLIF) and traditional discectomy in treatment of patients with massive lumbar disc prolapse

The radio anatomical arrangement of nerve roots at L3 level in cauda equina sac is it affected by diseases?

An observational study to discover the common conditions affecting the lumbosacral region that may affect lumbosacral position and tension. All the patients, underwent MRI exaamination (magnetic resonance imaging) in the supine position, were examined by the same consultant radiologist. The article was revised by the institutional ethical approval committee. The position of the nerve roots was observed, and the number of nerve roots was calculated anterior to a line passing between the mid-transvers process of L3(third lumbar vertebra). The number of nerve roots ahead of this line was calculated by the radiologist at the level of the right intervertebral foramen and at the left one. This procedure was applied to the normal group, and 5 common pathological diseases were repeated including single-level lumbar disc prolapse, multiple-disc prolapse, multiple bulge, spinal stenosis and spondylolisthesis (at the level of L45 (fourth to fifth lumbar vertebrae) or L5S1 (fifth lumbar to first sacral vertebrae) being outside the study area, i.e., L3). We noticed significant difference in the number of the nerve roots between the cases with herniated discs, spinal stenosis, and spondylolisthesis with the normal group and the significance was in ascending increment in significance being the highest in cases with spondylolisthesis, and even in the groups of other pathologies which are statistically not significant, we noticed that the significance is proportional to the severity of the disease being the least in single level cases (p 0.427), to be more significant on cases with multiple prolapses(p 0.319) to be more in cases with multiple bulges to start to be statistically significant in herniated, higher significance in cases with spinal stenosis to be the highest in cases with spondylolisthesis.

Uniportal Dual Mode Dry-Saline Endoscopy for Lumbar Disc Herniation

Objective: Posterior dry medium endoscopic lumbar discectomy techniques have been successfully used to treat lumbar disc prolapse. A drawback of these techniques is repeated blood staining of the scope tip while working close to the surgical target. To address this drawback, we modified the design of the previous Arthrospine system and made it compatible for use in air and saline medium to treat lumbar, cervical, and thoracic disc prolapse. Herein, we describe the operative technique and results of lumbar discectomy in a dual (air/saline) medium using this system.Methods: Eighty patients underwent endoscopic discectomy using the Arthrospine Duo system for lumbar disc prolapse. The procedure was conducted through a muscle dilatation approach using 5-mm and 10-mm dilators. The Arthrospine Duo tube was passed over a 10-mm dilator, the working insert was adjusted over the tube in a press-fit manner, and endoscopic discectomy was performed using a 30° arthroscope and conventional microdiscectomy instruments in an air or saline medium.Results: As per the modified MacNab criteria, 80% (n=64) of patients had excellent, 12.5% (n=10) good, 6.25% (n=5) fair, and 1.25 patients (n=1) had poor results. The leg pain visual analogue scale improved from 7.87±0.68 to 1.3±0.67 at 2 years of follow-up. As complications, dural tears and transient paraesthesia occurred in 4 patients (5%) each, nerve root injury in 1 patient (1.25%), and superficial wound infection in 5 patients (6.25%).Conclusion: The uniportal Arthrospine Duo system can be used in air/saline medium and is an excellent minimally invasive option for lumbar discectomy.

Predictive value of S100B and brain derived neurotrophic factor for radiofrequency treatment of lumbar disc prolapse

BackgroundThis work aimed to analyze serum S100B levels and brain-derived neurotrophic factor (BDNF) in patients with lumbar disc prolapse to test their predictive values concerning the therapeutic efficacy of pulsed radiofrequency.MethodsThis prospective interventional study was carried out on 50 patients candidates for radiofrequency for treating symptomatic lumbar disc prolapse. Pain severity and functional disability were assessed using the Numeric Rating Scale (NRS) and Functional rating index (FRI) before as well as two weeks, 1, 3, and 6 months after the radiofrequency. Quantitative assessment of serum S100B level and BDNF was done for all the included patients one day before radiofrequency.ResultsThe scores of NRS and FRI were significantly improved at two weeks, 1, 3, and 6 months following radiofrequency (P-value < 0.001 in all comparisons). Statistically significant positive correlations were found between duration of pain, NRS, and S100B serum level before radiofrequency, and both NRS (P-value = 0.001, 0.035, < 0.001 respectively) and FRI (P-value = < 0.001, 0.009, 0.001 respectively) 6 months following radiofrequency. Whereas there were statistically significant negative correlations between BDNF serum level before radiofrequency and both NRS and FRI 6 months following radiofrequency (P-value = 0.022, 0.041 respectively). NRS and S100B serum levels before radiofrequency were found to be independent predictors of NRS 6 months following radiofrequency (P-value = 0.040. <0.001, respectively).ConclusionSerum level of S100B is a promising biomarker that can predict functional outcomes after pulsed radiofrequency in patients with lumbar disc prolapse.

COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy.

Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution. Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020-February 2022). Further information was obtained from electronic patient records. In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (n = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%). Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.

Conventional versus tubular microdiscectomy for lumbar disc herniation: A prospective randomized study

Abstract Background: Microdiscectomy is a commonly performed surgical technique used to treat lumbar disc prolapse. A minimally invasive alternative called tubular discectomy is hypothesized to cause less tissue damage and result in a faster recovery compared to conventional discectomy. Previous studies have found similar pain resolution outcomes between two techniques, but they were underpowered and lacked data on differences in recovery time. Our study aims to compare functional outcomes, and assess differences in recovery time and perioperative complications between the two procedures. Materials and Methods: This prospective randomized study included 63 patients, divided into two groups. The preoperative evaluation was done by clinical examination and documenting Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores. Intra- and postoperative complications were also noted. Postoperative follow-up assessment was done at regular intervals up to 2 years. Results: Both groups showed a significant decrease in ODI, VAS leg and back scores following surgery, which continued to decline throughout the follow-up period. However, there was no significant difference in outcomes between the two treatment groups at each postoperative follow-up. There were also no significant differences in blood loss or intra- and postoperative complications. Patients who underwent tubular microdiscectomy had a significantly shorter hospital stay compared to conventional microdiscectomy. Conclusion: Both conventional and tubular microdiscectomy are effective means of treating disc herniation. While patients who underwent tubular microdiscectomy had a shorter hospital stay, the modest clinical benefits do not necessarily warrant the transition to a minimally invasive approach given the learning curve associated with the technique.

Comparison Between Clinical Findings and Magnetic Resonance Imaging Findings in Lumbar Prolapsed Intervertebral Disc

Introduction: Lumbar prolapsed intervertebral disc is commonly associated abnormality with lower backache. Disc herniation of same size can be asymptomatic in one patient and agonizing in another patient. Magnetic resonance imaging (MRI) is a gold standard diagnostic investigation for prolapsed intervertebral disc. Despite of high sensitivity sometimes MRI shows abnormal findings even in the asymptomatic individuals indicating a moderate relationship between MRI and symptoms in the patient. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Methodology: A descriptive cross-sectional study was conducted from 20 December 2021 to 15 September 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 078/78-009/HG). A convenience sampling method was used. The study consisted of patients with low back pain and radiation to lower extremity or patient with MRI scan of lumbar spine. Clinical and MRI findings were correlated to know the association and significance of MR findings in producing symptoms. Results: The study included 68 patients with back pain between 18 to 55 years (mean 41± 8.79 years). Neurological symptoms were present in 26 (38.23%) patients. Disc bulge in MRI was noticed in 48 (45.28%), protrusion in 46 (43.39%) and extrusion in 10 (11.32%) levels, most seen at L5-S1 level (66.11%). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.69), but not all disc bulges produced symptoms. Conclusion: Clinical features and Magnetic resonance imaging findings of disc prolapse had significant correlation similar to other studies done in a similar setting, but all imaging abnormalities may not have a clinical significance. Keywords: magnetic resonance imaging; intervertebral disc; prolapse; radiculopathy; correlation of data.

Immune-mediated resolution of a herniated lumbar disc prolapse aided by motor control exercises—a case report

Abstract Low back pain is the global leading cause of disability. Herniated intervertebral discs are a common cause of lower back pain. The natural history of the herniated intervertebral disc is that it can resorb spontaneously through an immune-mediated mechanism. Despite this favourable natural history, there is an increasing reliance on surgical intervention. A 64-year-old presented with a left L3/4 disc prolapse. With reassurance, simple analgesics, and motor control exercises, the MRI scan confirmed the complete resolution of the disc prolapse within 3 months. Patients with disc prolapses should be reassured that disc prolapses will naturally resolve and advised to remain active. Surgical intervention should only be considered with the presence of red flags, progressive neurology, or when clear evidence exists that all non-interventional techniques have been exhausted. With such a favourable natural history, caution should be exercised before surgical intervention is recommended.

Effect of Radiofrequency on Dorsal Root Ganglion Versus Transforaminal Steroids Injection on Tumor Necrosis Factor-Alpha Level in Lumbar Radicular Pain

BACKGROUND: The mechanism of pain control with pulsed radiofrequency (PRF) is unclear. OBJECTIVES: We aimed to compare the efficacy of combined PRF on dorsal root ganglion (DRG) with transforaminal epidural steroid injection (TFESI) vs TFESI-alone on pain improvement and serum tumor necrosis factor-alpha (TNF-a) level in lumbar disc-related radicular pain. STUDY DESIGN: Prospective, randomized, controlled trial. SETTING: Neurology and Pain Management clinics. METHODS: A total of 80 patients with lumbar disc prolapse were divided into 2 groups: combined PRF on DRG with TFESI group and TFESI-alone group. The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and Functional Rating Index (FRI) before intervention and at 2 weeks, 1 month, and 3 months after the intervention were observed. Serum TNF-a level was assessed pre- and post-intervention at 3 months. RESULTS: The scores of NRS-11, ODI, and FRI showed a significant improvement at 2 weeks, 1 month, and 3 months following intervention in both combined PRF &amp; TFESI group and TFESI-alone group (P &lt; 0.001 in all comparisons), with no significant difference between the 2 groups. Serum TNF-a levels showed a statistically significant reduction, 3 months following intervention in the combined PRF &amp; TFESI group (P &lt; 0.001), but not in the TFESI-alone group (P = 0.297) (P between groups &lt; 0.001). LIMITATIONS: The main limitation of this study is that TNF-a level was not assessed earlier to see how long the steroids might reduce TNF-a. On the other hand, further study with extended follow-up periods is needed to confirm the long-term lowering effect of TNF-a provided by PRF. CONCLUSIONS: Combined PRF on DRG with TFESI showed similar outcomes to TFESI-alone in relieving pain in patients with lumbar disc prolapse. However, PRF on DRG caused a significant decrease in TNF-a serum levels at 3 months. KEY WORDS: Pulsed radiofrequency, transforaminal steroids injection, tumor necrotic factor-alpha, lumbar disc prolapse

Pulsed radiofrequency in the management of lumbar radicular pain: initial experience

BackgroundLumbar radicular pain (LRP) is one of the most encountered complaints in neurosurgical practice that pose a challenge in its management as adequate pain control, which is not always achieved.ObjectiveThe aim of this study was to evaluate the role of pulsed radiofrequency as a minimally invasive tool in the management of lumbar radicular pain of lumbar discogenic origin.MethodsThis is a prospective study that included 20 patients with lumbar radicular pain with radiological evidence of lumbar disc prolapse, who have been subjected to pulsed radiofrequency.ResultsThe mean preoperative visual analogue score was 71 ± 14.38 dropped to a mean of 43.5 ± 21.47 at six-month follow-up. Seventy percentage of the study population had a satisfactory outcome, which did not correlate with the age, sex, or body mass index of the patients.ConclusionsPulsed radiofrequency is a safe and useful tool that may be used in the management of lumbar radicular pain.

How to spot the recurring lumbar disc? Risk factors for recurrent lumbar disc herniation (rLDH) in adult patients with lumbar disc prolapse: a systematic review and meta-analysis.

Despite a fast-growing evidence-base examining the relationship of certain clinical and radiological factors such as smoking, BMI and herniation-type with rLDH, there remains much debate around which factors are clinically important. We conducted a systematic review and meta-analysis to identify risk factors for recurrent lumbar disc herniation (rLDH) in adults after primary discectomy. A systematic literature search was carried out using Ovid-Medline, EMBASE, Cochrane library and Web of Science databases from inception to 23rd June-2022. Observational studies of adult patients with radiologically-confirmed rLDH after ≥3 months of the initial surgery were included, and their quality assessed using the Quality-In-Prognostic-Studies (QUIPS) appraisal tool. Meta-analyses of univariate and multivariate data and a sensitivity-analysis for rLDH post-microdiscectomy were performed. Twelve studies (n=4497, mean age:47.3; 34.5% female) were included, and 11 studies (n=4235) meta-analysed. The mean follow-up was 38.4 months. Mean recurrence rate was 13.1% and mean time-to-recurrence was 24.1 months (range: 6-90 months). Clinically, older age (OR:1.04, 95%CI:1.00-1.08, n=1014), diabetes mellitus (OR:3.82, 95%CI:1.58-9.26, n=2330) and smoking (OR:1.80, 95%CI:1.03- 3.14, n=3425) increased likelihood of recurrence. Radiologically, Modic-change type-2 (OR:7.93, 95%CI:5.70-11.05, n=1706) and disc extrusion (OR:12.23, 95%CI:8.60-17.38, n=1706) increased likelihood of recurrence. The evidence did not support an association between rLDH and sex; BMI; occupational labour/driving; alcohol-consumption; Pfirmann- grade, or herniation-level. Older patients, smokers, patients with diabetes, those with type-2 Modic-changes or disc extrusion are more likely to experience rLDH. Higher quality studies with robust adjustment of confounders are required to determine the clinical bearing of all other potential risk factors for rLDH.

1318 Cross-Sectional Study of Recurrent Disc Herniation Risk Factors and Predictors of Outcomes After Primary Lumbar Discectomy: A STROBE Compliance

Abstract Aim The purpose of this study is to determine if lifting weight, smoking status, occupational work, and diabetes were predictors for recurrent lumbar disk herniation (rLDH) leading to reoperation and if the outcome can be influenced by the reoperated level and side. Method From June 2010 to July 2019, the 2196 consecutive patients who underwent first-time single-level lumbar discectomy at our institution were revised. Data on first and second lumbar spine surgery were brought into the analysis. Multivariate Logistic Regression Analysis was performed to determine whether lifting weight, smoking status, occupational work, and diabetes were predictors for recurrent lumbar disk herniation. Multivariable Cox-regression analysis was performed for repeated lumbar disc herniation excision at the L4L5 and L5S1 levels independently. Results From the 101(4.59%) patients that presented with recurrent lumbar disc herniation (rLDH), 75 cases (3.41%) met the inclusion criteria. There were 54 cases of ipsilateral recurrent herniation and 21 contralateral. The group of diabetes patients who smoke was at high risk (Odds 2.77) of rapid recurrence of lumbar disc prolapse. Only the group of patients reoperated on the opposite side at the L4L5 level showed very less recurrence risk (Odd ratio 1.01) for lumbar disc prolapses compared to those reoperated on the same side who are 6.73 times at risk of recurrence. Conclusions Coexisting diabetes and smoking status increase the risk of rLDH and the patient’s outcome is favorable with pain-free after reoperation without the need for physiotherapy when the recurrence is on the same level and opposite side.

Microlumbar Discectomy vs Minimally Invasive Tubular Microdiscectomy: A Prospective Comparative Analysis

Background and Aim: Lumbar disc prolapse is a common cause of backache and radicular symptoms in lower limbs. Different surgical options have been described to compare the functional outcome, complications, and recurrence following surgery for lumbar disc prolapse by classical microlumbar discectomy (MLD) and minimally invasive tubular microdiscectomy. The advantages of one procedure over the other were also analyzed. Methods and Materials/Patients: A prospective, observational study conducted over a period of 1 year in the Department of Neurosurgery, Government Medical College Thiruvananthapuram, among patients who underwent surgical treatment for lumbar disc herniation by either microlumbar discectomy or minimally invasive surgery using a tubular retractor system. Ninety-nine patients who satisfied the inclusion and exclusion criteria were analyzed and tabulated for the outcome. Results: The two groups did not show a statistical difference in terms of functional outcome, complications, or recurrence rate. However, the need for post-operative analgesics, blood loss, and hence hospitalization was less in the tubular discectomy group. Conclusion: Both procedures are equally effective in terms of surgical results. However, the advantages and the subtle tendency of the patients to adopt “keyhole” make the tube an attractive option.

C-Arm Guided Epidural Steroid Injection: An Effective Treatment for Patients with Radiculopathy in Tertiary Level Hospital of Bangladesh

Introduction: Epidural steroid injections (ESI) have been utilized for over 50 years in the conservative therapy of prolapsed lumbar intervertebral discs. However, controversy persists regarding their effectiveness in reducing pain and improving function, with literature supporting and opposing them.&#x0D; Aim: To study the effectiveness of epidural steroid injection in treating pain caused by a prolapsed lumbar intervertebral disc and compare the effectiveness between caudal, transforaminal, and interlaminar injection routes.&#x0D; Materials and Methods: A total of 152 patients with back pain with Radiculopathy with a lumbar disc prolapse confirmed on MRI were included in the study. Their pre-injection Japanese Orthopedic Association Score (JOA) counted up. In this study, participants were enrolled using a simple randomization procedure (picking a card).in the Department of Physical Medicine &amp; Rehabilitation at BSMMU, Dhaka, from May 2020 to April 2021. Among 152 patients were intervenes as transforaminal (n=62), caudal (n=53), and interlaminar (n=25) approach with subsequently received epidural steroids as methylprednisone. Twelve individuals were dropped from the trial because they failed to show up for their scheduled therapy.&#x0D; Results: The prevalence increased dramatically, leading to a JOA Score at 12 months following injection via any of the three methods 53 (37.26%) via the caudal pathway, 62 (44.21%) via transforaminal, and 25 (18.53%) via interlaminar. At six months and 12 months post-injection, the transforaminal route was substantially more efficacious than the caudal (p=0.01) and interlaminar routes (p=0.03). Comparing the caudal and interlaminar methods yielded no statistically significant difference (p=0.36).&#x0D; Conclusion: In the current study, methylprednisone epidural injections effectively treat radiculopathy and back pain caused by a herniated lumbar disc. All three injection techniques are adequate, with the best result obtained by the transforaminal route.&#x0D; TAJ 2022; 36: No-1: 113-118

Effect of Body Mechanics Training Program on Low Back Pain and Disability among Patients with Lumbar Disc Prolapse

Context: Lumbar disc prolapse is one of the most common spinal pathologies, which can be associated with debilitating pain and neurological dysfunction. Evidence suggests that patients with disc prolapse and low back pain must be taught proper body mechanics to move safely and with the least strain possible on their back.&#x0D; Aim: Evaluate the effect of body mechanics training program on low back pain and disability among patients with lumbar disc prolapse. Methods: A quasi-experimental research design (study and control group) was utilized to achieve the aim of this study. This study was conducted in the neurosurgery department and neurosurgery outpatient clinic at Benha University Hospital on a purposive sample of patients diagnosed with lumbar disc prolapse. Three tools for data collection were used; a Structured interviewing questionnaire for patients; a visual analog pain scale, and Oswestry low back pain disability questionnaire.&#x0D; Results: Showed that the total mean knowledge score for the study and control group was 33.500±3.862 and 8.140±6.402, respectively, after one-month post-program implementation, with a statistically significant difference between both groups. Also, 75% of the study group had mild pain, and 58% of the control group had moderate pain post-program implementation, with statistically significant differences between the study and control group post-program, where p=0.000. Regarding functional disability scores among study and control groups pre and one month after program implementation. It shows that (67% and 63%) of the study and control groups had severe disability pre-program implementation. In contrast, post-program implementation, 65% of the study group had moderate disability, while 13% of the control group had moderate disability.&#x0D; Conclusion: Implementing body mechanics training program for patients with lumbar disc prolapse improved knowledge, reduced pain severity, and reduced disability among the study group compared to the control group. A simplified colored booklet about using body mechanics when performing activities of daily living should be available for all patients with lumber disc prolapse.

PROSPECTIVE RANDOMISED STUDY COMPARING ENDOSCOPIC DISCECTOMY WITH PERCUTANEOUS RADIO-FREQUENCYCOABLATION IN PATIENT WITH CONTAINED LUMBAR DISC PROLAPSE

Background: This study is to compare functional outcome in patients with radiculopathy with contained lumbar disc prolapse treated with endoscopic discectomy and percutaneous radio frequency co ablation. In this study, the radicular pain using VAS score and prospective functional results using SLR test were measured. Materials and Methods: Prospective randomised control study carried out in Department of Orthopaedics from the period Nov 2016 to Nov 2018. Source of data for study was the patients reporting to Orthopaedic OPD who fulfill the inclusion criteria. Total 30 patients were included in the study. Data was subjected to statistical analysis using Statistical package for social sciences (SPSS v 21.0, IBM). Inter group comparison (2 groups) was done using Mann Whitney U test. Intra group comparison was done using Wilcoxon Signed rank test (upto 2 observations) Friedmans (for &gt;2 observations) followed by followed by pair wise comparison using Wilcoxon Signed rank test. Results: The functional outcome in patients treated with radiofrequency coablation are better than patients treated with endoscopic discectomy. Conclusion: Both Radio-frequency co-ablation and percutaneous transforaminal endoscopic discectomy appear to be safe and effective minimally invasive day care treatment option for patients with contained lumbar disc prolapse with radiculopathy.