Lumbar Disc Prolapse Research Articles

Spinal Morphometry As A Novel Predictor For Recurrent Lumbar Disc Herniation Requiring Revision Surgery: Results of A Case Control Study.

There is conflicting data on the risk factors for recurrent lumbar disc herniation (rLDH). Most of the predictors for rLDH identified so far are acquired risk factors or radiological factors at the level of the herniation. Whole lumbar spine (WLS) morphometry has not been evaluated as a possible predictor of rLDH. We aimed to evaluate if preoperative spinal morphometry can predict the occurrence of rLDH requiring revision surgery. This retrospective case-control study on 250 patients included 45 patients operated for rLDH, 180 controls without rLDH who had previously undergone microdiscectomy for a single level lumbar disc prolapse, and a holdout validation set of 25 patients. Morphometric variables related to the WLS were recorded in addition to previously identified predictors of rLDH. Logistic regression (LR) analysis was performed to identify independent predictors of rLDH. LR yielded four predictors of which two were WLS morphometric variables. While increasing age and smoking positively predicted rLDH, increasing WLS interfacet distance and WLS dural-sac circumference negatively predicted rLDH. The LR model was statistically significant, χ2 (4) =15.98, P = 0.003, and correctly classified 80.3% of cases. On validation, the model demonstrated a fair accuracy in predicting rLDH (accuracy: 0.80, AUC: 0.70). Larger mean lumbar bony canals and dural sacs protect from the occurrence of symptomatic rLDH. These WLS morphometric variables should be included in future risk stratification algorithms for lumbar disc disease. In addition to the previously recognized risk factors, our study points to an underlying developmental predisposition for rLDH.

Comparative effect of transforaminal injection of Magnesium sulphate versus Ozone on oxidative stress biomarkers in lumbar disc related radicular pain

BackgroundWe aimed to investigate the effect of transforaminal injection of Magnesium sulphate versus Ozone on pain intensity, functional disability and the oxidative stress biomarkers; superoxide dismutase (SOD) and Glutathione (GSH) in patients with lumbar disc prolapse.MethodsThis randomized controlled trial was conducted on 135 patients having symptomatic lumbar disc prolapse, received either transforaminal injection of Magnesium sulphate with steroids, Ozone with steroids, or steroids alone. Assessment of pain severity and functional disability were done before intervention, 2 weeks, 1, 3, and 6 months after intervention. Serum SOD and GSH were measured for all included patients before and 2 weeks after intervention.ResultsThere was a statistically significant improvement in pain intensity and functional disability 2 weeks after intervention in the three groups, but at 1-month and 3-months after intervention, the significant improvement was in Mg sulphate and Ozone groups only. At 6-months follow up, Mg sulphate group only showed a significant improvement. There was a statistically significant increase in SOD and GSH serum levels, 2-weeks after intervention in both Magnesium sulphate (P-value = 0.002, 0.005 respectively) and ozone groups (P-value < 0.001, < 0.001), but there was no statistically significant change in SOD and GSH serum levels in control group.ConclusionTransforaminal injection of Mg sulphate in patients with lumbar disc prolapse causes significant long-term improvement (up to 6 months) in pain intensity and functional disability. The serum levels of SOD and GSH were significantly increased at 2 weeks following both transforaminal injection of Mg sulphate and ozone.

Additional operations after surgery for lumbar disc prolapse : indications, type of surgery, and long-term follow-up of primary operations performed from 2007 to 2008.

Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse. We retrieved data from the Swedish spine register about 3,291 patients who underwent primary surgery for a lumbar disc prolapse between January 2007 and December 2008. These patients were followed until December 2020 to record all additional lumbar spine operations and the reason for them. In total, 681 of the 3,291 patients (21%) needed one or more additional operations. More than three additional operations was uncommon (2%; 15/906). Overall, 906 additional operations were identified during the time period, with a mean time to the first of these of 3.7 years (SD 3.6). The most common reason for an additional operation was recurrent disc prolapse (47%; 426/906), followed by spinal stenosis or degenerative spondylolisthesis (19%; 176/906), and segmental pain (16%; 145/906). The most common surgical procedures were revision discectomy (43%; 385/906) and instrumented fusion (22%; 200/906). Degenerative spinal conditions other than disc prolapse became a more common reason for additional surgery with increasing length of follow-up. Most patients achieved the minimally important change (MIC) for the patient-reported outcomes after the index surgery. After the third additional spinal operation, only 20% (5/25) achieved the MIC in terms of leg pain, and 29% (7/24) in terms of the EuroQol five-dimension index questionnaire visual analogue scale. More than one in five patients operated on for a lumbar disc prolapse underwent further surgery during the 13-year follow-up period. Recurrent disc prolapse was the most common reason for additional surgery, followed by spinal stenosis and segmental pain. This study shows that additional operations after primary disc surgery are needed more frequently than previously reported, and that the outcome profoundly deteriorates after the second additional operation. The findings from this study can be used in the shared decision-making process. Cite this article: Bone Joint J2022;104-B(5):627-632.

The Added Value of Postoperative Neurotrophins/Peptide Mixture in Treating L5 Motor Weakness in Lumbar Disc Prolapse: A Preliminary Report of Multicenter Randomized Controlled Study

Background Data: Neurotrophins/peptide mixture is a porcine brain-derived peptide preparation with pharmacodynamic properties similar to those of endogenous neurotrophic factors. No study has evaluated the postoperative role of neurotrophins/peptide mixture in the recovery of postdiscectomy motor weakness. Purpose: This study aims to evaluate the effect of postoperative neurotrophins/peptide mixture treatment on the recovery of L5 motor weakness after lumbar discectomy compared to placebo. Study Design: Prospective randomized controlled study (preliminary report). Patients and Methods: In total, 15 patients (group I) with L5 weakness who received a postdiscectomy adjuvant neurotrophins/peptide mixture were compared to group II (15 postdiscectomy patients with L5 weakness) treated with a placebo. The whole patient population was followed up at 2 weeks, 1, 3, and 6 months, and 1 year for assessment of motor recovery. Results: The mean postoperative MRC score was significantly improved in both groups; however, the improvement was faster in group I than in group II. The mean MRC score improvement was significantly higher in group I than that in group II at 2 weeks and 1, 3, and 6 months; however, it was statistically insignificant at 1 year. At 1-year follow-up, 80 % of cases in group I had improved motor power up to grade 5 compared to 40 % of cases in group II. The rest of the patients reached grade 4 in both groups. There was no motor deterioration after improvement in either group. There were no reported drug-related adverse effects in group I. Conclusion: Neurotrophins/peptide mixture may be an efficient and safe adjunctive postoperative treatment for discogenic L5 motor weakness. It may accelerate recovery of nerve injury in an acute setting, which may be a result of accelerating nerve regeneration; however, the overall improvement was comparable to placebo. (2022ESJ2601)

Association of Hyperuricemia with Chronic Low Back Pain

Background: The Back pain affects about 20% of the population in Bangladesh in each year between the ages of 30-60 years. A well-defined pathology is identified in only about 15% of patients. Objective: To identify the association of hyperuricemia in patients with chronic low back pain. Materials and Methods: A descriptive cross-sectional study was performed on 180 patients among the ages of 18 to 75 years with chronic low back pain (CLBP). Data was collected through a structured questionnaire. X-rays and Magnetic Resonance Imaging (MRI) of the lumbosacral spine had been used to evaluate any findings in terms of low back pain. Serum uric acid (sUA) levels had been tested and recorded. Results: Joint pain (p &lt; 0.001), lumbar disc prolapse (p = 0.023), and disc degeneration (p = 0.011) were more in High-sUA than Low-sUA group. Female patients in H-sUA group had significantly higher occurrence of joint pain(p = 0.002), lumbar disc prolapse (p = 0.019), and disc degeneration (p = 0.004) than L-sUA group. In regression analysis, female sex (p = 0.036), duration of CLBP (p = 0.031), and sUA level (p = 0.025) were associated with radiological findings. In female patients association of duration of CLBP (p = 0.046) and sUA (p = 0.009). Conclusion: The serum UA level was significantly associated with CLBP in female patients. More studies are warranted to explore whether the two conditions exist simultaneously or there is a direct causal relationship between the conditions. KYAMC Journal. 2022;12(04): 213-217

Evaluation of Minimal Invasive Fragmentectomy in Treatment of Lumbar Disc Prolapse

Evaluation of Minimal Invasive Fragmentectomy in Treatment of Lumbar Disc Prolapse

Endoscopic Lumbar Discectomy Using Side-Viewing Conical Working Tube: An Institutional Experience

Abstract Objective The paradigm of surgical therapy for spinal disease especially for lumbar disc herniation (LDH) has gradually shifted from the traditional open surgeries to minimal invasive spinal surgeries. Endoscopic discectomy has been performed widely using various devices and techniques. In this study we present our experience of endoscopic discectomy using a unique device with separate side-viewing channel. Methods Twenty-six patients with LDH treated between March 2015 and April 2018 using the unique conical working tube with separate side-viewing endoscopic channel have been retrospectively analyzed. Their preoperative and postoperative Oswestry Disability Index (ODI) and Macnab scores were used to evaluate the outcome with a mean follow-up of 37.04 months. Results There were 18 males and 8 females with age ranging from 19 to 72 years (mean, 38.4 years). The follow-up ranged from 25 to 60 months with mean of 37.04 months. The mean preoperative ODI score was 72.4, which decreased to a mean of 7.6 and the outcome evaluated by Macnab criteria was 65.3% excellent, 19.2% good, 11.5% fair, and 3.8% poor. One patient underwent second surgery. None of the patients had to change their occupation postoperatively. Complications that occurred were dural tear in one patient and transient foot paresis in one, which improved spontaneously. Conclusion Endoscopic discectomy using conical working tube is a safe and effective technique for lumbar disc prolapse. The long-term results are comparable to the conventional techniques.

Ultrasound, Fluoroscopic-Guided Caudal, Lumbar Epidural Steroid Injections and Blinding Paraspinal Lumbosacral Steroid Injections in Patients with Low Back Pain with Radiculopathy

Background and Aims: Low back pain (LBP) is considered one of the most common health conditions in the world right now, and it affects many individuals throughout different stages of their lives. Chronic LBP (CLBP) was estimated to be between 5% and 10%, defined as LBP that lasts for 12 weeks. The most common causes of CLBP with radiculopathy are lumbar disc prolapse (LDP) and degenerative facet osteoarthropathy (DFO); the aim of this study is to investigate the efficacy of ultrasound (US) guided, fluoroscopy (FL) guided, Caudal Epidural Steroid Injection (CESI), lumbar epidural steroid injections (LESI), and blinding lumbosacral steroid injections (LSPSI) in patients with CLBP with radiculopathy. Patients and Methods: This is a randomized prospective study that was conducted at the department of rheumatology at Al Azhar University Hospital in Egypt between November 2020 and August 2021. A total of 100 patients with refractory CLBP with radiculopathy were enrolled in the study. Consequently, they were divided into 2 groups: the first consisted of fifty patients with CLBP and radiculopathy caused by LDP, as determined by lumbosacral magnetic resonance imaging (MRI), and the second group consisted of fifty patients with refractory low back pain and radiculopathy caused by DFO, as determined by lumbosacral plain x-rays and lumbosacral MRI. The following procedures were performed: US-guided CESI, FL-guided CESI, FL-guided LESI, US-guided LESI, and blinding LSPSI. Results: In the LDP group, there is a statistically significant difference between considered spinal nerve roots as regards Visual Analogue Scale (VAS) (at 2 months). Likewise, a statistically significant difference was found between blinding LSPSI and US-Guided LESI with respect to VAS (baseline) and VAS (2 months) (P-value = 0.018 and 0.003, respectively). Statistically significant differences were reported in VAS (2 months) for both FL-guided LESI and FL-guided CESI groups. Considering the VAS of studied spinal nerve roots in the DFO group, there is a statistically significant difference between the examined spinal nerve roots with respect to Oswestry Disability Index (ODI) (2 months). Similarly, there is a statistically significant difference in VAS (2 months) between US-guided LESI and para-spinal roots and FL-guided LESI and para-spinal roots (P-value = 0.038 and 0.021, respectively). Additionally, there is a statistically significant difference between the US-guided CESI, FL-guided CESI, FL-guided LESI, and spinal nerve roots with respect to ODI (at 2 months). (P-value = 0.033, 0.025 and 0.005, respectively). Conclusion: US is excellent in guiding CESI and LESI and should be the preferred alternative when FL is not provided, with a similar treatment outcome compared to FL-CESI and LESI.

Clinical Application and Experimental Research Progress of Huo-Luo-Xiao-Ling-Dan in Orthopedics and Traumatology

Huo-Luo-Xiao-Ling-Dan (HLXLD) comes from the famous doctor Zhang Xichun's "Intergrating Chinese and Western Medicine". The prescription has the function of promoting blood circulation and dredging collaterals, removing blood stasis and generating new blood, relieving swelling and pain. It is often used in the orthopedic department of Traditional Chinese medicine for the treatment of swelling and pain caused by qi and blood stasis caused by trauma or internal injury. And the prescription often has the effect of "simple, convenient, cheap and effective". It has good curative effect for many orthopedic diseases such as acute lumbar sprain, lumbar disc prolapse, rheumatic lumbago, knee osteoarthritis, fractures and postoperative complications. This paper reviews the efficacy of HLXLD based on the theory of blood stasis in Chinese medicine, combined with the clinical application and experimental studies of HLXLD in recent years, in order to provide reference for the treatment of orthopedic diseases.

A Prospective study on correlation of symptom complex and MRI findings in Lumbar disc prolapse

Background: Lumbar disc herniation is one of the common causes of low back pain throughout the world. Abnormalities detected in MRI do not always reflect low back pain, so these should be interpreted with consideration of thorough history and physical examination. Therefore, clinical correlation is required to delineate the importance of abnormalities in MRI. Materials and Methods: The study was a Prospective study conducted from 2015 to 2017 in the patients coming to our tertiary care centre. We selected patients with lumbar disc herniation confirmed with MRI to find out correlation of clinical features and MRI findings in determining the level of lumbar disc herniation. MRI findings analysed were level of disc herniation, position and type of disc herniation, neural canal compromise. Results: Out of the 102 patients studied, 44 had specific dermatomal distribution and 58 had non-specific distribution. Out of 139 levels of disc herniation, 62 levels showed disc bulge, 46 showed protrusion, 27 showed extrusion and 4 levels were with sequestration. Out of 139 levels of disc herniation, 42 levels had motor deficits. Conclusion: There is a good correlation between clinical findings and MRI findings. Disc bulge/protrusion/extrusion with central presentation was not significantly correlating with clinical features. But, independent of type of herniation, if there is para-central/far lateral position of disc with neural foramen compromise, there was significant correlation with clinical features.

Functional Outcome Of Unilateral Biportal Endoscopic Ligamentum Flavum Preserving Discectomy

Introduction: Low back pain affects roughly 70–80% of people at some point in their lives. Lumbar disc prolapse is one of the major reasons of low back pain that causes severe morbidity around the world, affecting primarily the working-class young population. We conducted this study to describe the unilateral biportal endoscopic (UBE) discectomy technique for lumbar herniated disc with the aim on how to perform theses procedure safely while also preserving the structures like the facet joints through the posterior interlaminar approach. Materials and Methods: This was a retrospective study conducted between July 2019 and July 2021. The total number of patients included in the study was 41. A total of 54 levels of discectomy were done. The visual analog scale was used to assess back pain and lower leg symptoms, the Oswestry Disability Index was used to assess degrees of disability, and modified Macnab criteria were used to assess overall outcomes of treatment. Results: Following the procedure, there was a significant improvement. The ultimate outcomes were excellent in 24 patients (58.53%), good in 15 (36.58%), fair in 2 (4.8%), and poor in 0 patients, according to the modified Macnab criteria. That is, 95.11% of patients had excellent or good results. Conclusion: The UBE discectomy approach for lumbar disc herniation is a minimally invasive procedure that is both safe and successful. There is no soft-tissue degradation or facet joint destruction.

Tubular Microdiscectomy for Recurrent Disc Prolapse Following Two Rounds of Open Laminectomy and Discectomy: A Case Report and Literature Review

Background Data: Recurrence of LDH has been reported in 5%–11% of patients after conventional discectomy, and most of these patients are usually treated with repeated discectomy through the same initial approach. Tubular microdiscectomy is an increasingly popular surgery for lumbar disc prolapse and has replaced conventional open surgery in the last decade. However, it requires more experience and has a steep learning curve, especially in revision cases.

Cauda Equina Syndrome—retention type (CESR): Outcome after delayed discectomy and decompression for lumbar disc herniation

Background: The objective of this study was to evaluate the functional outcome after lumbar discectomy in Cauda equina syndrome—retention type (CESR) patients with delayed presentation. Materials and Methods: Fourteen patients with CESR presenting after 48 h (i.e., 2–42 days) from the onset of symptoms were included in the study. Acute lumbar disc prolapse was the cause of CESR in all patients. A detailed history including age, sex, onset of back pain, bladder and bowel symptoms, neurological signs, level of lesion, timing of surgery, and neurologic recovery (resolution of pain, sensory and motor deficits, and urinary, rectal, and sexual dysfunction [SD]) were recorded and analyzed. Bladder dysfunction was assessed using the urinary symptom profile (USP) questionnaire. Bowel dysfunction was assessed using the neurogenic bowel dysfunction (NBD) questionnaire. SD in men was analyzed using the international index of erectile function (IIEF) questionnaire and Female SD was analyzed using the female sexual function index (FSFI) questionnaire. Physical and mental health was assessed by short-form 12 (SF-12). Results: 9M:5F with a mean age of 35 years (range 26–45 years) presented with back and leg pain, parasthesia in the limbs, and retention of urine. Nine patients had acute backache and five had chronic back pain. All patients were catheterized on admission. The disc herniation levels were L4/L5 (seven patients), L5/S1 (six patients), and one had L3/4. The mean time of onset of symptoms to presentation at the hospital was 9.7 days (range 2–42 days). Preoperative mean Oswestry disability index (ODI) was 67.4 (range 58–80), mean visual analog score (VAS) for back pain was 2.8 (range 0–7) and mean VAS for leg pain was 6.5 (range 5–9). Preoperatively, motor power was affected in 12 patients. At presentation, perianal sensation (PAS) was labeled as “decreased,” in 12 patients (85.7%), and “absent” in two patients (14.3%). Voluntary anal contraction (VAC) was reported as “weak” in 10 patients (71.5%) and “absent” in 4 patients (28.5%).At a mean follow-up of 30 months, five patients had complete and five patients had partial recovery of motor and sensory deficit. Complete restoration of bladder status was experienced in eight patients after a mean duration of 6 months following surgery (ranging from 3 to 10 months). Three patients had partial recovery of bladder function (stress or nocturnal incontinence or signs of post-voiding residual urine) after a mean duration of 10 months following surgery (range 7–15 months). The return of bowel functions was determined as “complete” in seven (50%), “partial” in five (35.7%) and “no recovery” in two patients (14.3%). All patients had varying grades of SD. The mean SD scores in the nine male patients were 36.1 ± 20.4. In the five female patients, the mean SD scores were 22.9 ± 6.2. The mean physical component summary (PCS) and mental component summary (MCS) scores were 44.7 ± 8.8 and 40.1 ± 10.7, respectively. The group mean was significantly lower (P < 0.0001) as compared to the population norm for age groups 25–45 years. Conclusion: Late presentations of patients with CESR had variable long-term outcomes following lumbar discectomy. The recovery of the bladder and sexual function probably is the worst affected after late decompression. Validated questionnaires provide the clinicians a guide to prognosticate.

Correlation of Chronic Back Pain and Hyperuricemia, Our Hospital Experience

Objective: This study aimed to analyze the prevalence of hyperuricemia in individuals with chronic low back pain.&#x0D; Methodology: It was a descriptive cross-sectional study performed between January 2021 to June 2021 in Medicine department of Bilawal Medical College LUMHS Jamshoro Pakistan. Patients between the age of 18 to 65 years have been investigated. Data was collected using a designed questionnaire. X-rays and Magnetic Resonance Imaging (MRI) of the lumbosacral spine were used to evaluate any discrepancies associated with low back pain. The levels of uric acid in the blood were measured and documented.&#x0D; Results: Out of 88 patients with chronic low back pain, 22 (25%) reported hyperuricemia. There was no significant difference in uric acid levels between men and women (P&gt;0.05). We observed that 86.36 %t (n=19) patients with elevated serum uric acid levels also experienced joint pain. Further radiological examination revealed lumbar disc prolapse in 72.7 % (n=16). We found that in 95.45% of the patients, disc space narrowing was present.&#x0D; Conclusion: Regardless of gender, one in four people with low back pain had hyperuricemia. Patients with low back pain have varying occupational and co-morbidities. Hypouricemia appears to be associated with lumbar disc prolapse and lumbar vertebral joint space constriction. This reveals that hyperuricemia aggravates degenerative spondylolisthesis.

Calcified lumbar disc prolapse technical note and management algorithm: a prospective study

Background: The literature lacks sufficient data about management of symptomatic calcified lumbar disc prolapse. The authors introduced a practical algorithm for surgical management of patients after failed conservative measures. Methods: A prospective study of 32 patients was conducted between 2012 to 2018. Patients had symptomatic calcified lumbar disc prolapse. Eight patients had unilateral radicular pain, four patients had unilateral claudication pain, nine patients had bilateral claudication pain, and 11 patients had mechanical back pain together with claudication symptoms. Preoperative motor examination revealed one patient with preoperative unilateral foot drop, two patients had preoperative unilateral weak ankle dorsiflexion, and 11 patients had weak extensor halluces longus extension. Fifteen patients had fusion surgery, 11 patients had unilateral decompression, and six patients had bilateral decompression surgery. Functional assessment of patients was done by Oswestry Disability Index (ODI), and radicular pain was assessed by visual analog scale (VAS). Results: There were 19 men and 13 women. The mean age was 39.2 yr. The mean operative time for unilateral decompression was 59 min, and bilateral decompression was 80 min. The mean operative time for fusion surgery was 126.4 min. Three patients had intraoperative dural tears. One patient had postoperative ankle dorsiflexion in comparison to preoperative examination, four patients had immediate postoperative lower-limb dysesthesia. The ODI and VAS postoperative improvements were statistically significant when compared with the preoperative values. The mean follow-up was 28.4 mo. Conclusions: The results of this study were encouraging in the adoption of the proposed algorithm for management of symptomatic calcified lumbar disc prolapse. Level of Evidence: Level III.

Lumbar Disc Herniation in Heavy Manual Workers: Conventional Microdiscectomy versus (MIS) TLIF with Unilateral Fixation

Introduction: Conventional discectomy is a common surgical method for treating lumbar disc prolapse. The situation may differ in heavy manual workers who may have more pronounced degenerative spine disease, broad-based disc herniations, and are expected to be exposed postoperatively to the same preoperative manual stress. This study was aimed at comparing the clinical outcomes in patients operated for conventional discectomy versus those operated for TLIF with unilateral spinal fixation.&#x0D; Methodology: Sixty patients underwent surgeries for lumbar disc herniation. They were divided into two groups; the microscopic conventional discectomy group and the fusion (TLIF and unilateral TPF) group. They were operated between 2017 and 2019. Participants were evaluated pre- and postoperatively at 3, 6, 9, and 12 months’ intervals. Pain was scored by Visual Analogue Scale (VAS) for both lower limb and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale and a new outcome score.&#x0D; Result: The two groups of patients were fairly homogeneous and comparable. Workload exposure to repetitive vibration was the biggest risk for disc prolapse and surgery (28.3%). Fusion group showed better clinical outcomes parameter including better VAS for back pain, better Prolo economic and functional rating scale, and better new clinical outcome score. In comparison, the discectomy group showed significantly higher recurrence rate and reoperation during the follow-up period. During the 12 months’ follow-up visit, when the patients were asked if, under the same circumstances, they would undergo the procedure again, 71.6% of the patients (43 patients) answered affirmatively and this reflects their satisfaction with the results of their surgeries. This satisfaction was reported in 27 patients (90%) in the fusion group and 16 patients (53.4%) in the discectomy group.&#x0D; Conclusion: Heavy manual workers treated with unilateral transforaminal interbody fusion reported less pain and lower disability scores all over the follow-up period. This technique is preferable to conventional discectomy because it reduces back and leg pain while avoiding the possibility of recurrence by heavy duties and maintains stability of the lumbar spine. We proposed a new clinical outcome score to monitor the clinical outcomes of spine surgery in heavy manual workers. It relates the outcomes to the hours of work, sick leaves, and patient satisfaction with surgery. In our group of patients, it showed significant improvement in the fusion group in comparison to the discectomy group.

Selective nerve root block in lumbar radiculopathy in lumbar disc prolapse

Back ground: Use of SNRB in lumbar disc prolapse to relieve lumbar radicular pain has been in practice during recent times. We conducted this prospective study to evaluate the pain relief following SNRB using steroid injection. Materials and Methods: This was a prospective study conducted on 60 patients aged 25 to 60 years, of both gender with complaints of low backache with radiculopathy, unilateral, or bilateral, not relieved by analgesics or physiotherapy. We used 1 cc (40 mg) of methylprednisolone with 1 cc of 2% xylocaine for selective nerve root block. We assessed the pain using VAS score before and after the procedure and follow-up was done at 1, 3 and 6 months for pain relief evaluation. Results: The mean age of our patients was 38.1 years ranging from 25 to 60 years. Majority were females (55%) and middle aged (40-50 years) (33.3%). Most of the cases were right sided (46.7%) and had L4-L5 herniation (34%), was postero-central on disc-axial section (46%) and had extrusion on sagittal section (50%). The pre-injection VAS score was 7.25 and immediate post injection VAS score decreased to 1.71. With further follow up at 1, 3 and 6 months, there was a moderately decreasing trend of VAS score. Conclusions: SNRB is a reasonably safe procedure to provide short-term pain relief for lumbar radiculopathy in lumbar disc prolapse.

Clinical profile of patients with lumbar disc prolapse

The motion in the lumbar spine is divided between five motion segments, although a disproportionate amount of the motion is in the lower segments (L3-L4 and L4-L5). The two lowest discs (L4-L5 and L5-S1) take the most strain and are the most likely to herniate. This can cause lower back pain and possibly numbness that radiates through the leg and down to the foot (sciatica). Written informed consent for participation in the study was obtained from all the subjects. After the patient’s informed consent was obtained, 150 patients with lumbar disc prolapse were subjected to epidural steroid infiltration out of which 101 underwent IL procedure and 49 underwent TF epidural steroid injections under the fluoroscopic guidance according to surgeons preference. As per my study out of the total 150 patients, 105(70%) improved in their symptoms only with epidural steroid and 45 patients (30%) proceeded to surgery, which was statistically significant.

Evaluation of Lumbar Fusion in Recurrent Disc Prolapse

Abstract Background Recurrent disc herniation is the most common cause of reoperation after the primary disc surgery, The management of recurrent disc herniation remains somewhat controversial. Surgical treatment for recurrent disk herniation can be broadly categorized as revision discectomy alone or revision discectomy and fusion or percutaneous endoscopic interlaminar discectomy. Aim of the work to evaluate and compare the therapeutic effect between different modalities of treatment of the recurrent lumbar disc protrusion (RLDP) through 3 groups: (1) First group treated by conventional discectomy. (2) Second group treated by discectomy and lumbar fusion either by PLF, PLIF or TLIF. (3) Third group treated by percutaneous endoscopic interlaminar discectomy. Patients and methods It is a prospective cohort study performed between January 2012 and April 2017 on 150 patients complained of recurrent lumbar disc herniation. They were surgically treated at the Department of Neurosurgery, Ain Shams University Hospitals. All patients are evaluated clinically by VAS, JOA and Oswestry disability index (ODI) through follow up period of 2 years (one month, 6 months, 1 yr, 2 yrs). They were divided into 3 groups (I&amp;II and III) each group was a fifty patients Results the mean overall recovery rate is 89%, comparison between the three groups showed significant improvement of the endoscopic group and fixation group than simple discectomy group in term of VAS LBP, leg pain , JOA and ODI. Intraoperative blood loss, length of operation and hospital stay were significant less in endoscopic group than fixation and simple discectomy group CONCLUSION Recurrent lumbar disc prolapse management is a controversial issue, there are different surgical modalities (either by open discectomy, discectomy and fixation or Percutaneous interlaminar lumbar discectomy PEILD) although those surgical modalities are successful the PEILD is the optional choice that offers less tissue trauma, rapid recovery, less cost effect and early return to work

Long-term core outcomes in cauda equina syndrome.

Cauda equina syndrome (CES) can be associated with chronic severe lower back pain and long-term autonomic dysfunction. This study assesses the recently defined core outcome set for CES in a cohort of patients using validated questionnaires. Between January 2005 and December 2019, 82 patients underwent surgical decompression for acute CES secondary to massive lumbar disc prolapse at our hospital. After review of their records, patients were included if they presented with the clinical and radiological features of CES, then classified as CES incomplete (CESI) or with painless urinary retention (CESR) in accordance with guidelines published by the British Association of Spinal Surgeons. Patients provided written consent and completed a series of questionnaires. In total, 61 of 82 patients returned a completed survey. Their mean age at presentation was 43 years (20 to 77; SD 12.7), and the mean duration of follow-up 58.2 months (11 to 182; SD 45.3). Autonomic dysfunction was frequent: 33% of patients reported bladder dysfunction, and 10% required a urinary catheter. There was a 38% and 53% incidence of bowel and sexual dysfunction, respectively: 47% of patients reported genital numbness. A total of 67% reported significant back pain: 44% required further investigation and 10% further intervention for the management of lower back pain. Quality of life was lower than expected when corrected for age and sex. Half the patients reported moderate or worse depression, and 40% of patients of working age could no longer work due to problems attributable to CES. Urinary and faecal incontinence, catheter use, sexual dysfunction, and genital numbness were significantly more common in patients with CESR. This study reports the long-term outcome of patients with CES and is the first to use validated patient-reported outcome measures to assess the CES Core Outcome Set. Persistent severe back pain and on-going autonomic dysfunction were frequently reported at a mean follow-up of five years. Cite this article: Bone Joint J2021;103-B(9):1464-1471.