Lumbar Disc Prolapse Research Articles

Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse in tertiary care hospital in South India

Functional outcome of microscopic lumbar discectomy for the treatment of lumbar disc prolapse in tertiary care hospital in South India

SELF CARE PRACTICES OF PATIENTS WITH LUMBAR DISC PROLAPSE IN THE POSTOPERATIVE PERIOD

Background: Self care practices affect the progress of many diseases including lumbar disc prolapse. This study aimed to assess self care practices of patients with lumbar disc prolapse in the post operative period. Setting: This study conducted at neuro-surgery department and outpatient clinic at Azhar university hospital in New Damietta city. A convenience sample of 124 adult patients diagnosed with lumbar disc prolapse were included in the study. Tool of data collection: data collected using structured interview questionnaire, it included four parts: demographic data, medical and surgical history, pain intensity and follow up and Self-care practices of patients with lumbar disc prolapse. Results: The result of present study showed that 100% of the studied patients felt pain when doing an activity and 72.6 % of them had unsatisfactory self care practicesin the post operative period. Conclusion: More than two third of the studied patients need improve self care practices regarding to unsatisfactory self care practices and there wasn't statistically significance relation between demographic data and self care practices. Recommendations: Design patient educational materials include proper self care practices of patients with lumbar disc prolapse in the post operative period . The health education program should be tailored every patient's individual needs .

Role of transforaminal epidural injections or selective nerve root blocks in the management of lumbar radicular syndrome - A narrative, evidence-based review

ObjectiveLumbar radicular Syndrome (LRS) is a common spinal pathology and is attributed to complex interplay of mechanical, inflammatory and immunological processes. Epidural injection of steroids has a significant therapeutic role in mitigating the inflammatory component of LRS. Trans-foraminal approach under image guidance enables a targeted drug delivery. The current narrative review discusses the various aspects related to lumbar trans-foraminal epidural injection of steroid (LTFIS). MethodsAn elaborate search on PubMed, Google and Medline databases was made using keywords “lumbar selective nerve root block”, “lumbar trans-foraminal epidural steroid injection”, “selective nerve root block in lumbar disc prolapse”, “trans-foraminal epidural steroid injection in lumbar prolapse”, “selective nerve root block in lumbar radiculopathy”, and “trans-foraminal epidural steroid injection in lumbar radiculopathy” The articles were selected based on specific inclusion criteria. ResultsOur search identified 539 articles. All articles discussing alternate procedures, LTFIS in other pathologies, diagnostic roles of LTFIS, not pertaining to concerned questions, in non-English language and duplicate articles were excluded. Review articles, randomised controlled trials or level 1 studies were given preference. Overall, 108 articles were included. Being a focussed narrative review, further screening [Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) or Methodological Index for non-randomized studies (MINORS) criteria] was not performed to select articles. Based on the evidence, LTFIS is an effective and useful treatment modality. It is offered to patients with lumbar disc herniation (LDH) presenting with persistent, unilateral, radiculopathy after a course of conservative measures for around 6 weeks’ duration. It has been reported to yield better results than caudal or inter-laminar epidural injections. The anti-inflammatory and nociceptive signal stabilization actions of steroids, as well as mechanical effects of washout of inflammatory mediators and neural lysis contribute to its efficacy. The three different approaches include sub-pedicular, retro-neural and retro-discal. The procedure is performed under image guidance using a water-soluble contrast under fluoroscopy. The four described radiculogram patterns include “arm”, “arrow”, “linear” and “splash”. Computerised tomography, ultrasonography and magnetic resonance imaging are other modalities, which may be helpful in performing LTFIS. The use of particulate versus non-particulate steroids is controversial. ConclusionThe overall success rate of SNRB is reported to be 76–88%. The majority of benefits are observed during immediate and early post-injection period. Clinical factors including duration and severity of symptoms, and radiological factors like presence of osteophytes, location, size and type of disc prolapse influence outcomes. The radiculogram “splash” pattern is associated with poor outcomes.

A comparative study between laminectomy and laminotomy in patient of lumbar disc prolapse

Introduction and Objective: The study aims to compare the effectiveness of laminectomy and laminotomy for treating lumbar disc prolapse. Materials and Methods: A prospective study of comparative study between laminectomy and laminotomy. In patient of lumbar disc bulge will be conducted in the department of Orhtopaedics, Sir Takhtsinhji Hospital, Bhavnagar, after getting permission from Institutional Review Board, Government Medical College, Bhavnagar. The Study will compose of 30 patients of lumbar disc bulge admitted in the Department of Orhtopaedics, Sir Takhtsinhji General Hospital, Bhavnagar. Patients will be included after approval of Institutional Review Board, Government Medical College, Bhavnagar. Detailed history regarding personal date, history of mechanism, pre- injury ambulatory status, preexisting local and systemic condition, menopausal status that may affect recovery. Full clinical examination will be done to assess the general condition of the patient, range of movement and any associated complains. MRI whole spine screening will be taken. After deciding the appropriate plan, patient will be prepared for surgery. Every patient will be operated upon as early as possible or within two days of getting fitness for anesthesia. All patients will be assessed with regard to operative time day of getting fitness for anesthesia. All patients will be assessed with regard to operative time, blood loose, hospital stay and post operative complications. Dressing will be checked on the 2nd , 4th, 6th post – operative day. Patients will be discharged and then after will be followed on 2nd wk, 6th wk, 12th wk, and 6th month. On follow up visits patients’ will be evaluated with odoms criteria, general and systemic examination. Results: Laminotomy has definitive advantages over leminectomy in terms of SHORT hospital stay an average of 5 days, less blood loss, Less postoperative pain and Epidural hematomas and Fibrosis, It has the advantage that it’s shorter length

Outcome of micro-lumbar discectomy and preventive measures to control discitis

Objective: The purpose of the present study is to describe the rate of post-operative discitis following micro-lumbar discectomy.
 Methods and Materials: This is a retrospective study of 203 patients who underwent micro-lumbar discectomy between March 2015 and April 2018 in our institute. Prior to surgery, patients were optimized by maintaining personal hygiene, controlling blood sugar in diabetics and withholding steroids. Standardized intra-operative measures were taken to prevent discitis. Post-operatively on day 7, patients were evaluated for symptoms like back pain, fever and wound infection. If there was any sign of infection then the patient was evaluated with a plain x-ray of lumbosacral spine, inflammatory blood markers like complete blood count, erythrocyte sedimentation rate, C-reactive protein and Magnetic Resonance Imaging of lumbosacral spine to rule out discitis.
 Results: There were 127 males and 76 females, the age ranging from 8 years to 80 years. MRI imaging showed 94.6% single and 5.4% multilevel disc prolapses with 4.2% high lumbar and 95.8% low lumbar disc prolapse. Indications for surgery were failed conservative treatment (44), intractable pain (102), neurological deficit (49), and cauda equina syndrome (8). None of the 203 patients developed post-operative discitis, however, some of them had nerve root injury (4), dural tear (5), wound infection (5) and pseudo-meningocele (2). Almost all patients were mobilized within 48 hours (98%) after surgery. 95% were discharged on the 7th day of surgery and 5% within two weeks. Radicular pain was relieved in 92% patients within one week, 6% within three weeks and 2% had no change. Low back pain was relieved in 80% of patients in three weeks, 15% in three months and 5% had persistent back pain. The recurrence rate was 2.5% in our series. 80% had joined their previous job after four weeks, 15% after three months and 5% had changed their job.
 Conclusions: Post-operative discitis can be prevented if appropriate precautions are taken like using separate dedicated neurosurgical operation theatre, prophylactic antibiotics, minimally invasive procedure and not curating the end-plates.

SURGICAL OUTCOME OF PERCUTANEOUS ENDOSCOPIC INTERLAMINAR LUMBAR DISCECTOMY TECHNIQUE

Background: Minimally invasive lumbar surgeries are becoming more popular and a routine around the world. Although good surgical outcomes have been reported for the endoscopic approach to treat lumbar disc herniation (LDH), the procedure still appears to be relatively difficult so operative failures and complications may be occurred. Objective: To assess the outcome of lumbar spinal endoscopic discectomy by Destandaeu technique as minimally invasive approach in Al Azhar experience. Patients and Method: Thirty five consecutive patients proved to have lumber disc prolapse, were treated with percutaneous endoscopic lumbar discectomy through interlaminar approach discectomy by Destandau's technique using Endospine Karl Storz system between September 2017 and October 2019 at the Neurosurgery Department, Al-Azhar University Hospitals. All patients included in this study have lumbar disc prolapse fulfilled the following criteria: Unilateral Radicular pain correlated with MRI finding, failure of conservative measures for at least 6 weeks, single level disc prolapse, and disc prolapse was central or paracentral. Follow up for 6 months postoperative and Clinical outcomes were assessed by using Visual Analogue Scale (VAS) score (for Mean pre- and postoperative pain score measurement) and Oswestry Disability Index (ODI), Patients Satisfaction measured by Modified Macnab Criteria at 6 months postoperative, Time of return to work, Recurrence or persistence of symptoms which need revision open surgery. Results: The mean age was 37.5 years, the mean operative time was 90 minutes, and the mean length of follow-up was 5 months. The mean hospital stay for endoscopic discectomy was 36 hours. There was a significant reduction in the severity of back pain and lower limb symptoms measured by (VAS) (ODI) in 87% (30 patients) at 6 months. The recurrence rate was 8.5% (3 patients) and persistent symptoms without improvement occurred in 5.7 % (2 patients) who subsequently underwent revision surgery. Most Patients returned to their previous occupation after surgery at a mean time of 35 days. Conclusion: Endoscopic discectomy by Destandau's technique for lumbar disc prolapse in properly selected patients was safe and minimally invasive technique.

SURGICAL OUTCOME OF PERCUTANEOUS ENDOSCOPIC INTERLAMINAR LUMBAR DISCECTOMY TECHNIQUE

Background: Minimally invasive lumbar surgeries are becoming more popular and a routine around the world. Although good surgical outcomes have been reported for the endoscopic approach to treat lumbar disc herniation (LDH), the procedure still appears to be relatively difficult so operative failures and complications may be occurred. Objective: To assess the outcome of lumbar spinal endoscopic discectomy by Destandaeu technique as minimally invasive approach in Al Azhar experience. Patients and Method: Thirty five consecutive patients proved to have lumber disc prolapse, were treated with percutaneous endoscopic lumbar discectomy through interlaminar approach discectomy by Destandau's technique using Endospine Karl Storz system between September 2017 and October 2019 at the Neurosurgery Department, Al-Azhar University Hospitals. All patients included in this study have lumbar disc prolapse fulfilled the following criteria: Unilateral Radicular pain correlated with MRI finding, failure of conservative measures for at least 6 weeks, single level disc prolapse, and disc prolapse was central or paracentral. Follow up for 6 months postoperative and Clinical outcomes were assessed by using Visual Analogue Scale (VAS) score (for Mean pre- and postoperative pain score measurement) and Oswestry Disability Index (ODI), Patients Satisfaction measured by Modified Macnab Criteria at 6 months postoperative, Time of return to work, Recurrence or persistence of symptoms which need revision open surgery. Results: The mean age was 37.5 years, the mean operative time was 90 minutes, and the mean length of follow-up was 5 months. The mean hospital stay for endoscopic discectomy was 36 hours. There was a significant reduction in the severity of back pain and lower limb symptoms measured by (VAS) (ODI) in 87% (30 patients) at 6 months. The recurrence rate was 8.5% (3 patients) and persistent symptoms without improvement occurred in 5.7 % (2 patients) who subsequently underwent revision surgery. Most Patients returned to their previous occupation after surgery at a mean time of 35 days. Conclusion: Endoscopic discectomy by Destandau's technique for lumbar disc prolapse in properly selected patients was safe and minimally invasive technique.

Endoscopic Treatment of Lumbar DISC Prolapses with Posterior Approachs

Endoscopic Treatment of Lumbar DISC Prolapses with Posterior Approachs

Effect of spinal decompression therapy and core stabilization exercises in management of lumbar disc prolapse: A single blind randomized controlled trial.

Spinal decompression therapy (SDT) has recently been used as a conservative treatment for lumbar disc prolapse (LDP). The effectiveness of SDT when compared with other conservative techniques with a well-designed randomized controlled trials is lacking. To find the efficacy of SDT and core stabilization exercises (CSE) on pain and functional disability in individuals with chronic LDP, and to compare with CSE alone. This single blind randomized controlled trial included thirty-one participants with a mean age of 38.68 ± 8.79 having chronic LDP with or without radiating symptoms were included in the study. The study group received SDT with CSE and control group received CSE alone along with interferential therapy for both groups. Pain and disability were estimated by Numerical Rating Scale (NRS) and Modified Oswestry Questionnaire (mOQ). The results demonstrated significant within-group improvements in all outcomes in both groups, the mean differences between pre to post intervention in SDT with CSE group were (NRS: 4.75, t= 12.81, p⩽ 0.001) and (mOQ: 45.13, t= 29.34, p⩽ 0.001), while in CSE group (NRS: 2.60, t= 13.67, p⩽ 0.001) and (mOQ: 27.67, t= 24.52, p⩽ 0.001). A combination of SDT with CSE has proven to be more significant when compared with CSE alone to reduce pain and disability in subjects with chronic LDP.

Prevalence of hyperuricemia in patients of lower back pain at Dow University of Health Science Civil Hospital Karachi, Pakistan.

Objectives: In our study we evaluate the hyperuricemia levels in patients presenting to us with the chief complaint of chronic lower back pain and determine the associations with age, gender and radiographic findings. Study Design: Cross sectional study. Setting: Dow University of Health Science Civil Hospital Karachi. Period: From April 2017 to September 2017. Material & Methods: Patients with lower back pain of a duration longer than three months and between the ages of 18 and 70 years were included. A complete history and physical examination was done for all the patients including relevant laboratory, radiographic and anthropometric measurements. The neurosurgeon also assessed the patient’s lower back pain and associated findings in the lower limbs. The patients also underwent radiographic evaluations via X-rays and Magnetic resonance imaging. Data were analyzed using IBM SPSS statistical software version 20. We considered a p value of < 0.05 to be statistically significant. Results: The final study population consisted of n= 110 patients of which n= 54 were males and n= 56 were females. Of the total patient population of the study n= 31 (28.18%) had increased serum uric acid and had nearly equal incidence in males and females (27.77% and 28.57% respectively). The highest incidence of hyperuricemia was found patients between 26 and 60 years of age. In our study n= 22 patients did not have any comorbid condition while joint pain was found in n= 24 patients (p-value of <0.05) of these patients they suffered from pain in their knees and tarsal joints. Lumbar disc prolapse was found in n= 21 patients (p-value of <0.05), lumbar disc degeneration was found in n= 16 patients (p-value of <0.0579). Furthermore, disc space narrowing was found in n= 27 patients having a p-value of <0.05. Conclusion: According to the results of our study hyperuricemia is found in one of every four with low back pain. There is a variable association between comorbid conditions and hyperuricemia. While an equal association is found between gender and hyperuricemia. There is also a strong association of hyperuricemia with joint space narrowing and lumbar disc narrowing of the lumbar vertebrae and it augments degenerative spondylolisthesis.

Management of recurrent unilateral lumbar disc herniation in a single level: unilateral versus bilateral pedicle screws fixation with interbody fusion

BackgroundLumbar interbody fusion procedure is a recognized surgical technique in management of a variety of lumbar pathologies including recurrent lumbar disc prolapse. Interbody fusion augmented by pedicle screw fixation has been considered to improve fusion rates and clinical outcomes. Interbody fusion is commonly associated with better fusion potentials through applying the bone graft in the load bearing, vascular position of the anterior, and middle spinal columns. However, it still remains unknown whether interbody fusion with unilateral pedicle screw fixation (UPSF) is superior to that with bilateral pedicle screw fixation (BPSF).Aim of the workThe aim of this study is to evaluate the efficacy and safety of unilateral versus bilateral pedicle screw fixation associated with interbody fusion for the management of single level unilateral recurrent lumbar disc prolapse as regard the clinical and biomechanical results, operation time, intraoperative blood loss, and postoperative stay.Material and methodsThis observational prospective comparative study of the two groups who were operated either unilateral (group A /15 patients) or bilateral (group B/15 patients) pedicle screw fixation with interbody fusion was done. Patients were followed up for 1, 6, ad 12 months.ResultsSignificant improvement in functional outcome of the two groups was noted compared to preoperatively, except in early postoperative period where the back VAS and ODI in the unilateral group was better than bilateral group. However, on further follow up, no significant difference was noticed. There was no significant difference comparing fusion rate, complication rate, and duration of hospital stay between the two groups at postoperative follow-up. There was significantly less blood loss, and significantly shorter operation time in the unilateral PS fixation group as compared with the bilateral PS fixation group in our study.ConclusionOur study suggested that TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation for the management of recurrent single level lumbar disc prolapse; it showed better clinical outcome scores of ODI and back VAS, and a significant reduction of the intraoperative blood loss as well as the operation time, without significant differences considering fusion rate, complication rate, and duration of hospital stay between the two groups at postoperative follow-up. However, BPSF with TLIF likely causes more degeneration at the cranial adjacent segment compared with UPSF techniques. Nevertheless, the long-term follow up is required to demonstrate the impact of these findings.

Characteristics of Lower Back Pain in Pregnant Ladies in Thiqar-Iraq

Objectives: to evaluate the frequency of back pain among pregnant female in Thiqar province in Iraq and its demographic characteristics.Methodology: this is a case series descriptive study of one hundred pregnant female in Thiqar province in Iraq complaining from lower back pain in different stages of their pregnancies. the patients were evaluated firstly by history taking through questioner specially prepared for this study ;as well as; clinical and radiological assessment.Results: in our study seventy one patients experience back pain in different stages of pregnancy giving a (71%) as frequency of back pain in the studded group. Most of the patients Seventy four patients (74%) developed the pain during the first trimester of pregnancy and ( 22%) experience the pain during the second trimester. Fifty eight (14) patients (11.96%) gave history of previous back problems before pregnancy; of these; nine patients (7.69%) diagnosed before pregnancy as herniated lumbar disc prolapse and kept on medical treatment and physiotherapy, 2 patients (1.7%) with previous laminectomy surgeries for herniated lumbar disc prolapse, 3 patients (2.56) with diagnosis of degerative spine. One patient underwent cesarean section for sever back pain dueto lumbar disc prolapse at the end of the pregnancy period ( non-gynecological indication for cesarean section ).Conclusion: lower back pain is a common problem during pregnancy ,and it shows some common epidemiological characteristics.

Posterolateral fusion combined with posterior decompression shows superiority in the treatment of severe lumbar spinal stenosis without lumbar disc protrusion or prolapse: a retrospective cohort study

BackgroundCurrently, discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS). However, studies on severe LSS without protruded intervertebral disc to minimize study bias are lacking. We aimed to investigate the effectiveness of sole posterior decompression with lumbar posterolateral fusion (PLF) and the necessity of discectomy and CF in patients with severe LSS without lumbar disc protrusion or prolapse.MethodsThis retrospective cohort study included 153 severe LSS patients without lumbar disc protrusion or prolapse who were admitted in a tertiary spine center with at least a 2-year follow-up between January 2014 and August 2017. Patients were divided into the PLF (n = 77; those who underwent posterior decompression with PLF in 1–3 segments) or CF (n = 76; those who underwent posterior decompression and discectomy with CF in 1–3 segments) groups. Pedicle screw instrumentation was applied to avoid postoperative instability. Clinical outcomes were assessed by visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Score (JOA, lumbar pain score). Duration of operation, blood loss, surgical cost, and postoperative complications were analyzed. Height of intervertebral space, lumbar lordosis, and bone union were confirmed by lumbar radiography or computed tomography.ResultsBoth groups achieved significant improvement in JOA, ODI, and VAS compared with preoperative values (P < 0.001), but without significant difference between the two groups. Both groups achieved high fusion rate without difference and correction of lumbar lordosis and intervertebral space height (P < 0.001), especially in the CF group (P < 0.05). Duration of operation, blood loss, and operation cost were significantly higher in the CF group than in the PLF group (P < 0.001). Eight complications were found in both groups (1, PLF group; 7, CF group; P < 0.05).ConclusionsAfter posterior decompression, PLF successfully achieves bony fusion and symptom relief with lower complication rate, lesser surgical blood loss, shorter operative time, and lesser cost than CF. Thus, sole posterior decompression with PLF is an effective treatment for severe LSS without lumbar disc protrusion or prolapse.

Case Series-Intradural Disc in Recurrence of Lumbar Disc Prolapse and Review of Literature

Case Series-Intradural Disc in Recurrence of Lumbar Disc Prolapse and Review of Literature

Knowledge of lumbar disc prolapse among population of Saudi Arabia: a hospital-based study

Knowledge of lumbar disc prolapse among population of Saudi Arabia: a hospital-based study

Percutaneous endoscopic lumbar discectomy in the elderly: An effective treatment for prolapsed disc: Consideration on 75 case

Backgroundendoscopic spinal techniques are becoming widely used for lumbar disc prolapse treatment. The advantages are a milder invasivity, a shorter recovery time, lesser scar tissue formation, and the possibility to be performed under spinal or locoregional anesthesia. All of these make endoscopy suitable even in elderly patients with severe comorbidities. However, few studies have described outcomes of percutaneous endoscopic discectomy in the elderly. Here we describe and compare two prospectively collected cohorts of patients, an elderly (>75 years) and a younger one, to highlights outcomes differences between age groups. We then discuss our results with the outcomes of similar studies published in the literature. MethodsPatients older than 75 years, with a confirmed diagnosis of lumbar disc prolapse, treated by an endoscopic technique between January 2015 and June 2017, were prospectively enrolled (Group E). Clinical and demographic data were collected, as well as data on the postoperative Visual Analogue Scale and Oswestry Disability Index at 3, 6 and 18 months. We then analyze a prospectively collected cohort of younger patients (≤50 years, Group Y), to allow for comparison of postoperative results. ResultsPercutaneous endoscopic lumbar discectomy was successful in 89% of elderly patients after a median follow-up of 14 months, with half of the cases discharged home after a median time of 28 h. Only two surgical complications occurred. No differences in mean postoperative leg pain was found between the two groups. A significant higher number of medical complications was found in the elderly group compared to the younger ones, and more frequently in ASA 3 or 4 patients who underwent general anesthesia. ConclusionOur study suggests that percutaneous endoscopic lumbar discectomy is a safe and feasible procedure for disc prolapse treatment in elderly patients, especially if combined with spinal anesthesia.

Double Consecutive Lumbar Discectomy: Is Fixation a Rule?

Abstract Background: Lumbar Disc Prolapse (LDP) represents less than 5% of all low back problems. Most of cases treated with conservative management. Surgery is needed in only 10% of cases. We will evaluate the need for hardware fixation after double consecutive lumbar discectomies. Aim of Study: Our study aims to answer the question of whether decompression-only surgery is sufficient for patients with double consecutive lumbar disc prolapse or they neces-sarily require spinal fixation and fusion. Patients and Methods: Our work was conducted on 30 patients with double consecutive LDP from January, 2016 to December, 2017 at Fayoum University Hospital. Double consecutive lumbar discectomy was done in all patients. Regular follow-up was done up to 6 months. Results: All cases had no instability 6 months after surgery. Four patients experienced mechanical low back pain 3 months postoperatively. MR images revealed facet joint arthropathy in two cases improved by medical treatment and the others required facet joint injection. Conclusion: Double consecutive lumbar discectomy is not considered a risk of instability but larger studies might be needed.

Transcriptome signatures reveal candidate key genes in the whole blood of patients with lumbar disc prolapse.

The present study aimed to investigate differentially expressed genes (DEGs) in whole blood (WB) obtained from patients with lumbar disc prolapse (LDP) and healthy volunteers. A total of 8 patients with LDP and 8 healthy volunteers were recruited. An Agilent SurePrint G3 human gene expression microarray 8×60 K was used to perform the microarray analyses. R was employed to identify DEGs, which were then subjected to bioinformatics analysis, including a Gene Ontology (GO) analysis, Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway analysis and protein-protein interaction (PPI) network analysis. DEGs in the degenerative annulus fibrosis (AF) and nucleus pulposus (NP) compared with non-degenerative tissues were also identified based on microarray data and the intersections of the three were assessed. Furthermore, reverse transcription-quantitative (RT-q)PCR was performed to confirm the aberrant expression levels of selected DEGs in the WB of all subjects. A total of 161 DEGs between LDP patients and the healthy controls were identified (128 upregulated and 33 downregulated). These DEGs were enriched in 293 biological process, 36 cellular component and 21 molecular function GO terms, as well as in 24 KEGG pathways. The PPI network contained 4 submodules, and Toll-like receptor 4 had the highest degree centrality. A total of 22 DEGs were common to the three groups of DEGs. The RT-qPCR assay confirmed that the expression levels of cytochrome P450 family 27 subfamily A member 1, superoxide dismutase 2, protein disulfide isomerase family A member 4, FKBP prolyl isomerase 11 and ectonucleotide pyrophosphatase/phosphodiesterase 4 were significantly different between the patient group and the volunteer group. In conclusion, several genes were identified as potential biomarkers in WB that should be further explored in future studies to determine their potential application in the clinical treatment and diagnosis of LDP, and the present bioinformatics analysis revealed several GO terms, KEGG pathways and submodules of the PPI network that may be involved in LDP, although the exact mechanisms remain elusive.

Risk Factors and Surgical Treatment for Recurrent Lumbar Disc Prolapse: A Review of the Literature.

We aim to present the current evidence on various risk factors and surgical treatment modalities for recurrent lumbar disc herniation (rLDH). Using PubMed, a literature search was performed using the Mesh terms “recurrent disc prolapse,” “herniated lumbar disc,” “risk factors,” and “treatment.” Articles that were published between January 2010 and May 2017 were selected for further screening. A search conducted through PubMed identified 213 articles that met the initial screening criteria. Detailed analyses showed that 34 articles were eligible for inclusion in this review. Sixteen articles reported the risk factors associated with rLDH. Decompression alone as a treatment option was studied in seven articles, while 11 articles focused on different types of fusion surgery (anterior lumbar interbody fusion, posterior lumbar interbody fusion, open transforaminal lumbar interbody fusion [TLIF], and minimally invasive surgery-TLIF). Management of the rLDH requires consideration of the possible risk factors present in individual patients before primary and at the time of second surgery. Both, minimally invasive and conventional open procedures are comparably effective in relieving leg pain, and minimally invasive techniques offer advantage over the other technique in terms of tissue sparing. Non-fusion surgeries involve the risk of lumbar disc herniation re-recurrence, and the patient may require a third (fusion) surgery.

Multilevel Unilateral Pedicular Screw Fixation with Interbody Fusion in Surgery of Double- and Triple-Segment Lumbar Disc Pathology

Background Data: In double- and triple-segment lumbar disc herniation, a facet hypertrophy is more encountered specially in the same side of disc herniation with subsequent ipsilateral concave curve scoliosis. Lumbar fixation with interbody fusion surgery is a scientific and feasible option. Some authors believe that unilateral pedicle screw fixation can provide similar biomechanical support to the traditional bilateral pedicle screw fixation. Purpose: To assess the strategy of use of unilateral pedicle screw fixation with lumbar interbody fusion in surgical treatment of multilevel (2-3) symptomatic lumbar disc herniation syndromes. Study Design: Retrospective observational analytic study. Patients and Methods: Retrospective evaluation of 216 patients' files who underwent unilateral pedicular screws fixation for management of degenerative lumbar disc pathology, from July 2007 to June 2017. Only 24 patient’s files were selected with multilevel symptomatic lumbar disc prolapse who were managed by unilateral pedicular screw fixation with interbody fusion. All patients were presented with symptoms of nerve root compression. Patients' data included age, gender, levels of disc prolapse, preoperative and postoperative Visual Analogue Scale (VAS) for back and leg and Oswestry Disability Index (ODI) for functional outcome, presence of complications, and finally patients’ satisfaction according to Odom’s criteria. VAS and ODI were retrieved preoperatively, immediately postoperatively, and 6 months postoperatively. Results: They were 18 males (75%) and 6 females (25%) with a male-to-female ratio of 3:1 and age ranging 35–63 years with a mean age of 49±9.8 years. Double-level disc prolapse was recorded in 20 (83.3%) patients, while it was triple in 4 cases (16.7%). At the last follow-up, back pain VAS improved from 7.5±1.47 to 1.12±1.03, leg pain VAS from 8.7±1.04 to 0.33±0.63, and ODI from 78±8.3 to 11.08±4.6. Excellent and good Odom’s outcomes were reported in 95% of our patients. Conclusion: Our study suggests that unilateral pedicular screw fixation with interbody fusion for the management of multiple level ipsilateral lumbar disc disease could be considered as an effective and less invasive method with satisfying clinical outcomes. (2019ESJ191)