Background: Upper lumbar disc herniations (ULDHs) are rare and present significant technical challenges due to the inability to retract the conus medullaris. Here, we reviewed our outcomes treating 62 patients with L1-2-disc herniations with open laminectomy/microdiscectomy (OLM) without fusion. Methods: Between 2005 and 2022, we performed 62 OLM procedures at the L1–2 level without fusion. Our analysis included demographic characteristics and outcomes assessments (Visual Analog Scale leg pain, Modified Japanese Orthopaedic Association score), plus 1-year postoperative dynamic X-rays to confirm stability. Results: L1-2-disc herniations occurred in 0.9% out of a larger series of lumbar discs we reviewed. Patients’ presenting symptoms typically included back (95%)/leg pain (82%), cauda equina symptoms/signs (64%), and neurogenic claudication (45%); more than 50% of patients had been symptomatic for over 1 year. Postoperatively, no discs recurred, and patients exhibited neither clinical nor radiological symptoms/signs of instability. Conclusion: The OLM technique for removal of L1-2 lumbar disc herniations resulted in adequate outcomes without evidence of spinal instability.

Lumbar disc herniation (LDH) is a primary cause of radiculopathy, a prevalent and debilitating neurological condition characterized by nucleus pulposus (NP) extrusion from the intervertebral disc (IVD), leading to the compression of nearby neural structures and causing neuropathic pain and neurological deficits. The pathophysiology of LDH involves progressive IVD degeneration, triggered by the accumulation of mechanical stress, inflammatory processes, and oxidative stress, leading to cellular damage, disc cell apoptosis, and extracellular matrix degradation. Clinically, LDH patients typically present with radicular pain, neurological deficits, and symptoms of sciatica, which may vary in intensity depending on the level and extent of the herniation. Diagnosis relies on clinical correlation and imaging studies, with magnetic resonance imaging as the gold standard. Treatment for a herniated NP depends on the symptoms and severity of nerve compression. Without severe or progressive neurological deficits, first-line treatment includes conservative management. Surgery is indicated when there is significant nerve compression, refractory pain, or progressive neurological deficits. This comprehensive review focuses on LDH, aiming to provide a neurologically oriented appraisal. First, it delves into the pathomechanism of LDH, offering updated insights into the biological and biomechanical processes that lead to disc herniation and subsequent nerve involvement. Second, it examines current diagnostic approaches, including advanced imaging techniques and neurological assessment methods, used to accurately identify and characterize LDH. Finally, it explores the evolving spectrum of management strategies, encompassing conservative treatments and various interventional and surgical options, with a particular emphasis on the neurological outcomes and considerations associated with each approach.

Objective: To address the insufficient integration of theory and practice in surgical clinical clerkship teaching, the limited availability of authentic clinical cases, and the limitations of traditional standardized patients (SPs) in terms of consistency and organizational cost, this study aimed to develop an artificial intelligence-based standardized patient (AI-SP) teaching framework grounded in structured clinical case data. Lumbar disc herniation was used as a representative condition for application and exploratory implementation. Methods: An exploratory teaching application design was adopted. Based on the learning objectives of the lumbar disc herniation chapter in standard surgery textbooks, a layered AI-SP system was developed, comprising a case data layer, a clinical rules and teaching logic layer, and an AI interaction layer. Clinical case data were derived from a single-center spine surgery practice and were de-identified and structured into teaching-oriented data units. Diagnostic and therapeutic principles from textbooks, together with expert consensus and clinical guidelines, were abstracted into rule constraints and scenario evolution logic. The interaction layer employed a large language model to support multi-turn dialogue, with standardization ensured through role restriction, rule-based control, and consistency validation. The system was embedded into three stages of clerkship teaching—pre-clerkship preparation, in-clerkship guidance, and post-clerkship consolidation—and representative interaction workflows were developed. Results: A layered AI-SP architecture and information flow model tailored for surgical clinical clerkship teaching was established. Under predefined rule constraints, the system was able to generate stable patient narratives consistent with textbook content and clinical reasoning, enabling reproducible and controllable standardized teaching scenarios. An exploratory application suggested that the AI-SP facilitated the formation of a more structured disease understanding before students entered real clinical settings, improved the consistency and focus of clerkship discussions, and supported repeated practice under conditions of limited clinical resources. Quantitative evaluation of learning outcomes was not conducted in this study. Conclusion: The AI-SP framework, developed using artificial intelligence and structured clinical case data, may serve as an auxiliary tool for surgical clinical clerkship teaching by providing a controlled and standardized interactive training environment without replacing students’ clinical judgment. Future studies should incorporate multicenter case data and employ controlled designs with quantitative outcome measures to systematically evaluate the educational effectiveness.

Radiographic Predictors of Lumbar Disc Re-Herniation Requiring Repeat Discectomy or Fusion - A Matched Retrospective Cohort Analysis.

Full-endoscopic versus microscopic spinal decompression for lumbar disc herniation: a meta-analysis of 20 cohort studies.

Sarcopenia and malnutrition in children with extrahepatic portal vein obstruction.

The role of collagen pathologies and ligamentous laxity in lumbar disc herniation and its recurrence: a systematic review and meta-analysis.

Objective: Lumbar discectomy is one of the most frequently undertaken procedures for the management of lumbar disc herniation. However, it may be complicated by recurrent disc herniation, with reported rates as high as 25%. To the authors’ knowledge, this study is the largest systematic review to date, analyzing the clinical and radiographic risk factors for recurrent disc herniation.Methods: A systematic literature search of Embase and PubMed/Medline, covering the period from inception to October 1, 2025, was conducted to identify case-control or cohort studies reporting risk factors for recurrent disc herniation. Risk factors were classified into baseline, clinical, and radiographic risk factors. Meta-analysis was performed for any reported risk factor with data from 3 or more studies. The assessment included an evaluation of publication bias and heterogeneity.Results: A total of 51 studies published during the search timeframe, comprising 52,479 patients, met the inclusion criteria. Recurrent disc herniation occurred in 6,794 patients (12.9%). Significant risk factors for disc herniation included high body mass index (BMI) (standard mean difference [SMD], 0.48; 95% confidence interval [CI], 0.26–0.70), diabetes (odds ratio [OR], 1.48; 95% CI, 1.23–1.77), increased sagittal range of motion (SMD, 2.15; 95% CI, 0.35–3.94), and Modic changes (OR, 2.97; 95% CI, 2.20–4.01). No other significant predictors for recurrent disc herniation were identified.Conclusion: In conclusion, patients with high BMI, diabetics, increased sagittal range of motion, and presence of Modic changes are at increased risk of recurrent disc herniation. Future prospective studies are needed to validate the risk factors identified in this study associated with recurrent disc herniation.

Interpretable prediction of prolonged length of stay for patients undergoing lumbar disc herniation surgery based on machine learning and SHAP.

Traditional Chinese medicine (TCM) is widely used in managing lumbar disc herniation (LDH), but heterogeneous outcome reporting in its trials hinders evidence synthesis. This study intends to develop a core outcome set (COS) for TCM-LDH to standardize reporting and improve research quality. Candidate outcomes were identified via a systematic review of TCM-related randomized controlled trials (RCTs) for LDH, with studies retrieved from multiple databases between January 1 2019 and December 31 2023 and supplemented by clinical trial registry searches. Semistructured interviews with LDH patients and clinician questionnaires were conducted to refine candidate outcomes. Two Delphi rounds were carried out among clinicians, pharmaceutical researchers, journal editors, methodologists, and patients, followed by an online-offline consensus meeting to finalize the COS. A candidate outcome pool was established via a systematic review (413 RCTs, 51 registered studies), 30 LDH patient interviews, and 73 clinician surveys. After integration, deduplication, and steering committee refinement, two rounds of Delphi surveys were conducted. Following a consensus meeting attended by 24 multidisciplinary experts, 7 core outcomes were finalized for LDH: lumbar dysfunction, pain/discomfort, recurrence rate, straight leg raise angle, adverse reactions/adverse events, TCM syndromes, and sciatica frequency. The developed COS for TCM-related LDH clinical trials provides standardized recommendations for outcome selection and reporting, which can enhance the consistency of research evidence, facilitate meta-analysis, and ultimately advance the quality of TCM-based interventions for LDH.

Prospective single-center observational cohort study. To assess whether prior arthroscopic experience is associated with a shorter learning curve in uniportal interlaminar endoscopic lumbar discectomy (IELD), primarily in terms of operative efficiency, and to descriptively evaluate perioperative complications and patient-reported outcomes. In accordance with STROBE guidelines, 240 consecutive patients with single-level lumbar disc herniation (MSU A/B, non-calcified, symptom duration ≤ 3 months) underwent IELD between 2021 and 2023 at a single academic orthopedic center. Procedures were performed by three spine surgeons without prior endoscopic experience; one surgeon had performed more than 300 shoulder arthroscopies. Operative time was analyzed using cumulative sum (CUSUM) methodology and linear regression. Missing outcome data were handled using last observation carried forward. Complications were recorded descriptively and stratified by learning phase and surgeon. Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain were assessed preoperatively and at 3 and 12 months. All surgeons demonstrated a three-phase learning curve consisting of learning, improvement, and stabilization phases. Operative efficiency stabilized after approximately 50 cases across surgeons. The surgeon with prior arthroscopic experience reached the CUSUM inflection point earlier (case 12) compared with the other surgeons (cases 24-26). The overall major complication rate was 9.2% and was highest during the initial learning phase. ODI and VAS scores improved significantly at 3 and 12 months (all p < 0.001), with no statistically significant between-surgeon differences at final follow-up. Prior arthroscopic experience was associated with earlier adaptation during the initial learning phase of IELD, as measured by operative time. Following procedural stabilization, no statistically significant differences were detected in operative efficiency, major complication rates, or patient-reported outcomes between surgeons. These findings suggest that arthroscopic experience may facilitate early adaptation to endoscopic visualization and workflow but does not independently determine long-term clinical outcomes. III.

Letter to the Editor: analysis of cost differences between comparing Percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopy (UBE) in the treatment of lumbar disc herniation under diagnosis-related group (DRG) payment - a retrospective cohort study.

This study is devoted to developing a nomogram predicting the achievement of minimal clinically important difference (MCID) in patients with lumbar disc herniation (LDH) following percutaneous endoscopic lumbar discectomy (PELD). The patients involved were followed up for at least 2years. Univariate logistic analysis and multivariable logistic regression were applied for identifying factors significantly influencing the achievement of MCID. Based on the selected factors, a nomogram was developed using R (v4.4.2). Discriminative ability, calibration, and clinical utility of the nomogram were evaluated by receiver operating characteristic curve (ROC), calibration curve, and decision curve analysis (DCA), respectively. The study involved 442 patients, of which 23 (5.20%) failed to achieve the MCID. The statistical analysis identified the baseline Visual Analog Scale (VAS) score, presence of Lasegue's sign, and fat infiltration rate (FIR) of the multifidus muscle as independent risk factors. The nomogram showed good discrimination in development (AUC 0.84, 95% CI 0.73-0.95) and internal validation (AUC 0.88, 95% CI 0.69-0.98). Calibration was assessed by Hosmer-Lemeshow test and calibration curves, with p-values of 0.536 (development) and 0.369 (internal validation), and mean absolute errors (MAE) found (development) and 0.026 (internal validation). Decision curve analysis suggested positive net benefit across threshold probabilities of ~ 52-98% (development) and > 68% (internal validation). Baseline VAS scores, presence of Lasegue's sign, and FIR of multifidus muscles are predictive factors for achieving the MCID in patients undergoing PELD. The study developed and validated a nomogram that can predict the achievement of MCID following PELD by assessing preoperative risk factors in patients with lumbar disc herniation.

Objective Lumbar disc herniation (LDH) has demonstrated a rising prevalence in contemporary clinical practice, significantly compromising patients’ daily lives and potentially necessitating surgical intervention. While annulus fibrosus suture (AFS) techniques are increasingly incorporated into surgical protocols, current evidence remains inconclusive regarding their definitive clinical advantages. Methods We performed a comprehensive search of eight databases from inception to September 2025 to identify published articles on AFS for LDH. Outcome measures encompassed operative time, incision length, blood loss, length of stay (LOS), visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, disc height, recurrence, and complication. The quality of the studies was analyzed using the RoB-2 and ROBINS-I tools. Statistical analyses were performed using RevMan 5.4 software and Stata 17 software. The GRADE approach was used to evaluate the certainty of evidence for outcomes. Results A total of 58 studies encompassing 5,765 patients diagnosed with LDH. The control group had shorter operative time (MD = 4.85, 95% CI: 2.79 to 6.92, P &amp;lt; 0.00001) compared to the AFS group. There were no differences in terms of incision length, blood loss, LOS, JOA score, ODI score, and complication between the techniques. AFS group demonstrated a significant benefit over control group in terms of VAS score (MD = −0.24, 95% CI: −0.33 to −0.14, P &amp;lt; 0.00001), disc height (SMD = 1.36, 95% CI: 0.73 to 2.00, P &amp;lt; 0.0001), and recurrence (RR = 0.34, 95% CI: 0.27 to 0.42, P &amp;lt; 0.00001). The results of subgroup analysis showed that different study types and different follow-up times were a source of heterogeneity. The quality of evidence for outcome measures ranges from very low to moderate. Conclusion Current evidence suggests that AFS therapy may be advantageous in improving clinical symptoms and may reduce postoperative recurrence. Due to limited data and low quality of evidence, additional large-scale, multicenter trials are needed to verify and strengthen these findings.

Background This study aimed to determine the impact of discectomy on back pain and to identify the factors associated with back pain improvement. Methods A retrospective analysis was conducted on patients with lumbar disc herniation who underwent lumbar microdiscectomy at Fujian Medical University Union Hospital. Visual Analogue Scale (VAS) scores for back and leg pain were assessed before and after the tubular lumbar microdiscectomy. Results A total of 111 patients were included in this study. Pre- and post-operative VAS scores for back pain were 4.86 and 2.59, respectively. For radicular leg pain, pre- and post-operative VAS scores were 4.86 and 2.59, respectively. Univariate and multivariate analyses showed that the preoperative lumbar VAS score was significantly associated with improvement in back pain after tubular discectomy. Conclusion Tubular microdiscectomy significantly alleviated back pain symptoms in patients with lumbar disc herniation. The findings of this study may help spine surgeons in better educating patients regarding post-operative expectations following this surgical procedure.

Unilateral Percutaneous Transforaminal Endoscopic Approach With Bilateral Decompression for Large Central Lumbar Disc Herniation Complicated by Bilateral Neurological Symptoms: A 2-Year Retrospective Clinical Study

Risk factors and surveillance for post discharge surgical site infections: A prospective analysis.

Efficacy and safety of unilateral biportal endoscopy vs. percutaneous endoscopic interlaminar approach in lumbar disc herniation: A meta‑analysis​

Introduction Chronic sciatica, frequently attributable to lumbar disc herniation, imposes substantial burdens on patients’ quality of life and healthcare systems. Conventional interventions, including pharmacotherapy and physical therapy, are widely employed yet constrained by limited efficacy, necessitating the exploration of complementary modalities such as acupuncture. This systematic review and meta-analysis synthesizes evidence from randomized controlled trials (RCTs) published over the past decade (2015.05 – 2025.05) to evaluate the efficacy of acupuncture in alleviating leg pain intensity and improving functional mobility outcomes among patients with chronic sciatica. Methods We searched four databases (PubMed, EMBASE, Cochrane Library, Web of Science) for RCTs on acupuncture versus control (sham acupuncture, standard care, or conventional acupuncture). Studies included adults with sciatica from herniated disks, assessed via VAS for pain and ODI for function. Data were pooled using random-effects models with subgroup analyses for heterogeneity. Bias risk was assessed with the Cochrane tool. Results Eleven RCTs ( n = 868 participants, predominantly from China) were included. The results demonstrated that acupuncture significantly reduced leg pain VAS scores compared with those of controls (SMD = –1.08, 95% CI: –1.41 to –0.75), with consistent efficacy across the sham acupuncture (SMD = –1.05), standard care (SMD = –1.02), and conventional acupuncture (SMD = –1.12) subgroups. Acupuncture also improved functional disability (ODI: SMD = –0.57, 95% CI: –0.84 to –0.31; 7 studies, n = 621). The results indicate both statistical significance and clinical relevance, supporting acupuncture as an effective intervention. Discussion Acupuncture effectively alleviates pain and aids functional recovery in chronic sciatica, highlighting its role in multidisciplinary pain management. However, methodological limitations in the extant literature necessitate cautious interpretation, and future high-quality RCTs are warranted to strengthen evidence-based clinical implementation. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251067853 , identifier (CRD420251067853).

This study investigated the direct (cigarette smoke extract, CSE) and indirect (low nutrient) effects of cigarette smoking on intervertebral disc cell energy metabolism, with a focus on glucose consumption and lactate production in lumbar discs. Lumbar IVDs from Sprague-Dawley rats were harvested and dissected into nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous endplate (CEP) regions. Minced tissue cultures from each region were exposed to physiological control (5.5mM glucose, 5% oxygen), CSE-treated (physiological + 10% CSE), or low-nutrient conditions (1.5mM glucose, 1% oxygen). Glucose consumption rates (GCR) and lactate production rates (LPR) were measured using a biochemical analyzer. A finite element model was developed to simulate nutrient transport and adenosine triphosphate (ATP) synthesis in the IVD under experimental conditions. Both CSE and low-nutrient conditions significantly reduced GCR and LPR in AF and NP, where NP cells exhibited the greatest metabolic activity. Low-nutrient conditions increased the LPR:GCR ratio, indicating an increase in glycolysis. CEP metabolism was marginally impacted by treatments. Computational modeling revealed that CSE conserved oxygen but reduced ATP synthesis, while low-nutrient conditions severely depleted glucose, oxygen, and ATP. Combined effects of CSE and nutrient deprivation exacerbated the reduction in ATP availability. Cigarette smoking impairs IVD cellular energy metabolism through both direct toxic exposure and indirect nutrient deprivation mechanisms, with the modeled low-nutrient conditions having a more pronounced effect. The NP is the most metabolically sensitive region in the IVD, while the CEP is more resilient to fluctuations with its environment. These findings provide insights into IVD metabolic adaptations to smoking.