Lumbar Disc Herniation Research Articles

Minimally invasive far lateral tubular microdiscectomy: surgical technique and case series of 176 patients.

Far lateral (extraforaminal) disc herniations comprise approximately 10% of symptomatic lumbar disc herniations. They represent operative challenges due to accessibility and surgical unfamiliarity. Surgical strategies in the past have included open discectomy and posterior lumbar interbody fusion. Tubular microdiscectomies have gained traction due to their minimally invasive advantages, including reduced morbidity, pain and length of hospital stay. We report our retrospective single institution consecutive case series of tubular far lateral microdiscectomies. One hundred and seventy-six patients were operated on over an eight-year period. Clinical outcomes were assessed after institutional ethics approval. We additionally describe our surgical technique with an illustrative video case. Over a mean follow-up of 21 weeks, 77% of patients had good or excellent clinical outcomes according to the MacNab criteria. 12% of patients underwent reoperation at the index level for symptom recurrence or persistence. Mean length of hospital stay was 1.3 days. There was a 1% rate of both postoperative haematoma and infection. Mean operation duration was 86minutes. This case series represents the largest currently reported in the literature. Minimally invasive microdiscectomies performed through tubes allow for precise localisation, reduced tissue disruption and favourable clinical outcomes. Our results appear consistent with a review of the literature, demonstrating the safety and efficacy of this approach.

97. Efficacy and safety of SI-6603 (condoliase) in radicular leg pain associated with lumbar disc herniation: results from two phase 3, randomized, double-blind controlled trials

97. Efficacy and safety of SI-6603 (condoliase) in radicular leg pain associated with lumbar disc herniation: results from two phase 3, randomized, double-blind controlled trials

P55. The power of radiomics: machine learning predicts MRI features of resorption of the lumbar disc herniation

P55. The power of radiomics: machine learning predicts MRI features of resorption of the lumbar disc herniation

P294. Surgery for lumbar disc herniation: surgeon's clinical judgment versus actual improvement in patient reported outcomes

P294. Surgery for lumbar disc herniation: surgeon's clinical judgment versus actual improvement in patient reported outcomes

Vascular loops mimicking herniated lumbar discs: fair warning.

The authors report their experience with twenty-one consecutive patients who presented with symptoms and imaging characteristics of a herniated lumbar disc; of whom, at the time of surgery had a vascular loop instead. The procedure was performed on 14 women and seven men with a mean age of 39years. Clinical complaints included lumbar aching with one limb overt radiculopathy in all patients; with additional sphincter dysfunction in two cases. Symptoms had developed within a mean period of three months. In all patients, the disc was exposed through an L5-S1 (n = 10); L4-L5 (n = 5) and L3-L4 (n = 6) open minimal laminotomy. In 16 patients, rather than a herniated disc they had a lumbar epidural varix, while an arterio-venous fistula was found in the remaining five cases. In all cases, the vascular disorder was resected and its subjacent disc was left intact. One patient had a postoperative blood transfusion. While the radiculopathy dysfunction improved in all patients, four patients reported lasting lumbar pain following surgery. The postoperative imaging confirmed the resolution of the vascular anomaly and an intact disc. The mean length of the follow-up period was 47months. Either epidural varix or arterio-venous fistula in the lumbar area may mimic a herniated disc on imaging studies. With the usual technique they can be operated safely. Resection of the anomaly can be sufficient for alleviating radiculopathy symptoms.

Characteristics in patients with very early therapeutic response of condoliase chemonucleolysis for lumbar disc herniation.

Treatment of lumbar disc herniation (LDH) using condoliase chemonucleolysis (CC) requires more time than surgery to demonstrate therapeutic effects. This study aimed to identify patients who show significant improvement in leg pain very early after CC and to determine pretreatment factors that can predict a very early therapeutic response. The study included 52 patients who underwent CC for treatment-resistant LDH. Scores for low back and leg pain measured by a numerical rating scale were assessed at four time points (1day, 1 week, 1 month, and 3 months after CC). Patients who reported subjective pain relief the day after treatment and further exhibited an improved straight leg raising (SLR) angle compared to pretreatment were classified as "very early responders (VER)". Of the 52 patients, 39 (75%) were VER, and 13 (25%) were non-VER. The VER showed earlier improvement in leg pain. The VER had a significantly higher proportion of positive SLR test patients (p = 0.01) and a significantly smaller pretreatment SLR angle compared to the non-VER (VER vs. non-VER: 40.6 ± 19.0 vs. 63.1 ± 16.9, p < 0.001). There were no significant differences in the level, type, and size of LDH and the disc regression rate between the two groups. Patients with a smaller pretreatment SLR angle are more likely to experience very early or early symptomatic relief, with a significant and sustained reduction in leg pain up to 3 months after CC treatment.

Transforaminal lumbar endoscopic discectomy: should we abandon it for L5-S1 foraminal and extraforaminal lumbar disc herniations? A prospective non-randomised study and literature review

Purpose The aim of this study is to investigate the clinical outcomes of transforaminal lumbar endoscopic discectomy (TLED) in patients with L5-S1 lumbar disc herniation (LDH). Materials and methods Seventy-five consecutive individuals with diagnosed foraminal/extraforaminal L5-S1 LDH were included in this study. All patients underwent TLED, being subsequently evaluated in a 2-year follow-up period. Assessment was performed preoperatively and at 6 weeks and 3, 6, 12 and 24 months postoperatively. Visual Analogue Scale (distinctly applied for lower limb – VAS-LP and low back – VAS-BP pain) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire were implemented to assess pain and health-related quality of life (HRQoL) of enrolled individuals, respectively. Results No major perioperative complications were observed. Recorded values of all studied indices were demonstrated to feature a clinically and statistically significant amelioration at 6 weeks, presenting lesser improvement at 3 months with subsequent stabilisation. VAS-LP and VAS-BP values were displayed to reach a plateau in 6 months postoperatively, whereas all parameters of SF-36 continued to present a statistically significant improvement until the end of follow-up at 2 years. Conclusions TLED represent a safe and efficient technique in terms of diminishing perceived pain and improving HRQoL in patients with L5-S1 LDHs. However, specific patient- and technique-related circumstances on the ground of low surgical experience may limit its effectiveness in these patients.

Biomechanical Study of Symmetric Bending and Lifting Behavior in Weightlifter with Lumbar L4-L5 Disc Herniation and Physiological Straightening Using Finite Element Simulation.

Physiological curvature changes of the lumbar spine and disc herniation can cause abnormal biomechanical responses of the lumbar spine. Finite element (FE) studies on special weightlifter models are limited, yet understanding stress in damaged lumbar spines is crucial for preventing and rehabilitating lumbar diseases. This study analyzes the biomechanical responses of a weightlifter with lumbar straightening and L4-L5 disc herniation during symmetric bending and lifting to optimize training and rehabilitation. Based on the weightlifter's computed tomography (CT) data, an FE lumbar spine model (L1-L5) was established. The model included normal intervertebral discs (IVDs), vertebral endplates, ligaments, and a degenerated L4-L5 disc. The bending angle was set to 45°, and weights of 15 kg, 20 kg, and 25 kg were used. The flexion moment for lifting these weights was theoretically calculated. The model was tilted at 45° in Abaqus 2021 (Dassault Systèmes Simulia Corp., Johnston, RI, USA), with L5 constrained in all six degrees of freedom. A vertical load equivalent to the weightlifter's body mass and the calculated flexion moments were applied to L1 to simulate the weightlifter's bending and lifting behavior. Biomechanical responses within the lumbar spine were then analyzed. The displacement and range of motion (ROM) of the lumbar spine were similar under all three loading conditions. The flexion degree increased with the load, while extension remained unchanged. Right-side movement and bending showed minimal change, with slightly more right rotation. Stress distribution trends were similar across loads, primarily concentrated in the vertebral body, increasing with load. Maximum stress occurred at the anterior inferior margin of L5, with significant stress at the posterior joints, ligaments, and spinous processes. The posterior L5 and margins of L1 and L5 experienced high stress. The degenerated L4-L5 IVD showed stress concentration on its edges, with significant stress also on L3-L4 IVD. Stress distribution in the lumbar spine was uneven. Our findings highlight the impact on spinal biomechanics and suggest reducing anisotropic loading and being cautious of loaded flexion positions affecting posterior joints, IVDs, and vertebrae. This study offers valuable insights for the rehabilitation and treatment of similar patients.

Conservative combination therapy of sciatica due to lumbar disc herniation with mechanical physiotherapy (McKenzie), gabapentin, and transforaminal epidural injections

Treatment of sciatica due to lumbar disc herniation can be surgical or conservative. Conservative management has been described to be effective in 90% of patients; however, in most studies no consistent treatment concept was used. In the present study, we evaluated the effect of acombined nonsurgical management (McKenzie physiotherapy, gabapentin, and periradicular injections) in 40patients during a10-day inpatient treatment. In addition to the neuro-orthopedic examination, pain severity at rest and after walking were assessed. The Oswestry pain disability scale, the pain severity scale, and the painDETECT scale were examined to assess neuropathic pain components. The duration of incapacity for work and the requirement of alater surgery were recorded. Examinations were performed on the day of admission, on days3, 6, 10, and84, 3months after discharge. During conservative treatment, acontinuous reduction of pain and an improvement of the straight leg raise test as well as finger-to-floor distance could be documented. As the three treatment options were introduced with atime delay, it could be demonstrated that all significantly contributed to the improvement. All treatments were tolerated without side-effects and persistent improvement after 12weeks. On admission, 32% of patients revealed aneuropathic pain component which decreased to 7% at the follow-up. A total of 28patients showed impaired muscle strength on admission, which decreased to 7patients on follow-up. Electromyography revealed pathological results in 70% of patients examined. Asignificant improvement of quality of life (Oswestry Disability Index [ODI]) could be observed and the patients returned to work after 5.8weeks. Only 3/40patients required surgical management due to persistent pain. The combined nonsurgical operative treatment program is effective and well tolerated.

Radiofrequency ablation of superior hypogastric ganglion and dorsal root ganglion reduces neuropathic pain in L5-S1 disc anterior protrusion: a case report

Approximately 36%-55% of patients with chronic low back pain (LBP) have neuropathic pain syndrome. Prescription of adjuvant analgesics or antidepressants is effective in reducing pain but requires special attention. A female patient, 57 y, presented with complaints of LBP for 5-7 days. Pain was spread bilateral in the hips-groin, as well as to the fingers and soles (NRS 6-8, PainDETECT 35). She had history of falls 10 y ago, but still worked for 5 hours daily. She had allodynia, dysesthesia, hyperalgesia, and L4-5 and L5-S1 hypesthesia. Magnetic resonance imaging (MRI) showed postero-central and lateral bulged L4-5 and L5-S1 discs. Radiofrequency ablation (RFA) 70o of superior hypogastric ganglion for 90 sec, and pulsed radiofrequency (PRF) 42o of dorsal root ganglion (DRG) L4-5, L5-S1 bilaterally for 2 min reduced nociceptive pain (NRS 2-3) and neuropathic pain (PainDETECT 12). Post-surgical medication included levofloxacin, gabapentin, paracetamol, amitriptyline and Vitamin B12. The sympathetic ganglia supply the anterior segments of the lumbar vertebrae and the anterior longitudinal ligament, often overlooked as a cause of pain. The management of LBP patient depends upon the etiology, whether associated to structural abnormalities or nerve dysfunction. Keywords: anterior disc herniation, dorsal root ganglion, lumbar disc herniation, neuropathic pain, superior hypogastric ganglion, radiofrequency Citation: Budisulistyo T. Radiofrequency ablation of superior hypogastric ganglion and dorsal root ganglion reduces neuropathic pain in L5-S1 disc anterior protrusion: a case report. Anaesth. pain intensive care 2024;28(4):757−761; DOI: 10.35975/apic.v28i4.2523 Received: August 02, 2023; Reviewed: December 26, 2023; Accepted: December 26, 2023

Modic changes in patients with lumbar disc herniation followed more than 1 year after lumbar discectomy: a systematic review and meta-analysis.

Modic changes (MCs) are identified as an independent risk factor for low back pain. Different subtypes of MCs vary in their impact on postoperative pain relief. However, consensus on the transformation of postoperative MC fractions in patients with distinct MC subtypes is lacking. This comprehensive systematic review and meta-analysis searched English-language articles in PubMed, Cochrane Library, Web of Science, and Embase databases until January 2024. Studies included focused on patients transitioning between various microcrack subtypes post-discectomy. The primary outcome measure was the transformation between different postoperative microcrack fractions. Eight studies with 689 participants were analyzed. Overall, there is moderate to high-quality evidence indicating differences in the incidence of MC conversion across MC subtypes. The overall incidence of MC conversion was 27.7%, with rates of 37.0%, 20.5%, and 19.1% for MC0, MC1, and MC2 subtypes, respectively. Thus, postoperative MC type transformation, particularly from preoperative MC0 to MC1 (17.7%) or MC2 (13.1%), was more common, with MC1 transformation being predominant. Patients with preoperative comorbid MC1 types (19.0%) exhibited more postoperative transitions than those with MC2 types (12.4%). This study underscores the significance of analyzing post-discectomy MCs in patients with lumbar disc herniation, revealing a higher incidence of MCs post-lumbar discectomy, particularly from preoperative absence of MC to MC1 or MC2. Preoperative MC0 types were more likely to undergo postoperative MC transformation than combined MC1 or MC2 types. These findings are crucial for enhancing surgical outcomes and postoperative care.

The Influence of Adolescent health-related Behaviors on Degenerative Low Back Pain Hospitalizations and Surgeries in Adulthood: A Longitudinal Study.

Retrospective longitudinal study. This study aims to investigate the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on the development of low back pain requiring hospitalization or surgery. The baseline data were surveys gathered biennially in 1981-1997 (the Adolescent Health and Lifestyle Survey) and individually linked with outcome data, degenerative low back pain hospitalizations, and spine surgeries retrieved from the Care Register for Health Care. A total of 47 724 participants were included. Explanatory variables included physical activity, high BMI, smoking, monthly drunkenness, chronic diseases, and family SES. A logistic regression model was used to analyze the influence of adolescent health-related behaviors (physical activity, high BMI, drunkenness, smoking), self-reported chronic disease, and low socioeconomic status (SES) on degenerative low back pain hospitalization, lumbar disc herniation (LDH) hospitalization and/or spine surgery. Covariates were selected using directed acyclic graphs (DAGs). A total of 5538 participants had degenerative low back pain hospitalizations, 2104 had LDH hospitalizations, and 913 had spinal surgery over an average of 27-years follow-up. High BMI (aOR 1.25, CI 1.12-1.38), smoking (aOR 1.53, CI 1.43-1.62), monthly drunkenness (aOR 1.17, CI 1.10-1.26), and chronic diseases (aOR 1.47, CI 1.35-1.61) in adolescence increased the odds of hospitalizations during follow-up. In addition, high BMI (aOR 1.37, CI 1.09-1.72), smoking (aOR 1.40, CI 1.21-1.61), and monthly drunkenness (aOR 1.19, CI 1.01-1.39) increased the odds of spine surgeries. We found that smoking, high BMI, monthly drunkenness, chronic diseases, and low family SES in adolescence increased the likelihood of degenerative low back pain hospitalizations in adulthood. In addition, high BMI, smoking, and monthly drunkenness in adolescence increased the odds of spinal surgeries.

Outcome of intradiscal condoliase injection therapy for patients with recurrent lumbar disc herniation.

Retrospective cohort study. This study aimed to compare data from patients who received intradiscal condoliase (chondroitin sulfate ABC endolyase) injection for primary lumbar disc herniation (LDH) and recurrent LDH. Chemonucleolysis with condoliase for LDH is a treatment with relatively good results and a high safety profile; however, few studies have reported recurrence after LDH surgery. The study participants were 249 patients who underwent intradiscal condoliase injection for LDH at nine participating institutions, including 241 patients with initial LDH (group C) and eight with recurrent LDH (group R). Patient characteristics including age, sex, body mass index, disease duration, intervertebral LDH level, smoking history, and diabetes history were evaluated. Low back pain/leg pain Numerical Rating Scale (NRS) scores and the Oswestry Disability Index (ODI) were used to evaluate clinical symptoms before treatment and at 6 months and 1 year after treatment. Low back pain NRS scores (before treatment and at 6 months and 1 year after treatment, respectively) in group C (4.9 → 2.6 → 1.8) showed significant improvement until 1 year after treatment. Although a tendency for improvement was observed in group R (3.5 → 2.8 → 2.2), no significant difference was noted. Groups C (6.6 → 2.4 → 1.4) and R (7.0 → 3.1 → 3.2) showed significant improvement in the leg pain NRS scores after treatment. Group C (41.4 → 19.5 → 13.7) demonstrated significant improvement in the ODI up to 1 year after treatment; however, no significant difference was found in group R (35.7 → 31.7 → 26.4). Although intradiscal condoliase injection is less effective for LDH recurrence than for initial cases, it is useful for improving leg pain and can be considered a minimally invasive and safe treatment method.

A phase 3, randomized, double-blind, sham-controlled trial of SI-6603 (condoliase) in patients with radicular leg pain associated with lumbar disc herniation

BACKGROUND CONTEXTSI-6603 (condoliase) is a chemonucleolytic agent approved in Japan in 2018 for the treatment of lumbar disc herniation (LDH) associated with radicular leg pain. Condoliase, a mucopolysaccharidase with high substrate specificity for glycosaminoglycans (GAGs), offers a unique mechanism of action through the degradation of GAGs in the nucleus pulposus. As LDH management is currently limited to conservative approaches and surgical intervention, condoliase could offer a less invasive treatment option than surgery for patients with LDH. PURPOSEThe Discovery 6603 study (NCT03607838) evaluated the efficacy and safety of a single-dose injection of SI-6603 (condoliase) vs sham for the treatment of radicular leg pain associated with LDH. STUDY DESIGN/SETTINGA randomized, double-blind, sham-controlled, phase 3 study conducted across 41 sites in the United States. PATIENT SAMPLEMale and female participants (N=352; aged 30–70 years) with contained posterolateral LDH and unilateral radiculopathy/radicular leg pain for greater than 6 weeks. OUTCOME MEASURESThe primary endpoint was the change from baseline (CFB) in average worst leg pain score at 13 weeks, assessed using the 100-mm visual analogue scale. Key secondary endpoints were CFB in average worst leg pain score at 52 weeks, herniation volume at 13 weeks, and Oswestry Disability Index (ODI) score at 13 weeks. Safety evaluations included adverse events (AEs) and imaging findings. METHODSParticipants were randomized 1:1 to receive a single intradiscal injection of condoliase (1.25 units) or sham injection followed by 52 weeks of observation. The primary and key secondary endpoints were assessed using a mixed model for repeated measures (MMRM) analysis and a protocol-specified multiple imputation (MI) sensitivity analysis on the modified intention-to-treat (mITT) population. A prespecified serial gatekeeping algorithm was used for multiple comparisons. Safety endpoints included AEs, laboratory tests, vital signs, imaging (by X-ray and magnetic resonance imaging [MRI]), and occurrence of posttreatment lumbar surgery. RESULTSOf the 352 randomized participants, 341 constituted the mITT population (condoliase n=169; sham n=172) and the safety population (condoliase n=167; sham n=174). For the primary endpoint, the condoliase group showed significantly greater improvement in CFB in worst leg pain at Week 13 (least squares mean [LSM] CFB: −41.7) compared with sham injection (−34.2; LSM difference: −7.5; 95% confidence interval [CI]: −14.1, −0.9; p=.0263) based on the MMRM analysis. CFB in worst leg pain at Week 52 favored condoliase vs sham, but the difference was not statistically significant (p=.0558), which halted the serial gatekeeping testing algorithm and dictated that the CFB in herniation volume and ODI scores at Week 13 would be considered nonsignificant, regardless of their p-values. Treatment group differences in CFB in herniation volume and ODI score favored the condoliase group vs sham at all timepoints. The MI sensitivity analysis showed differences in CFB in worst leg pain at Week 13 (p=.0223) and Week 52 (p=.0433) in favor of the condoliase group. Treatment-emergent AEs (TEAEs) were more common in the condoliase group (≥1 TEAE: 71.9%; ≥1 treatment-related TEAE: 28.1%) compared with the sham group (≥1 TEAE: 60.3%; ≥1 treatment-related TEAE: 10.3%). Of the TEAEs, spinal MRI abnormalities and back pain occurred most frequently. No treatment-related serious AEs occurred. CONCLUSIONSCondoliase met its primary endpoint of significantly improving radicular leg pain at Week 13 and was generally well tolerated in patients with LDH. Chemonucleolysis with condoliase has the potential to provide a less invasive treatment option than surgery for those unresponsive to conservative treatment strategies.

The paravertebral lymphatic system is involved in the resorption of the herniated nucleus pulposus and the regression of inflammation associated with disc herniation

ObjectiveTo investigate the role of the paravertebral lymphatic system in the nucleus pulposus herniation (NPH) resorption and the inflammation regression. DesignClinical specimens (n = 10) from patients with lumbar disc herniation (LDH) were collected, C57BL/6 (n = 84) and conditional Vegfr3 knockout mice (n = 14) were used. Immunofluorescence staining detected lymphatic vessels (LVs) and NP cells. Near-infrared imaging assessed lymphatic drainage function, and Alcian Blue/Orange determined inflammation. ResultsLymphangiogenesis was observed in the herniated NP of patients with LDH, and the proportion of capillary LVs was higher than that of collecting LVs (mean 68.2% [95% confidence interval: 59.4, 77.1]). In NPH mice, NP cells were detected in paravertebral tissue (38.6 [32.0, 45.2]) and draining lymph nodes (dLN) at 4 h (76.9 [54.9, 98.8]). A significant increase of NP cells in dLNs was observed at 24 h (157.1 [113.7, 200.6]). Most of the herniated NP cells were cleared in paravertebral tissue after 1 week (7.5 [4.4, 10.6]), but disc inflammation peaked at 1 week (19.9 % [14.7, 25.1]), along with persistent lymphangiogenesis (9.5 [7.2, 11.8]). However, conditional Vegfr3 knockout mice exhibited impaired lymphangiogenesis (5.7 [4.4, 7.0]) and herniated NP cells clearance (6.1 [1.8, 10.5]) during NPH, leading to exacerbated disc inflammation (23.7% [19.3, 28.2]). ConclusionThe paravertebral lymphatic system is involved in the NPH resorption and inflammation regression. Promoting lymphangiogenesis may be a novel strategy for facilitating NPH resorption and inflammation regression in patients with LDH.

The Impact of Demographic Characteristics, Obesity, Surgical Level, and Intervertebral Disc Properties on Recurrence of Lumbar Disc Herniation

This study focused on identifying factors influencing recurrent lumbar disc herniation (RLDH) by analyzing demographic data, body mass index (BMI), and radiologic disc properties in patients undergoing single-level unilateral lumbar disc herniation surgery. Our retrospective analysis included 2 groups from our clinic: Group 1 (n= 41) with patients experiencing RLDH requiring a second surgery, and Group 2 (n= 73) with patients having a single surgery and no recurrence over at least a 5-year follow-up. We assessed age, sex, diabetes mellitus (DM), hypertension (HT), BMI, Pfirrmann disc degeneration type, herniation types (protrusion, extrusion, and sequestration), and surgical level. The mean ages of Groups 1 and 2 were 48.93 ± 13.47 and 44.4 ± 11.79 years, respectively, with no significant age difference (P= 0.064). Gender distribution was also not significantly different, with 63.41% males in Group 1 and 56.16% in Group 2 (P= 0.450). DM prevalence was similar in both groups (P= 0.727). Notably, HT was significantly lower in Group 2 (P= 0.018). The average BMI was comparable between groups (P= 0.607), and no significant difference in Pfirrmann disc degeneration scores was observed (P= 0.547). Radiologic disc type distributions did not significantly differ (P= 0.448). Most surgeries in both groups were at the L4-5 level, with no significant differences in surgical levels (P= 0.456). We found that factors like gender, age, DM, obesity, surgical level, disc degeneration, and disc types do not significantly impact RLDH. However, the higher occurrence of HT in recurrent cases indicates a potential area for further research.

Spontaneous regression of lumbar disc herniation: four cases report and review of the literature.

Spontaneous regression of lumbar disc herniation refers to shrinkage or disappearance of herniated nucleus pulposus without invasive surgical treatments. This phenomenon has been reported and is supported by improved clinical symptoms and radiographic after conservative treatment, but the underlying mechanism remains unclear. This article reports 4 cases of disc reabsorption and reviews the distribution of several clinical and radiographic factors of disc herniation reabsorption of total 46 patients, including the four from our study, gathered from 28 recent publications. Some of these factors are present with anomalous distributions. But some factors have similar deviations in patients with lumbar disc herniation. Therefore, more research is needed to explore the correlation between those factors and disc reabsorption.

Transpedicular Percutaneous Discectomy for High-Grade Down-Migrated Lumbar Disc Herniation

Objective: The purpose of this study was to evaluate the clinical outcomes of percutaneous endoscopic discectomy using the transpedicular approach for hernias with down-migration.Methods: The study involved a retrospective descriptive analysis of 7 patients who underwent surgery by 2 senior surgeons at 4 different hospitals between 2016 and 2024. The minimum follow-up period was 6 months. All patients were treated with lumbar discectomy through a transpedicular approach with an oblique trajectory. Preoperative and postoperative clinical data were collected for statistical analysis.Results: The surgical procedures were successful and complication-free for all patients. The preoperative and postoperative radicular visual analogue scale and Oswestry Disability Index scores were compared, and the differences were statistically significant (p&lt;0.05).Conclusion: At the last follow-up, 100% of patients had good to excellent results according to the modified MacNab criteria. The transpedicular approach, when using a percutaneous endoscopic technique, requires precise surgical planning and accurate knowledge of the vertebral anatomy. The technique can be made more accessible to inexperienced surgeons by describing it with different instrumentation.

Inflammatory Bowel Disease as a Risk Factor for Complications and Revisions Following Lumbar Discectomy.

Retrospective cohort study. Patients with IBD are at an increased risk for postoperative complications following surgery. The goal of this study is to investigate if inflammatory bowel disease (IBD) is a risk factor for complications following lumbar discectomy. We identified IBD patients who underwent lumbar discectomy for lumbar disc herniation (LDH) and matched to them with controls without IBD in a1:5 ratio. We excluded patients with a history of spinal injury, cancer, infection, trauma, or surgery to remove the digestive tract. We used multivariate logistic regression analyses to compare postoperative outcomes, including 90-day complications, 90-day emergency department visits, and 90-day readmissions. In addition, 2-year re-discectomy rates and a 3-year lumbar fusion rate were compared between the cohorts. After applying the study criteria, we identified 6134 IBD patients with LDH for further analysis. With the exception of dura tears, patients with IBD had significantly higher rates of medical complications, incision-related complications, ED visits, and readmission rates compared to patients without IBD, especially for the 2-year and 3-year rates of disc recurrence and revision surgery. Patients with IBD who underwent lumbar discectomy are at a significantly higher rate of complications. Therefore, spine surgeons and other health care providers should be aware of this higher risk associated with IBD patients and properly treat the patients' IBD before surgery to lower these risks.

Research Status and Future Prospects of Acupuncture and Moxibustion in the Treatment of Lumbar Disc Herniation

Research Status and Future Prospects of Acupuncture and Moxibustion in the Treatment of Lumbar Disc Herniation