Lumbar Herniated Nucleus Pulposus Research Articles

Comparison of whole trunk muscle mass between healthy and lumbar herniated nucleus pulposus patients using abdominal pelvic computed tomography.

Paraspinal muscle asymmetry is associated with low back pain (LBP) problems. This study aimed to analyze skeletal muscle areas around the lumbar vertebra and compare the ratio of anterior and posterior muscles between patients with lumbar herniated nucleus pulposus (HNP) and healthy individuals using abdominal pelvic computed tomography (APCT). After propensity score matching, 122 HNP patients and 122 non-HNP individuals were finally used for analyses. In APCT, axial cut images were collected at the level of the third lumbar vertebra lower end plate and only the muscle structure was obtained. After obtaining the muscular portion of their image, we measured the skeletal muscle area (SMA). Second, for analysis relation of sarcopenia and HNP, the status of low skeletal muscle mass was determined using a previously reported criteria based on APCT scans in the Republic of Korea. From the analysis of the anterior-posterior muscles, the ratio of anterior SMA was statistically significantly larger in the HNP group than in the non-HNP group. Regarding the anatomical classification of trunk muscles, a statistically significant left-right imbalance to peripheral muscle in HNP men was observed. Regarding the status of low skeletal muscle mass, no statistical difference in prevalence between the two groups were observed. Moreover, no statistical difference in the prevalence of low skeletal muscle mass obesity was observed. The lumbar flexor muscle was larger in HNP than others, showing trunk muscle imbalance. However, low skeletal muscle mass is not associated with HNP.

Application of critical pathway of integrative medical service for lumbar herniated nucleus pulposus: A protocol for single-centered prospective observational study.

Lumbar herniated nucleus pulposus (L-HNP) is a condition in which fibroblasts escape due to degenerative changes or external forces in the intervertebral disc, causing neurological symptoms by compressing the dura mater or nerve root. The purpose of this study is to analyze and compare the effectiveness, economic feasibility, and safety of using an integrated medical service critical pathway (CP) in L-HNP patients. This single-center prospective observational study will be performed at Kyung Hee University Medicine Hospital and Kyung Hee University Korean Medicine Hospital. The inclusion criteria are a diagnosis of L-HNP on magnetic resonance imaging or computed tomography scans, age under 80 years, a visual analog scale score of 7 or higher for either lower back pain or lower extremity pain. The included 102 participants will be classified into 6 groups (n = 17 in each group): CP application with conservative treatment; CP application with open discectomy; CP application with intrabody fusion; conservative treatment without CP application; open discectomy without CP application; and interbody fusion without CP application. We will collect data on the visual analog scale, ODI, SF-36, and EQ-5D-3L scores; number of admission days; medical staff satisfaction; patients health service satisfaction; waiting time for consultations; use of pain relievers; and CP application and completion rates. In future, this study is expected to serve as a basis for follow-up studies on the development and application of CPs in integrated medical services for various diseases, including lumbar herniated nucleus pulposus.

HNP LUMBALIS

Lumbar herniated nucleus pulposus (HNP) is a disorder characterized by local displacement of the disc beyond the anatomical boundaries of the intervertebral space causing pain, weakness or numbness, and/or tingling in myotomal or dermatomal distribution. HNP is the most common cause of low back pain. Lumbar HNP itself has several underlying etiologies, such as old age, excessive axial load, connective tissue disorders, and congenital abnormalities. Management of HNP can be carried out non-operatively or operatively, depending on the severity, the symptoms that arise, and the response to non-operative treatment.

Comparison of levels of toxic trace elements in two most common spinal pathologies in three different tissues

Aim: The toxic trace element levels in serum, bone (lamina), and intervertebral disc tissues of patients with lumbar spinal stenosis and lumbar herniated nucleus pulposus (HNP) which are the two most common spinal pathologies were determined, and it was investigated whether they have a role in the pathophysiology of these pathologies. Materials and methods: Cadmium (Cd), aluminium (Al), arsenic (As), mercury (Hg), and lead (Pb) levels in serum, intervertebral disc, and bone (lamina) tissue of patients with HNP (=20) and 30 with lumbar spinal stenosis (LSS) (n=30) were determined by Inductively Coupled Plasma Mass Spectrometry technique. Results: LDH group Cd serum level was found to be significantly higher than LSS group Cd serum level (p=0.024). The Al disc level in the HNP group was found to be significantly higher than the Al disc level in the LSS group (p=0.038). While As serum level increased in LDH group, it was determined that As bone level increased very significantly (r= 0.699, p=0.001). In the LSS group, it was determined that the Hg disc level increased significantly as the Hg serum level increased (r=0.608, p<0.01). On the other hand, as the Hg serum level increased in the LDH group, the Hg disc level also decreased significantly (r= -0.579, p<0.01). Conclusion: The difference in toxic trace element levels seen in these pathologies has been discussed in terms of possible causes in light of current literature. The findings of our study support the hypothesis that toxic trace elements may be effective in lumbar disc degeneration.

Degenerative changes of lumbar spine and their clinical implications in patients with axial spondyloarthritis.

The objective of this study was to assess degenerative changes (DCs) on magnetic resonance imaging (MRI) of lumbar spine in axial spondyloarthritis (axSpA) and non-specific mechanical low back pain (mLBP). Patients were consecutively recruited and all underwent MRI of the lumbar spine in this cross-sectional study. Disk degeneration (DD, Pfirrmann classification), endplate changes (Modic, types 1, 2, and 3), annular fissure, disk bulging, and protrusion or extrusion at each lumbar spinal level were assessed using anonymized images. Patients with axSpA were assessed for disease activity, functioning, and quality of life. Univariate and subsequent multivariate logistic regression analyses with adjustments of various covariates were used to assess association between MRI findings and clinical variables. One hundred twenty-three patients had non-radiographic (nr-axSpA) and 144 had radiographic axSpA/ankylosing spondylitis(AS). Degenerative changes were more prevalent in patients with mLBP (n = 105) than axSpA. Disk degeneration was the most prevalent MRI finding, followed by annular fissure, disk herniation (protrusion or extrusion), and Modic changes (MCs) in axSpA. Disk herniation was more prevalent in patients with nr-axSpA compared to AS. Modic changes (OR = 6.455), lumbar disk herniation (OR = 2.278), annular fissure (OR = 2.842), conventional synthetic or biologic disease-modifying antirheumatic drugs (csDMARDs) non-users (OR = 2.225), and advanced age (OR = 31.556) were factors associated with an increased risk of DD in axSpA. Coexisting DD increased the burden of disease in axSpA. A considerable proportion of patients with axSpA had DD at the lumbar spine. These degenerative changes might explain some of the complaints and should not been overlooked in patients with axSpA. Key Points • Lumbar herniated nucleus pulposus (LHNP) is more frequent in nr-axSpA while MC is more frequent in AS. • DD may cause an increase in BASFI and BASMI scores in axSpA. • Spinal DCs might be an alternative explanation for low back complaintsand should not been overlooked in patients with axSpA.

Diagnostic accuracy of contrast and non-contrast 1.5 tesla magnetic resonance imaging for lumbar herniated nucleus pulposus based on surgical findings

This study aims to provide the latest information regarding the accuracy of contrast and non-contrast 1.5 Tesla MRI in the diagnosis of lumbar Herniated Nucleus Pulposus (HNP) compared with surgical findings. We included studies with subjects diagnosed with lumbar HNP due to degenerative processes, preoperative 1.5 Tesla contrast, and non-contrast MRI and described the number of findings of MRI diagnostic tests (index test) on the actual conditions found during surgery (reference standard). We searched literature from 5 databases: ProQuest, Pubmed, Cochrane Library, Biomed Central, and ScienceDirect. The sensitivity and specificity of contrast and non-contrast 1.5 Tesla MRI ranged between 64-95% and 55-100% (95% CI) with the area under the curve above the threshold on the ROC curve. Two studies compared the accuracy of MRI and Computed Tomography (CT) myelography with a wider ROC curve on CT myelography than on MRI. The ROC curve which has a wide area under the curve above the threshold depicts the relationship between sensitivity and specificity, shows that contrast non-contrast 1.5 Tesla MRI has a good accuracy in HNP diagnostic.

Development and Validation of Deep Learning-Based Algorithms for Predicting Lumbar Herniated Nucleus Pulposus Using Lumbar X-rays.

Lumbar herniated nucleus pulposus (HNP) is difficult to diagnose using lumbar radiography. HNP is typically diagnosed using magnetic resonance imaging (MRI). This study developed and validated an artificial intelligence model that predicts lumbar HNP using lumbar radiography. A total of 180,271 lumbar radiographs were obtained from 34,661 patients in the form of lumbar X-ray and MRI images, which were matched together and labeled accordingly. The data were divided into a training set (31,149 patients and 162,257 images) and a test set (3512 patients and 18,014 images). Training data were used for learning using the EfficientNet-B5 model and four-fold cross-validation. The area under the curve (AUC) of the receiver operating characteristic (ROC) for the prediction of lumbar HNP was 0.73. The AUC of the ROC for predicting lumbar HNP in L (lumbar) 1-2, L2-3, L3-4, L4-5, and L5-S (sacrum)1 levels were 0.68, 0.68, 0.63, 0.67, and 0.72, respectively. Finally, an HNP prediction model was developed, although it requires further improvements.

CORRELATION OF PAIN INTENSITY AND HEALTH-RELATED QUALITY OF LIFE IN LUMBAR HERNIATED NUCLEUS PULPOSUS IN RSUD PROF. DR. MARGONO SOEKARJO

Low back pain (LBP) was a health problem that disturbed clinically, socially, and economically. There was a worldwide and national increase of LBP every year. Both LBP and ischialgia were specific symptoms of herniated nucleus pulposus (HNP). Location of HNP mostly happened at L4-L5 and L5-S1 level. Chronic pain which existed in HNP patients could affect health-related quality of life. The aim of this study was to analyze correlation of pain intensity and quality of life in HNP patients in RSUD Prof. Dr. Margono Soekarjo in 2011-2013. This was a cross-sectional study with 26 subjects. Bivariable analysis was done by using Pearson correlation test with stratification based on body mass index. This study was approved by the Research Ethics Committee of FK Unsoed.. There was a significant correlation of pain intensity and quality of life (p<0,01) with negative direction and very strong correlation (r=-0,908) in normoweight respondents, and also strong correlation (r=-0,794) in obese respondents. There was also a significant correlation (p<0,001) with negative direction and very strong correlation (r=-0,852) in all respondents. Pain intensity has the strongest correlation with physical disability domain (r=-0,853). Higher pain intensity strongly impacts on the lower quality of life in lumbar HNP patients of RSUD Prof. Dr. Margono Soekarjo, and vice-versa.

The Effectiveness of Core Stability Exercise to Improve Functional Ability in A Lumbar Herniated Nucleus Pulposus Patient: A Case Study

Background: Hernia Nucleus Pulposus (HNP) is a condition in which the nucleus pulposus has bulged from the intervertebral disc, consequently damages the walls of the annulus fibrosus and compresses the nerves. Clinical problems such as radiating pain, sensory disturbances according to dermatomes, muscle weakness, restricted range of motion, especially during flexion, and decreased functional ability. Core stability exercise is one of the physiotherapy treatments to reduce pain and improve the patient's functional ability with lumbar HNP. The purpose of this study is to determine the effectiveness of core stability exercise on increasing functional ability in cases of lumbar HNP with Modified Oswestry Low Back Pain Disability Questionnaire as a parameter. Methods: A single case study provided a physiotherapy intervention to a 56-year-old female patient for four weeks with four evaluations. The dose of exercise given was three times a week, three sets, five repetitions, 6-9 minutes of each type of exercise, and hold time 5-10 seconds. The improvement of functional ability is measured by using the Modified Oswestry Low Back Pain Disability Questionnaire. 
 Results: There was an improvement in functional ability as measured by Modified Oswestry Low Back Pain Disability Questionnaire. At pre-intervention, the Modified Oswestry score was 52% meaning the patient had severe disability. On the 4th week evaluation, the patient's Modified Oswestry score decreased to 26%, indicating moderate disability. 
 Conclusion: This study showed that core stability exercise effectively improved functional ability in a patient with lumbar HNP.

Clinical results of combined interlaminar and transforaminal endoscopic discectomy for central large disc herniation

ObjectiveThe purpose of this study was to inscribe the combined interlaminar with transforaminal endoscopic discectomy for central large disc herniation and report clinical results. MethodsPatients diagnosed with large central lumbar herniated nucleus pulposus who underwent combined interlaminar and transforaminal endoscopic discectomy between 2015 and 2020 were reviewed. Perioperative data, preoperative and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) back pain scores, VAS leg pain scores, and complications were evaluated and recorded at 1 week and 3 and 6 months postoperatively and each year thereafter. ResultsThe study revealed 9 cases (22.22% female). The average age of patients was 42.33 ± 19.8 years old (range, 18–83 years old). The levels of surgery were L3-4 in 22.22%, L4-5 in 77.77%. This combined approach has an average operative time of 104.44 ± 22.42 min. The VAS Back and Leg were improved from pre-operative score from 5.0 ± 2.0, 4.42 ± 2.93 to 2.18 ± 1.97 and 2.55 ± 2.84 retrospectively at 1 week. The ODI score was improved pre-operative from 46.85 ± 15.61% to 14.94 ± 19.08% at 3 month follow up. There were 2 cases (22.22%) diagnosed of recurrent disc herniation. No case of epidural hematoma, infection, permanent neurological deterioration, cauda equina syndrome. ConclusionsCombined interlaminar and transforminal endoscopic discectomy is an option for central large lumbar disc herniation.

Scoliosis Secondary to Lumbar Spine Herniated Nucleus Pulposus in Adolescents: A Case Report

Introduction: Herniated nucleus pulposus (HNP) is infrequent among children and adolescents. The first case of surgical intervention for disc herniation was reported in a 12-year-old child. Since then, very few cases or series of cases have been published. The reactive scoliosis is frequently associated with lumbar HNPs, a compensatory effort to relieve nerve compression. Moreover, reactive scoliosis secondary to lumbar HNP is typically associated with children and usually resolves with effective management of lumbar HNP. Although the surgical intervention is frequently employed among adults, only 0.5% of discectomies are carried out in children <16 years old. The current case report is of a 15-year-old girl, with no history of spinal ailment, who presented with a large disc herniation at L4–L5 region, associated with a reactive secondary scoliosis, which was resolved following a successful surgical intervention.
 Case Report: A 15-year-old female with known case of scoliosis and a history of lower back pain for nine months following a fall while playing football presented at outpatient clinic. She sought medical opinion after two months of persistent pain with radiculopathy to the right side toward big toe. Similarly, there was normal plantar reflex and no clonus or Hoffman sign. There was positive straight leg raise test as well as positive contralateral straight leg raise test. Scoliosis is idiopathic in majority of young patients. However, it might also arise as a part or complication of a triggering health state. Although scoliosis has been frequently associated with lumbar HNP among adolescents, most patients with lumbar disc ailment in this age group might be underdiagnosed initially. Similarly, in our case study the patient was not diagnosed when medical opinion was sought after two months of persistent pain with radiculopathy to the right side toward big toe. The clinical characteristics of pediatric lumbar HNP are usually comparable to those seen in adults; however, one distinguishing feature is that up to 90% have a positive straight-leg raising test. The most common symptom is lumbar pain; limitation of lumbar motility and lassegue are the most common signs. The etiology, pathophysiology, and patterns of the scoliotic posture in cases secondary to HNP remain debated. It is highly recommended to do CT scan in cases of adolescent lumbar HNP to rule out apophyseal ring fracture; accurate diagnosis helps surgeon in planning the appropriate surgical intervention needed. Scoliosis secondary to lumbar disc herniation is observed occasionally, therefore, its clinical significance and pathophysiology are not well-established. However, it is well-recognized that children’s spines have superior adaptive capacity, which shields nervous tissue. An example of this could be scoliosis in patients with root compression, when they bend to the side contrary to the compression, causing an enlargement of the affected foramen and root release. It has been reported that 80% of the patients with disc herniation and scoliosis had the convexity on the side of the root compression. The MRI findings revealed that the scoliosis widened the foramen. Similarly, in our case report the X-ray depicted scoliotic deformity with convexity toward the right side. MRI is the best imaging technique to indicate disc herniation and eliminate other likelihoods in both children and adolescents. Surgical interventions, such as micro-endoscopy discectomy and percutaneous endoscopic lumbar discectomy, could achieve considerable pain relief and function improvement. Our case finding revealed that microscopic discectomy relieved the pain and improved the scoliosis.
 Conclusion: Lumbar disc herniation is a rare entity among both children and adolescent and may also result in scoliosis and lumbar pain with or without sciatica. Therefore, lumbar disc herniation in association with scoliosis need vigilant evaluation of signs and symptoms in addition to appropriate diagnostic imaging. Imaging has a vital role in the diagnosis of underlying disease state and helps in clinical management along with surgical planning. The appropriate treatment is discectomy.

Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia

BackgroundThe objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). MethodsA prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. ResultsWe recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7–10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1–4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15–96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15–96.93). ConclusionType of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.

The Effect of Pulsed Radiofrequency on Radicular Pain in Lumbal Herniated Nucleus Pulposus: A Systematic Review and Meta-analysis.

ContextRadiofrequency therapy is a medical procedure mainly used to reduce pain with a low complication rate (less than 1%), ease of application, and low cost. This review’s objective was to (1) evaluate the pulsed radiofrequency (PRF) effectiveness in treating radicular pain and (2) assess the PRF procedure’s safety in managing radicular pain in lumbar herniated nucleus pulposus (HNP).MethodsA systematic review and meta-analysis. A tertiary care center and an academic medical center. Six full articles with the following features were selected for this review: (1) Articles published in English; (2) studies on the PRF effect on radicular pain in lumbar HNP; and (3) randomized control trials.ResultsThe studies showed that the PRF group had a reduction in pain scores at each evaluation. In four of the studies, the PRF group showed a more significant reduction in pain scores than the control, and in two of the studies, the reduction in pain scores was not significant in the PRF group compared to the control. An adverse effect was reported in one patient experiencing increased radicular pain after PRF. Lack of data required for statistical analysis, and lack use of a uniform duration for the PRF procedure by all the studies.ConclusionsPRF can be used as a promising clinical recommendation for pain management with minimally invasive radicular pain techniques due to lumbar HNP.

2. The reherniation after decompression (RAD) score identifies patients at low risk for reherniation after lumbar decompression surgery

BACKGROUND CONTEXT Herniations of lumbar intervertebral discs are one of the most common injuries sustained across the United States, and present challenges in management for the spine surgeon. Though patients often experience symptomatic relief following surgical decompression, reherniation is a common, yet unpredictable occurrence that may lead to further adverse outcomes. PURPOSE The purpose of this study was to create a prognostic tool to identify patients at greatest risk for reherniation after surgery. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients were identified by reviewing magnetic resonance imaging (MRI) studies and clinical documentation to identify all patients receiving surgical decompression of the lumbar spine for a herniated nucleus pulposus (HNP) from 2006 to 2018. OUTCOME MEASURES Reherniation of a lumbar intervertebral disc after decompression surgery. METHODS Following identification of the eligible cohort, patient charts were subsequently queried for type, location and incidence of reherniation events after decompression surgery. Baseline demographic (age, sex, body mass index (BMI), American Society of Anesthesiologist (ASA) Class, smoking history), clinical (duration of symptoms, type of herniation, number of planned operative levels), and radiographic information (pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), coronal angulation (CA), lumbar lordosis (LL)) was also collected. Following an 80:20 training and testing data split, multiple imputation and LASSO logistic regression were employed to build and validate a predictive model to identify patients at risk for reherniations after surgery. Ten folds of cross-validation were used to identify tuning parameters for the LASSO logistic regression model, allowing for selection of the strongest predictors for reherniation events. This model was subsequently refit to the multiply-imputed data to allow calculation of pooled model estimates. A threshold to distinguish patients as low- or high-risk for reherniations was established using Youden's index. The threshold for statistical significance was set p RESULTS A total of 517 patients (318 male, 199 female) presented for surgical decompression of a lumbar HNP, in which 51 experienced reherniations after surgery. Patients had a mean age of 45.2±13.9 years, BMI of 29.4±6.3 kg/m2, and 22.4±28.0 months of follow-up. Most herniations were paracentral (431/517; 83.4%), followed by central (55/517; 10.6%), and far lateral (29/517; 5.6%). Reherniations were seen at a mean of 46.0±70.0 months after surgery. LASSO logistic regression identified nine significant predictors for reherniations: age, sex, ASA class, operative levels, duration of preoperative symptoms, paracentral disc herniation, preoperative PI, preoperative LL, and VAS-Leg scores. Paracentral disc herniations and duration of preoperative symptoms were the strongest positive and negative predictors for reherniation outcomes, respectively. Validation of this model demonstrated excellent model discrimination (AUC: 0.834), sensitivity (71.4%), and specificity (87.6%). Within the testing cohort, 16.3% and 83.7% of patients were identified as high- and low-risk, respectively. Of these, 29.4% of high-risk patients (5/17) sustained future reherniations, while nearly all low-risk patients (85/87; 98.7%) experienced no recurrence of their HNP. CONCLUSIONS This is the first study to develop and validate a screening tool to identify patients with clear differences in risk for reherniation after lumbar decompression for HNP. With further validation, this tool can be readily implemented in clinical practice, and may accurately identify patients likely to experience lasting surgical benefit for lumbar disc herniations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Should Initial Management for Lumbar Herniated Nucleus Pulposus Resulting in a Dense Nerve Palsy Be Surgical.

Should Initial Management for Lumbar Herniated Nucleus Pulposus Resulting in a Dense Nerve Palsy Be Surgical.

Clinical outcomes of lumbar diseases specific test in patients who undergo endoscopy-assisted tubular surgery with lumbar herniated nucleus pulposus: an analysis using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ)

PurposeThis study was to evaluate clinical outcomes using a patient-oriented test that scores health-related quality of life (HRQOL) for patients after minimally invasive surgery using microendoscopic discectomy (MED) for lumbar disc hernia. Few studies regarding MED in terms of disease-specific quality of life measures using Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) have been published.MethodsRetrospective analysis of the surgical and clinical outcomes with regard to reducing pain and improving the functional status for 31 patients who underwent MED for lumbar disc hernia was conducted. These patients were evaluated at 3-year follow-up. The evaluations were based on a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the JOABPEQ, which is an objective, patient-oriented test that assesses HRQOL in patients with lumbar disorders.ResultsA low rate of improvement was seen only in mental health until 1 year, the low rate of improvement in mental health and was independently correlated with body mass index (BMI), pre-operative scores on the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP), and scores on the BS-POP at 12 months post-operatively.ConclusionsAll categories of VAS, JOA scores, and all domains of JOABPEQ were significantly higher over 3 years than those obtained pre-operatively. But only mental health domain showed mild improvement until 1 year. Moreover, BMI showed a negative correlation with improvements in the mental health domain post-operatively. As patients may be mentally exhausted from lumbar disc herniation, pre-operative mental health may be improved by surgical treatment.

54. Preoperative MRI predictors of health related quality of life improvement after microscopic lumbar discectomy

54. Preoperative MRI predictors of health related quality of life improvement after microscopic lumbar discectomy

Full-Endoscopic Interlaminar Lumbar Discectomy: Retrospective Review of Clinical Results and Complications in 545 International Patients

Minimally invasive techniques have been developed to provide access to the disc with better visualization while causing less muscle trauma and its consequences. This study was aimed at evaluating the clinical outcomes and complications of the fully endoscopic lumbar discectomy interlaminar approach in a large number of patients. Patients diagnosed with lumbar herniated nucleus pulposus who underwent fully endoscopic interlaminar lumbar discectomy between 2011 and 2016 were reviewed. Perioperative data, preoperative and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) back pain scores, VAS leg pain scores, and complications were evaluated and recorded at 1 week and 3 and 6 months postoperatively and each year thereafter. The study cohort comprised 545 patients (average age, 46.43 years; 34.31% female). The affected levels were L2-3 in 1.47%, L3-4 in 6.96%, L4-5 in 49.45%, andL5-S1 in 44.69%. Mean preoperative ODI, VAS back pain score, and VAS leg pain score were 43.00%, 5.00, and5.69,respectively. Postoperative ODI at 1 month wasreduced to15.59% and remained within a range of 14.83%18.32%throughout follow-up. Postoperative VAS back and leg pain score results at 1 week were decreased to 1.66 and 1.79, respectively, and remained at 1.89-3.14 and 1.59-2.66, respectively, throughout follow-up. Sixty-six recurrences (12.11%) were diagnosed. Intraoperative complications were nerve root-related (n= 3) and dural tear (n= 1). Postoperative complications included numbness (n= 18), weakness (n= 5), and residual disc (n=1). No infections or hematomas were reported. Fully endoscopic interlaminar lumbar discectomy is a safe, effective option for treating lumbar disc herniation, with a long recurrence-free recovery.

Cervical and Lumbar Herniated Nucleus Pulposus Resorption after Acupotomy with Integrative Korean Medicine Treatment: A Case Series of Two Patients

Cervical and Lumbar Herniated Nucleus Pulposus Resorption after Acupotomy with Integrative Korean Medicine Treatment: A Case Series of Two Patients

The Effect of Preoperative Symptom Duration on Postoperative Outcomes After a Tubular Lumbar Microdiscectomy.

This is a retrospective cohort study. This study aims to characterize the effect of preoperative symptom duration on postoperative outcomes after minimally invasive lumbar microdiscectomy (MIS LD). It is unknown whether extended nonoperative treatment before MIS LD has implications for long-term clinical outcomes even after surgery is performed. A prospectively maintained surgical registry of patients undergoing MIS LD by a single surgeon between 2013 and 2017 was reviewed. Preoperative symptom duration was dichotomized into 2 groups (≤6 and >6 mo). Only patients with full clinical data at 6 months postoperative follow-up were included in the study. Clinical outcomes were assessed at 6, 12 weeks, and 6 months after surgery. The number of patients obtaining a minimum clinically important difference was assessed. Groups were compared with the χ analysis and the student t tests for categorical and continuous data, respectively. In total, 94 patients were identified. A total of 45 patients (47.9%) had symptom duration ≤6 months. No differences in baseline characteristics were found (P>0.05). Patients with shorter symptom duration had significantly greater improvement in Oswestry Disability Index scores at 6 weeks (P=0.004), 12 weeks (P=0.022), and 6 months (P=0.005). Patients with shorter duration of symptoms also obtained minimum clinically important difference for Oswestry Disability Index at a greater rate than those with longer duration of symptoms (P=0.015). Although patients who underwent MIS LD within 6 months of symptom onset had similar baseline characteristics compared with patients who underwent surgery after 6 months of symptoms, the patients with longer preoperative symptom duration had worse functional outcomes at 6 months after surgery. These results suggest that earlier MIS lumbar microdiscectomy may provide a functional benefit for patients. Further studies should therefore evaluate the efficacy of nonoperative treatment in the setting of lumbar herniated nucleus pulposus, as prolonged conservative management may potentially impair functional recovery after surgery.