Management Of Lumbar Disc Prolapse Research Articles

A comparative study of mckenzie approach versus mulligan mobilization with a common use of if in the management of lumbar disc prolapse

The purpose of this study was to compare the effectiveness of McKenzie's approach versus Mulligan's mobilization with the common use of interferential therapy in the management of Lumbar disc prolapse. Thirty (30) individuals; aged between 20 to 45 years, presenting with prolapse inter vertebral disc with symptom duration within one month, were randomized into two groups. Group-A received the McKenzie approach with interferential therapy and Group B received Mulligan mobilization with interferential therapy. The treatment duration was four weeks. Data was obtained on pain intensity levels i.e. visual analogue scale (VAS) and level of functional disability, Oswestry disability index (ODI). The mean score of ODI reduced from a mean of 37.8667 to 29.4667 in group-A (McKenzie approach with interferential therapy group) whereas in group B (Mulligan mobilization with interferential therapy) the mean score has been improved from 38.2667 to 16.8. The pain and disability score analysis within both group A (P= 5.9x10-07) and group B (P=1.7x10) shows significant improvement while inter-group comparison shows significant improvement in group-B subjects as compared to group-A (p=9.9x10-10). The mean score of VAS had improved from a mean of 6.78667 to 4.44; mean in group-A (McKenzie approaches with interferential therapy group) whereas in group B (Mulligan mobilization with interferential therapy group) The mean score of VAS had improved from a mean of 6.98667 to 2.62; The score analysis for intergroup comparison showed the strength significantly improved in group-B subjects as compared to group-A subjects (p=5.17703 X 10-6). The results of this study demonstrate that Mulligan SNAGs with interferential therapy is a superior treatment approach as compared to McKenzie's approach with interferential therapy in managing Lumbar disc prolapse.

Homoeopathic management of lumbar disc prolapse with spondylosis: A case report

Lumbar disc prolapse is a painful condition that occurs due to herniation of nucleus pulposus through annulus fibrosis in the lower spine. Usually this occurs due to wear and tear of outer annulus fibrosis. The spinal nerve root is then got irritated by this disc protrusion resulting pain in lower spinal region and also as radiating pain down to legs. Age is one of the important etiological factors because degenerative changes are very common. Even though this bank officer was above 70 years, and had lumbar spondylosis and scoliosis, after taking the Homoeopathic Constitutional medicine symptomatically relieved. Bryonia 30 and Rhus tox 30 were considered initially but Natrum mur 200 had relived her pains. Dr. Hahnemann says in Aphorism 210 that in so-called corporeal diseases, always has alteration in mind and disposition.

Endoscopic Management of Lumbar Disc Prolapse

Background: Endoscopic management of lumbar disc herniation as a minimally invasive procedure become more popular around the world. Although accepted surgical outcomes of the endoscopic approach to manage lumbar disc herniation [LDH], this procedure still to be relatively challenging and needs a high learning curve, so operative failures and complications may occur. The Aim of The Work: To assess using the endoscope in the management of lumbar disc prolapse by interlaminar approach using Easy Go and Destandau systems. Patients and Methods: This is study included twenty patients, who had lumbar disc herniation, and operated by using Easy Go and Destandau's endoscopic systems after the failure of conservative treatment. They were included between March 2016 and April 2020. They followed up for at least three months postoperatively. All were selected from the Neurosurgery Department, Al-Azhar University Hospitals, Egypt. Results: Low back pain was the main complaint reported by all patients. The radicular side was mainly the left side [70.0%] and L4/L5 was the most common affected level [65.0%]; the disc protrusion was mainly paracentral [80.0%]. There was a significant pain reduction after surgery when compared to before surgery. The outcome was excellent for 55.0%, good for 25%, fair for 15% and poor for 5%. Complications were in the form of unintended durotomy among 10.0%, nerve injury among 10.0% and infection among 5.0%. Conclusion: Endoscopic lumbar discectomy through interlaminar approach by Destandau's and Easy Go systems become a golden procedure to manage lumbar disc prolapse at any level especially L5-S1 as a minimally invasive technique with some accepted complications that can easily be managed compared to classic traditional open techniques.

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.

Management of Lumbar Disc Prolapse Associated with Retrolisthesis

Background: retrolisthesis is the posterior displacement of one vertebral body in relation to the adjacent vertebrae to a degree less than a dislocation. However, lots of neurosurgeons consider retrolisthesis as incidental finding a rising prove that it is not a rare condition and a cause of many backaches. Aim of work: to compare between discectomy with or without fixation as regards to pain, function and rate of reoperation in patients with lumbar disc prolapse associated with retrolisthesis. Patients and Methods: This study is prospective and retrospective study in fifty cases of patients with single level of lumbar disc prolapse associated with retrolisthesis in Al-Azhar University hospitals and Health Insurance hospitals in time between 2018 and 2019. Twenty-four patients were undergone discectomy alone and 26 patients were undergone discectomy plus lumbar fusion surgery. Results: the main level of retrolisthesis is L5-S1 with higher incidence than other high levels. Sixty six percent (33 cases of 50) and conservative treatment plays an important role in initiation of treatment but surgery by discectomy and fixation according to case demand is the main convenient solution. Conclusions: In this study we showed that patients with lumbar disc prolapse with retrolisthesis should be managed by discectomy alone in cases presented with radicular pain more than low back pain with dynamic study shows no instability. And should be managed by discectomy and fixation in cases presented with low back pain more than radicular pain with dynamic study showing instability or MRI finding shows advancing facet arthritis.

Management of Lumbar Disc Prolapse Associated with Retrolisthesis

Management of Lumbar Disc Prolapse Associated with Retrolisthesis

Percutaneous endoscopic spinal surgery for lumbar disc prolapse in Erbil city of Iraq: A study on 60 patients

Background: As an alternative to back surgeries, endoscopic spinal operations is the most effective and safe procedure that does not impose the fear reaction to the patients. Objective: In this study the results, complications, and outcomes of 60 patients complaining from prolapsed lumbar inter-vertebral discs who experienced prolapsed endoscopic lumbar discectomy (PELD) were reported. Patients and Methods: This is a prospective study conducted in three sentinel hospitals over a period of 3 years (2013-2015) in Erbil city of Iraq. Clinical findings in addition to pre-operative MRI were the main diagnostic methods used for including patients who were suffering from lumbar disc herniation at different levels. Clinical appraisal was done utilizing the modified Macnab criteria. The Storz lens spinoscope was utilized to perform PELD. Results: Sixty patients (37 males and 23 females) with lumbar disc herniation were included in the study. The mean operative time was 50 minutes. Patients were discharged during 1st 24 hours post-operatively. After surgery, patients were followed up for two months to three years with a mean of 18 months. Seven (11.7%) patients developed complications including one (1.7%) instance of shallow nerve injury, three (5%) with dural tears, two (3.3%) instances of intermittent delayed disc prolapse and one patient (1.7%) had post-operative discitis. Modified Macnab criteria (excluding patients with long dural tear) showed excellence results for 36 patients, while good results were observed for 17 patients, reasonable results for 3 patients and poor results for 2 patients. The achievement rate was 91.4% . Conclusion:Although endoscopic spinal discectomy is a compelling procedure for management of lumbar disc prolapse, and although its final outcome is reasonable it is not devoid from complications.

Percutaneous endoscopic lumbar discectomy: Results of first 100 cases

Background:Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications.Materials and Methods:One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab's criteria, visual analog scale, and Oswestry Disability Index.Results:The mean followup period was 2 years (range 18 months - 3 years). Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days.Conclusions:Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.

Microdiscectomy or tubular discectomy: Is any of them a better option for management of lumbar disc prolapse

Objectives:Various types of minimally invasive techniques have been developed for the treatment of lumbar disc herniation. The original laminectomy was refined into microdiscectomy (MD). MD is the gold standard in management of lumbar disc herniation and is used as a yardstick for comparison with newer procedures such as tubular discectomy. So far, no studies have been reported in Indian population comparing tubular discectomy and microdiscectomy. The aim of this study was to compare immediate postoperative and 1-year outcome of patients undergoing tubular discectomy with those undergoing MD and to evaluate the learning curve as well as complication rates of tubular discectomy.Materials and Methods:Forty-six patients of MD and 102 (48 early and 54 late) patients of tubular discectomy (TD) were operated at Indian Spinal Injuries Centre, which is a tertiary level center between July 2009 and January 2012. They were studied for the following data: Baseline characteristics, visual analog scale (VAS) for leg pain and back pain, Oswestry Disability Index (ODI) scores, length of hospital stay, time taken to return to work, duration of surgery, intra- and post-operative complications, and reoperation rates.Results:The VAS score for leg pain, back pain, and ODI scores showed improvement in both groups during the 1st year after surgery. Time taken to return to work and mean hospital stay was shorter in case of TD as compared to MD group. The mean duration of surgery was 34 min shorter for conventional MD. The incidence of dural tear was 6.5% in MD group and 10.4% in early TD and decreased to 7.4% in late TD group.Conclusion:This study revealed that rate of recovery is significantly faster for TD as compared to conventional MD. In contrast, we encountered fewer complications in MD approach as compared to TD which although were not statistically significant and which also decreased as we gained experience.

Management of Lumbar Disc Prolapse by Ozone Therapy: A Prospective Study

Management of Lumbar Disc Prolapse by Ozone Therapy: A Prospective Study

Improvized management of lumbar disc prolapse in Antarctica

Improvized management of lumbar disc prolapse in Antarctica

Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica?

Patients with acute lumbar disc prolapse with sciatica who are not considered candidates for surgery are usually treated with physiotherapy and non-steroidal anti-inflammatory agents. Moreover, the treatment with benzodiazepines is common practice in the absence of class I or II level of evidence. Here we assessed the role of benzodiazepines in the conservative management of acute lumbar disc prolapse. Using a placebo-controlled, double-blinded design, 60 patients were randomized to receive placebo or diazepam in addition to mechanical physiotherapy and analgesics for the first 7 days of conservative treatment of clinically and radiologically confirmed lumbar disc prolapse. The primary objective was to evaluate if physiotherapy plus analgesics, but without benzodiazepines, is equivalent to the same therapy plus benzodiazepines. The primary endpoint was centralization of referred pain at day 7. Twenty-six female and 34 male patients were enrolled. The median age was 42 years (range 22–68 years). Analysis of the primary endpoint demonstrated equivalence between placebo and diazepam (median 60% vs. 50% reduction of distance of referred pain at day 7) within the predefined equivalence tolerance of 20% at a significance level of p < 0.05. Regarding the secondary endpoints, the median duration of the stay in hospital was shorter in the placebo arm (8 vs. 10 days, p = 0.008), and the probability of pain reduction on a visual analog scale by more than 50% was twice as high in placebo patients ( p < 0.0015). Benzodiazepines should not be used routinely in patients treated with mechanical physiotherapy for lumbar disc prolapse.

Surgical interventions for lumbar disc prolapse.

Disc prolapse accounts for five percent of low-back disorders but is one of the most common reasons for surgery. The objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Spine and abstracts of the main spine society meetings within the last five years. We also checked the reference lists of each retrieved articles and corresponded with experts. All data found up to 1 January 2007 are included. Randomized trials (RCT) and quasi-randomized trials (QRCT) of the surgical management of lumbar disc prolapse. Two review authors assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary. Forty RCTs and two QRCTs were identified, including 17 new trials since the first edition of this review in 1999. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring. Despite the critical importance of knowing whether surgery is beneficial for disc prolapse, only four trials have directly compared discectomy with conservative management and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an inter-position gel covering the dura (five trials) and of fat (four trials) show that they can reduce scar formation, though there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy, There are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy. Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).