Prolapsed Intervertebral Disc Research Articles

WDRIV-Net: a weighted ensemble transfer learning to improve automatic type stratification of lumbar intervertebral disc bulge, prolapse, and herniation

The degeneration of the intervertebral discs in the lumbar spine is the common cause of neurological and physical dysfunctions and chronic disability of patients, which can be stratified into single—(e.g., disc herniation, prolapse, or bulge) and comorbidity-type degeneration (e.g., simultaneous presence of two or more conditions), respectively. A sample of lumbar magnetic resonance imaging (MRI) images from multiple clinical hospitals in China was collected and used in the proposal assessment. We devised a weighted transfer learning framework WDRIV-Net by ensembling four pre-trained models including Densenet169, ResNet101, InceptionV3, and VGG19. The proposed approach was applied to the clinical data and achieved 96.25% accuracy, surpassing the benchmark ResNet101 (87.5%), DenseNet169 (82.5%), VGG19 (88.75%), InceptionV3 (93.75%), and other state-of-the-art (SOTA) ensemble deep learning models. Furthermore, improved performance was observed as well for the metric of the area under the curve (AUC), producing a ≥ 7% increase versus other SOTA ensemble learning, a ≥ 6% increase versus most-studied models, and a ≥ 2% increase versus the baselines. WDRIV-Net can serve as a guide in the initial and efficient type screening of complex degeneration of lumbar intervertebral discs (LID) and assist in the early-stage selection of clinically differentiated treatment options.

Evaluation of Comparative Efficacy of <i>Swadamshtradi Tail Matrabasti</i> and <i>Katibasti in Katishoola</i> (I.V.D.P.) – A Comparative Randomized Clinical Study

Background: The primary cause of Katishoola is vitiation of the Vata Dosha. As a symptom of several illnesses including Katigraha, Trikagraha, Prushtagraha, Kativayu, Trikashoola, Prushtashool, Vataja Shoola, Trika Vedana, and Grudrasi Vata, Katishoola is also mentioned in certain ancient literature. Low back discomfort, also known as katishoola, is a common ailment throughout early and middle adulthood. It is the most typical complex that is commonly associated with the musculoskeletal system. Almost all adults can recall having back pain at some point in their lives. The effectiveness of Katibasti and Swadamshtradi tail Matratail in Katishoola (Intervertebral Disc Prolapse (I.V.D.P.)) is the goal. Aim: I.V.D.P. were to evaluate the assesscacy of Swadamshtradi Taila Katibasti in Katishoola, to evaluate the effieffectiveness of Swadamshtradi Taila Matrabasti in Katishool, and to compare the effect of Swadamshtradi Taila Matrabasti and Swadamshtradi Taila Katibasti in Katishoola. Methods: This was a comparative randomized clinical study - a minimum of 30 patients distributed equally in two groups, 15 patients in each group. In Group A, 15 patients were given a standard Matrabasti procedure with Swadamshtradi Taila’s help for nine days. In Group B, 15 patients were given a traditional method of Katibasti with the help of Swadamshtradi Taila for nine days. Paired t-test was used for the assessment of parameters. Results: Matrabasti showed statistically highly significant improvement in cardinal symptoms of Katishoola; comparing the percentage-wise relief, Katibasti seems to be more effective on overall symptoms of Katishoola. Conclusion: Shwadanshtradi oil matrabasti is more effective and easily available. Major Findings: Group B showed significant changes in pain, stiffness, restricted movement and Scobers test. Group A showed highly significant changes in SLRT parameters.

Occupational management of low back pain secondary to prolapsed intervertebral disc in a Malaysian healthcare worker: a case report emphasizing ergonomic intervention and risk reduction strategies

Low back pain (LBP) is a commonly encountered medical disorder in Malaysia's primary care setting, though establishing a direct connection between LBP and the workplace environment in adults is challenging. This case presents a clinic nurse who developed LBP due to a prolapsed intervertebral disc and her clinical management from an Occupational Health Doctor perspective. Her occupational management involved a walk-through survey at an urban hospital, which identified bone marrow aspiration as her most physically demanding task. Detailed assessment revealed that during this procedure, the nurse maintained awkward postures and performed repetitive movements while standing for extended periods. A Rapid Entire Body Assessment score of 4 suggested a medium risk, meriting further investigation. To accommodate her condition, the nurse was placed on light duty, with job modifications recommended to limit standing to no more than four hours and to avoid lifting objects exceeding five kilograms. Although the criteria for an occupational disease are not met, it is classified as a work-aggravated condition, given that her LBP was likely worsened by her daily work activities. In conclusion, effective management of occupational LBP requires thorough risk assessments. Modifying tasks and supervisor intervention are essential when job duties could exacerbate pre-existing LBP.

A case of incidentally detected spina bifida at DV1 level in a fighter pilot: Aeromedical deliberations

A failure of closure neural tube normally results in spina bifida. The lesions may occur anywhere along the spine but are more common in the lumbosacral region (90%) in comparison to the thoracic (6%) or cervical (3%) spines. According to policy guidelines, all cases of spina bifida are unfit for all branches and trades in military flying, except for spina bifida in the sacrum and 5th lumbar vertebra, if completely sacralized. When various congenital defects are considered, spina bifida at the SV1 level is relatively innocuous. However, an anomaly in the upper spinal regions is associated with the narrowing of the spinal canal, which may be accompanied by herniation of meninges. This could be exacerbated and lead to abrupt incapacitation during flight when a spine like this is subjected to high +Gz accelerations or ejection forces. This paper highlights a case of a fighter aircrew who was incidentally detected to have spina bifida at 1st dorsal vertebra level during evaluation for cervical prolapsed intervertebral disc and the aeromedical deliberations for its disposal.

Comparing the Effectiveness of Lumbar Traction and Mckenzie Exercises versus Mckenzie Exercises Alone on Pain, Range of Movement and Function on Individuals with Intervertebral Disc Prolapse

Background: Low back pain has a huge economic impact on any healthcare system. Prolapse in lumbar intervertebral disc (PIVD) can lead to the development of LBP. Until the moment, there is inconclusive evidence regarding the best treatment option for PIVD. Aim: The purpose of this research was to examine the effectiveness of lumbar traction and McKenzie exercises versus McKenzie exercises alone on pain, range of movement and function on individuals with PIVD. Methods: A randomised clinical trail study design was utilised in this research. Participants were divided into two groups. Group A received lumbar traction and McKenzie exercises and Group B received McKenzie exercises alone. Different outcome measures such as goniometer readings, Oswestry Disability Index and numeric pain rating scale were used. Quantitative data was represented using descriptive statistics, while qualitative data was depicted through frequencies and percentage. Various statistical analyses were conducted to interpret the collected data. Results: Thirty-two individuals took part in this study. Sixteen individuals were allocated in each group in this study. There was no statistical significant difference between both groups in terms of gaining more range of movement and restoring lost function (p>0.05). However, there was a significant statistical change between groups in favour of Group A in terms of pain reduction (p<0.05). Conclusion: The findings of this study suggest that it will be more beneficial to add lumbar traction to McKenzie exercises to achieve more pain reduction. It seems that adding lumbar traction helped to relieve pain as it might helped in relieving excessive pressure exerted between lumbar vertebrates.

Assessment of Pain and Neurological Involvement in Patients with Lumbar Intervertebral Disc Prolapse Who Underwent Fenestration Discectomy

Assessment of Pain and Neurological Involvement in Patients with Lumbar Intervertebral Disc Prolapse Who Underwent Fenestration Discectomy

Effectiveness of Lumbar Transforaminal Epidural Steroid Injection in Patients with Radiculopathy - A Prospective Observational Study

Background: Lumbar radiculopathy is a common condition characterized by pain radiating from the lower back to the lower limb, with high prevalence rates in the Indian population. Objectives: To evaluate the effectiveness of lumbar transforaminal epidural steroid injections in patients with radiculopathy. Materials and Method: The present study included 31 patients with intervertebral disc prolapse and radiculopathy confirmed by MRI. Patients received lumbar transforaminal epidural steroid injection and were assessed at baseline, immediately after, and at 6, 12, and 24 weeks using Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), and Patient Satisfaction Questionnaire-18 (PSQ-18). A statistically analysis was carried using the Friedman test and Post-hoc Wilcoxon signed rank test with p<0.005 as significant value. Results: Numerical Rating Scale (NRS) scores decreased substantially from 6.81 to 3.45 immediately after the procedure and remained low at 6-12 weeks (3.42-3.74), with a slight increase at 24 weeks (4.23). Similarly, Oswestry Disability Index (ODI) scores improved notably from 44.19 to 29.16 immediately after the procedure and remained improved at 6-24 weeks (30.00-33.48). Patient Satisfaction Questionnaire-18 (PSQ-18), showed a brief improvement post-procedure (4.09) but returned to near baseline levels (3.97-4.01) over the long-term follow-up period. These findings were statistically significant, with p-values of 0.000 for NRS, ODI, and PSQ-18 scores over follow-ups. Conclusion: Transforaminal epidural steroid injection is a safe and effective treatment for lumbar radiculopathy, providing short-term pain relief and functional improvement. However, long-term efficacy remains unclear, highlighting the need for further large-scale, long-term research to optimize treatment outcomes.

A Study of the Clinical Characteristics of Patients with Low Back Pain at a Single Center in Baghdad

Background: Low back pain is a prevalent and consequential problem in contemporary culture. In the early phases of their careers, many athletes who train particularly hard have considerable low back difficulties Aims of study is to enhance understanding and guide best management practices for those with or at risk of low back pain and to identify diverse aspects of clinical and epidemiological factors in Iraqis for low back pain. Patients and methods: A cohort of 440 individuals diagnosed with Low back pain (LBP) from the rheumatology department at Baghdad Teaching Hospital-Medical City in Baghdad province were involved in the current cross-sectional investigation. The sample consisted of 180 men and 260 women, with an average age of 45.7±14.8 years. The research was carried out from 12/October/2023 to 12 /March/2024. Results: All individuals in this study had LBP. The means age was 45 for the group of patients under consideration. 7 ± 14. 8 years. LBP had the highest incidence in the middle-aged (40-59 years 23%) and the lowest was recorded for the aged above 70 years (7. 5%). Females accounted for 59. 1% of the participants. Most of them; a percentage equivalent to 75. 5% were married. Approximately a third or 30% were employed while, 70.9% of the respondents were jobless. 6 % were overweight people and 77 % were non smokers in the study group. The mean age at the first complaint, visit and diagnosis of the disease were 43. 0 ± 14. 0 years (range: 11–75), 43. 3 ± 14. 2 years (range: McGregor observed that 11% to 78% of patients had some degree of in Continuation of Disturbances: Symptoms, defective vision, and 43. 5 ± 14. 2 years (range: 14–78),respectively. Intervertebral disc prolapse was the most frequent diagnosis among the patients with LBP (49. 8%), while infections were the least frequent (0. 2%). In the following aspects of the Oswestry Low Back Pain Disability Scores, majority participated as follows; 44. 3% with fairly severe pain intensity, 42% who require some help with personal care but mostly manage with it, 39. 5% who lift heavy weights but manage light to medium weights, 34. 1% who are prevented from walking more than 100 yards by their pain, 37. 5 The Analyzed Oswestry Low Back Pain Disability Score mean was 22. 22 ± 7. 26. Conclusion: LPB has a higher frequency among the female population

The impact of yoga therapy on lumbar intervertebral disc prolapse: A systematic review

ABSTRACT This systematic review is aimed to evaluate the effect of yoga therapy on lumbar intervertebral disc prolapse (LIVDP) also known as lumbar disc herniation (LDH). Databases such as PubMed/Medline, Cochrane Library, Science Direct, and search engine Google Scholar were searched from 2007 to 2024. Randomized control trials (RCTs), case studies, and quasi-experimental studies involving yoga therapy and LIVDP/LDH were included in the study. The PRISMA guidelines were followed to extract the 10 articles for the study. The primary outcomes included disability scores, pain intensity, nerve conduction, and structural changes. 10 studies involving 546 patients were included in the study. The average sample size of the studies was 54.6 patients. The length of intervention varied from 3 weeks to 4 months with an average of 2 sessions/week. This study demonstrated that yoga therapy is an effective, affordable, and preventive treatment for LIVDP and low back pain. However, additional high-quality, large-scale RCTs and studies are needed for clinically significant results.

Comparison of the Clinical Effects of Unilateral Biportal Endoscopic and Microscopic Lumbar Discectomy

Introduction : Micro discectomy is the surgical procedure of choice for treating lumbar disc herniations. A laminectomy can cause instability, significant epidural fibrosis, continued radiated pain, and surgical site infection, although there is still concern about the dangers of muscle damage, such as to the multifidus, and excessive articular facet resection. Unilateral biportal endoscopic discectomy has been suggested as a less invasive therapeutic approach.Objective: To compare the clinical effects in terms of pain, impairment, and complications associated with percutaneous endoscopic lumbar discectomy with standard micro discectomy for the treatment of disc herniations. Materials and methods: A study of 60 people with disc herniations who were treated with either microdiscectomy or unilateral biportal endoscopic lumbar discectomy. The Oswestry Disability Index and visual analogue score for back and leg pain was evaluated after three, six, and twelve months. Results: In comparison to Group E, Group M's mean operating time was substantially lower (p<0.05). In addition, it took group M more time on average to get back to work. (p<0.05), and the VAS score at 3 showed a statistically significant change (p<0.05). At three months, group M's Oswestry Low Back Pain Disability score was considerably greater than group E's. (p<0.001). Conclusion: In terms of a three-month return to work and wound infections, endoscopic surgery has a little advantage over microscopic surgery. Both techniques are efficient and safe for lumbar discectomy. However, after 6 months of follow-up, the results seem to be comparable. Keywords: Intervertebral Disc Prolapse, Discectomy, Endoscopy, Intervertebral Disc, Micro Discectomy, Visual Analog Scale, Oswestry Low Back Pain Disability Score

Clinical correlation of Magnetic Resonance Imaging (MRI) with symptom complex in prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian.

Objective: To assess the clinical correlation of MRI with the symptoms of prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian. Study Design: Cross Sectional study. Setting: Tertiary Care Hospital, Kharian. Period: February 2022 to August 2022. Methods: The patients with age range 18 to 50 years, visiting hospital with complaint of low back pain and radicular pain were included in this study. Physical and neurological examination was conducted followed by MRI. The symptoms were correlated with MRI findings through correlation analysis with p<0.05 as significant. Results: The mean age was 38.09 ± 8.4 years with majority (54.6%) of patients in age range 41 to 50 years. The male patients (69.3%) and hard labor workers (59.3%) were more effected. Protrusion was the most prevalent type (60%). SLR was significantly associated with disc bulge and protrusion (p<0.001). The loss of power (56.6%) had significant correlation with disc protrusion (p < 0.001). Majority (55.3%) of the cases comprised of nerve root compression with more (47.3%) and significant prevalence in protrusion (p < 0.001). The multiple nerve root involvement had significant association with disc extrusion (p<0.001). Conclusion: MRI is a good means of indicating disease level in prolapsed intervertebral disc disease. However, some of the clinical symptoms show high association with the radiological findings, whereas, some are not good indicators.

Correlation Between Direction of Prolapsed Intervertebral Disc (PIVD) And Lumbar Vertebral Alignment

Abstract Purpose: The purpose of this research was to establish a link between direction of a prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment. Methods: This cross-sectional study included 102 participants with prolapsed intervertebral discs in the lumbar segment and lumbar vertebral mal-alignment of both sexes between the ages of 30 and 50 who had undergone MRI and X-ray for the lumbo-sacral spine. The Numerical Pain Rating Scale (NPRS) was used to assess outcome, MRI scans were used to determine the direction and amount of PIVD, and lumbar spinal alignment was assessed using X-rays in the AP and lateral views. SPSS version 26.0 was used for statistical analysis. Findings: Among the 102 participants, The study found that only 2.94% of 102 participants had Prolapsed Intracranial Disc Disease (PID) at the L1-2 level, with many on multiple levels. Prolapsed intervertebral discs were prevalent in 46.07% of individuals, with scoliosis in 33.33%, exaggerated lumbar lordosis in 4 subjects, and anterolisthesis in 20.59%. The study found a significant correlation between posterocentral and anterolisthesis, biforaminal and flatback, right paracentral and left paracentral prolapse and scoliosis (p<0.0001), with biforaminal direction being particularly significant for anterolisthesis and retrolisthesis (p=0.0050, 0.0014). The lumbosacral angle had a mean value of 31.79, and the mean of pain on rest was 1.99±1.38 and during activity was 5.51±1.66. Conclusion: It concluded that there was a significant relationship between the direction of prolapsed intervertebral disc (PIVD) and lumbar vertebral alignment.

Cloward Procedure Outcome using Hashmi Cage for Anterior Cervical Discectomy and Fusion Experience in Pakistan

Abstract: Background: We aim to focus on ACDF patients treated with Hashimi cage filled with autologous bone. We will assess the safety of this approach based on the specific surgical level and its outcome. Objective: Study aims to evaluate the results of the Hashmi cage used in the Cloward Procedure while using odom’s based criteria for the outcome. Materials and Methods: This was a descriptive study researched at the Neuro Spinal Cancer Care Institute in Karachi, time duration from 16 June 2016 to 31 June 2022. The study included patients with a single-level prolapsed intervertebral cervical disc. During the surgery. Bony Fusion was assessed using movement ≤ 1 mm in flexion and extension cervical X-rays, was required. Result: We had 162 patients; among them males were 102 (62.96%) and female patient were 60 (37.03%). The median range for the age was from 23 to 63 years with mean 48 years ± 3.6 age. Clinically the patients presented with radiculopathy, commonly of the C6 level which was patients (63.73%). Odom’s based criteria were used to evaluate the results of the procedure. Among the patients, 92.84% showed excellent outcomes, 4.9% had good results, 1.8% had fair outcomes, and 1.23% had a poor outcome. Conclusion: ACDF with the Hashmi cage and plate application is a highly effective treatment option. This approach not only ensures better removal of the problematic discs but also significantly increases the likelihood of successful fusion and better radiological outcomes.

Acute Pain Management in Vatakaphaja Gridhrasi

Gridhrasi is one of the Vataja Nanatmaja Vyadhi in which the vitiated Vata afflicts the Kandara and Sira of lower limb leading to Stambha, Ruk, Toda along with Spandana starting from Kati Pradesha to Prustha, Janu, Jangha and Pada of either one side or both side of the lower limbs. Due to similarities in the clinical presentation, it can be studied under the spectrum of Intervertebral Disc Prolapse of lumbar spine. It is a condition affecting the spine in which the annulus fibrosus is damaged enabling nucleus pulposus to herniate, due to which there will be compression of Spinal Cord or the exiting nerve roots causing severe pain in the low back radiating to lower limbs. The incidence of Herniated disc is about 5 to 20 cases per 1000 adults annually and is most common in male patients when compared with female. In this case a male patient of age 36 suffering with acute pain in the low back region was effectively managed by Nadi Sweda followed by dry cupping for 7 days, followed by Patra Pinda Sweda for 7 days. The study shows significant relief in the pain and remarkable improvement in the range of movement of lumbar spine.

A Case Study with Six-Week Physiotherapy Rehabilitation Intervention on Intervertebral Disc Prolapse Disorder

This article describes the case of an adolescent female with lumbar disc herniation characterized by chronic low back pain (LBP) and antalgic gait. A 27-year-old woman presented with chronic low back pain and subsequent deterioration in her quality of life and impairment in activities of daily living. The patient was evaluated and diagnosed based on her medical history, clinical examination and imaging. She had shown failure in both her symptomatic and functional improvement in natural history and conservative management due to an injury to the facet joint of her lower lumbar spine. Pain radiating to the lower extremities in a young adolescent should be considered, especially in cases of minor trauma or when her LBP becomes chronic. Further research is needed on the long-term effects of such disc injuries in young adults and how best to conservatively manage these patients. Includes discussion of disc herniation pain associated with adolescent disc injuries.

Comparison Between Clinical Findings and Magnetic Resonance Imaging Findings in Lumbar Prolapsed Intervertebral Disc

Introduction: Lumbar prolapsed intervertebral disc is commonly associated abnormality with lower backache. Disc herniation of same size can be asymptomatic in one patient and agonizing in another patient. Magnetic resonance imaging (MRI) is a gold standard diagnostic investigation for prolapsed intervertebral disc. Despite of high sensitivity sometimes MRI shows abnormal findings even in the asymptomatic individuals indicating a moderate relationship between MRI and symptoms in the patient. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Methodology: A descriptive cross-sectional study was conducted from 20 December 2021 to 15 September 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 078/78-009/HG). A convenience sampling method was used. The study consisted of patients with low back pain and radiation to lower extremity or patient with MRI scan of lumbar spine. Clinical and MRI findings were correlated to know the association and significance of MR findings in producing symptoms. Results: The study included 68 patients with back pain between 18 to 55 years (mean 41± 8.79 years). Neurological symptoms were present in 26 (38.23%) patients. Disc bulge in MRI was noticed in 48 (45.28%), protrusion in 46 (43.39%) and extrusion in 10 (11.32%) levels, most seen at L5-S1 level (66.11%). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.69), but not all disc bulges produced symptoms. Conclusion: Clinical features and Magnetic resonance imaging findings of disc prolapse had significant correlation similar to other studies done in a similar setting, but all imaging abnormalities may not have a clinical significance. Keywords: magnetic resonance imaging; intervertebral disc; prolapse; radiculopathy; correlation of data.

RELATIONSHIP BETWEEN THE RISK FACTORS AND LOWER BACK PAIN (LBP) AMONG LOCAL POPULATION OF KARACHI

Low back pain is a widespread issue affecting a significant portion of the population and is a leading cause of work-related absences. Approximately 80% of individuals experience low back pain at some point in their lives. This study involved a sample of 140 subjects selected from three universities. The research was observational, utilizing non-probability convenience sampling. The study comprised 140 patients primarily complaining of low back pain, with 42% attributing their symptoms to specific spinal injuries or lifting heavy objects, while 58% reported non-traumatic pain with a gradual onset. Among the patients, 54% experienced localized pain, while 46% had radiating pain. Magnetic Resonance Imaging (MRI) was conducted on all 140 patients, revealing that 48% suffered from Prolapsed Intervertebral Disc (PIVD), while the remaining 52% dealt with mechanical backaches, degenerative disorders, infective issues, and metabolic disorders. The affected vertebrae levels included L4-L5, L5-S1, L3-L4, and L2-L3. Surprisingly 98% had no awareness of their postural habits, therefore there is need to make the people aware about it.

Functional Outcomes and Successful Predictors of Lumbar Transforaminal Epidural Steroid Injections (LTFESIs) for Lumbar Radiculopathy Under Fluoroscopic Guidance: A Prospective Study.

Lumbar radiculopathy, a common and debilitating condition, often necessitates a multimodal approach for effective management. Lumbar transforaminal epidural steroid injection (LTFESI) has emerged as a valuable therapeutic option when conservative measures fall short. Recent interest in long-acting and non-particulate steroids prompts a critical examination of their impact on LTFESI outcomes. This prospective study aims to evaluate the efficacy of LTFESI in improving pain and functional outcomes in patients with lumbar radiculopathy, focusing on long-acting and non-particulate steroids, and analyse the associated economic burden. The study, conducted from October 2017 to April 2019, involved 52 patients with lumbar radiculopathy meeting specific criteria. LTFESI was administered using a hospital-based prospective design. Functional outcomes were assessed using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) scores at various intervals. Statistical analyses were performed to identify predictors of successful outcomes. Participants (average age 43.22 years, 27 (51.92%) male) exhibited diverse Michigan State University (MSU) grade profiles and predominantly had pathology at the L4-5 level. The study demonstrated a significant and lasting functional improvement in 43 (82.69%) of patients after LTFESI. Patients with 2AB-type intervertebral disc prolapse (IVDP) showed lower response rates, emphasizing subtype influence. The efficacy of LTFESI was sustained for up to six months in almost 82.69% of patients, highlighting its potential for long-lasting benefits. The difference in the mean ODI score pre-injection and six months post-injection is statistically significant (p<0.0001). A total of four patients (7.69%) underwent surgical treatment for lumbar radiculopathy as their symptoms did not improve after injection. For all four patients (7.69%), surgery was done one month after injection. Five patients (9.61%) had ODI scores of more than 40, indicating severe disability at the end of six months. So, in nine patients (17.3%), the injection given was not effective at the end of six months, four (7.69%) of whom were operated on and five (9.61%) patients received conservative treatment. Thus, 43 (82.69%) of patients had a good outcome. The study reinforces LTFESI as an effective and safe intervention, providing substantial and lasting benefits for lumbar radiculopathy. The majority experienced immediate relief, supporting its role as an intermediate option between conservative management and surgery. Identified predictors of decreased success underscore the importance of early intervention and tailored treatment plans. The study emphasizes LTFESI's diagnostic and therapeutic potential, with economic benefits and safety highlighted. LTFESI emerges as a safe and effective intervention for lumbar radiculopathy, offering substantial and enduring pain relief. The study contributes valuable insights into the nuanced outcomes of LTFESI, including the impact of IVDP subtypes, factors influencing success, and the procedure's cost-effectiveness. While acknowledging limitations, this work adds to the growing evidence supporting LTFESI as a crucial component in the management of lumbar radiculopathy.

ULTRASONOGRAPHY AS AN INTRAOPERATIVE TOOL FOR LOCALIZATION OF THE ANATOMICAL LEVEL IN LUMBOSACRAL SPINE SURGERIES

Aims and Objectives: The aims and objectives of the study are to find the effectiveness of ultrasound as a pre-operative adjunct to localize the anatomical intervertebral level of interest and study its accuracy by comparing it with the gold standard intra-operative fluoroscopy and to study factors affecting localization of anatomical vertebral level by ultrasound. Methods: This was a prospective study conducted in the Department of Neurology Department of Neurosurgery and Neuroimaging and Interventional Radiology, NIMHANS Hospital, Bengaluru, over a period of 1 year. 50 cases of lumbosacral degenerative diseases were included in this study on the basis of pre-defined inclusion and exclusion criteria. All patients underwent ultrasonography of the lumbosacral spine followed by pre-operative X-ray of the lumbosacral spine using the C-ARM. The accuracy of good localization of the desired level of the lumbosacral spine by ultrasound as compared to X-ray was determined. p&lt;0.05 was taken as statistically significant. Results: There were 22 (44%) males and 28 (56%) females with a M: F ratio of 1:1.27. The mean age was 46.7±13.5 years. 46 (92%) cases were diagnosed with prolapsed intervertebral disc (PIVD) and 4 (8%) cases with Grade II spondylolisthesis radiologically. Good localization which constitutes exact localization, close upper, and close lower localization added up to 82% of the cases (41/50) and the rest 18% were tagged as poor localization (9/50). The accuracy of good localization in both the groups of PIVD and spondylolisthesis (listhesis) was 82.6% and 75%, respectively. Conclusion: Ultrasound can be used as an exceptionally good and accurate method of localizing the anatomical intervertebral level for patients undergoing various lumbosacral spinal surgeries.

Effect of Agnikarma with Kshoudra over Ankle and Foot in Sciatica due to L4-L5 Intervertebral Disc Prolapse

Sciatica is a syndrome characterized by pain radiating from the low back into the buttock and into the lower extremities along its posterior or lateral aspect and most commonly caused by prolapse of lumbar intervertebral disc. The term is also used to refer the pain anywhere along the course of sciatic nerve. Modern medical practice for sciatica includes oral NSAIDs, opioid and non-opioid analgesics, muscle relaxants, localized corticosteroid injections, physiotherapy and if the above measures fail finally surgery. Sciatica can be correlated with Gridhrasi mentioned under Vata vyadhi in Ayurvedic classics. Various treatment modalities like Snehana, Swedana, Vasthi etc are indicated in Gridharsi. These are very effective treatment procedures but take relatively a more time for pain relief. Agnikarma is very beneficial in painful conditions caused by Vata as it gives immediate relief of pain. Here the patient was treated with Agnikarma using Kshoudra over the tender spots of ankle and foot of affected lower limb. Outcome measures like pain, numbness, tenderness, SLR and ODI were assessed before treatment, after treatment, 7th day and on 14th day. The result showed that Agnikarma with Kshoudra done over ankle and foot gives immediate relief of pain and numbness of sciatica due to L4-L5 intervertebral disc prolapse.