Herniated Nucleus Pulposus Research Articles

Physical capability and patient-reported well-being after spinal surgery: a 20-year cohort from the Kuopio Osteoporosis Risk Factor and Prevention study combined with the Finnish Care Register for Health Care.

Studies investigating the effect of spinal surgery on both physical capability (PC) and subjective well-being (SW) are scarce. We aimed to investigate self-reported PC and SW up to 20 years after lumbar spine surgery. 6,612 postmenopausal Finnish women (47-56 years at baseline [BL]), from the Osteoporosis Risk Factor and Prevention (OSTPRE) study, were followed-up (FU) for 20 years. The Finnish Care Register for Healthcare (CRFH) provided data on surgery in the OSTPRE population on lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH). PC and SW of women with lumbar surgery was compared with that of women without lumbar surgery. A chi-square analysis was conducted to analyze the statistical differences in the distribution of PC and SW. A propensity score-matched control analysis was also performed in addition to analysis of the total populationbased control group. In women without lumbar surgery 94% reported good PC at BL, which decreased to 79% at the 20-year FU. For those with LSS/LDH surgery, 84%/(37/50) reported good PC at BL and 80%/(33/50) at 20-year FU, respectively. Good SW was reported by 48% of the control group at BL, 50% at 10-year FU, and 42% at 20-year FU. Women with LSS/LDH surgery before the 10-year FU reported good SW as follows: (6/50)/38% at BL, (12/48)/39% at 10-year FU, and (9/50)/37% at 20-year FU. Patients with LSS and LDH report lower PC and SW. Lumbar spinal surgery improves PC and SW in the short term, with early LDH surgery showing the greatest benefits whereas late surgery did not. Overall, PC and SW are lower both initially and during the 20-year FU when compared with the age-matched controls except for early LDH surgery.

PENGARUH PEMBERIAN TENS DAN McKENZIE EXERCISE TERHADAP PENINGKATAN FUNGSIONAL LUMBAL PADA PENDERITA ISCHIALGIA AKIBAT HNP LUMBAL DI RSUD PANGKAJENE DAN KEPULAUAN

Background: Ischialgia is pain that is felt along the sciatic nerve and continues along the leg. Ischialgia can be caused by a herniated nucleus pulposus which causes radicular pain due to disc pressure on the nerve roots exiting the intervertebral foramen. Ischialgia can cause functional lumbar barriers in carrying out daily activities, especially sitting for a long time, walking long distances and standing for a long time.Methods: This study was a pre-experimental study with a one group pretest-posttest design, aiming to determine the effect of TENS and McKenzie Exercise on improving lumbar function in patients with ischialgia due to lumbar HNP. This research was conducted at Pangkajene and Kepulauan Hospital, with the sample being ischialgia sufferers due to lumbar HNP who fit the inclusion criteria. The number of samples was 28 people who were given treatment in the form of TENS and McKenzie Exercise 12 times. Lumbar functional measurement using the Oswestry disability index.Results: Based on the descriptive test in this study, the mean lumbar functional value before treatment was 44.839 to 29.336 with a difference of 15.504 after treatment. The statistical results using the Wilcoxon test show that p = 0.000 is less than α = 0.05 (p < α) which means that the working hypothesis is accepted.Conclusion: TENS and McKenzie Exercise have a significant effect on improving lumbar function in patients with sciatica due to lumbar HNP.Keywords: Transcutaneous Electrical Nerve Stimulation, McKenzie Exercise, Lumbar Functional, Lumbar HNP

The Influence of Systolic Blood Pressure at the Time of Extubation on the Development of Postoperative Spinal Epidural Hematoma.

The most common cause of neurological complications after a biportal endoscopic spine surgery (BESS) is postoperative spinal epidural hematomas (POSEH). The objective of this study was to determine the influence of systolic blood pressure at extubation (e-SBP) on POSEH. A total of 352 patients who underwent single-level decompression surgery including laminectomy and/or discectomy with BESS under the diagnosis of spinal stenosis and herniated nucleus pulposus between August 1, 2018, and June 30, 2021, were reviewed retrospectively. The patients were divided into two, a POSEH group and a normal group without POSEH (no neurological complication). The e-SBP, demographic factors, and the preoperative and intraoperative factors suspected to influence the POSEH were analyzed. The e-SBP was converted to a categorical variable by the threshold level that was decided by maximum area under the curve (AUC) in receiver operating characteristic (ROC) curve analysis. Antiplatelet drugs (APDs) were taken in 21 patients (6.0%), discontinued in 24 patients (6.8%), and not taken in 307 patients (87.2%). Tranexamic acid (TXA) was used in 292 patients (83.0%) in the perioperative period. Of the 352 patients, 18 patients (5.1%) underwent revision surgery for the removal of POSEH. The POSEH and normal groups were homogenous in age, sex, diagnosis, operation segments, operation time, and lab findings that were related to blood clotting, whereas there were differences in e-SBP (163.7 ± 15.7 mmHg in POSEH group and 154.1 ± 18.3 mmHg in normal group), APD (4 takers, 2 stoppers, 12 non-takers in POSEH group and 16 takers, 22 stoppers, 296 non-takers in normal group), and TXA (12 use, 6 not use in POSEH group and 280 use, 54 not use in normal group) in single variable analysis. The highest AUC in the ROC curve analysis was 0.652 for 170 mmHg e-SBP (p < 0.05). There were 94 patients in the high e-SBP group (≥ 170 mmHg) and 258 patients in the low e-SBP group. In multivariable logistic regression analysis, only high e-SBP was a significant risk factor for POSEH (p = 0.013; odds ratio, 3.434). High e-SBP (≥ 170 mmHg) can influence the development of POSEH in biportal endoscopic spine surgery.

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.

INTERLAMINAR ENDOSCOPIC LUMBAR DISCECTOMY - CLINICAL OUTCOME

ABSTRACT Objective: Evaluate the clinical outcome of patients with lumbar disc herniation (HDL) operated by endoscopic interlaminar microdiscectomy. We evaluated epidemiology, time to return to work, and technique-related complications as secondary outcomes. Method: Prospective longitudinal study, where patients with HDL with surgical indications were evaluated. They underwent endoscopic discectomy exclusively using the interlaminar technique. Clinical results were evaluated using the Oswestry 2.0 questionnaire (ODI) and the visual analog scale (VAS). In this study, we inserted the Macnab postoperative satisfaction index. In parallel with these indices, we analyzed the results regarding epidemiology variables, time to return to work, and complications. Such questionnaires were applied preoperatively, postoperatively the day after surgery, and one year after. Results: In 132 patients selected for the study, we obtained significant clinical improvement in the ODI and VAS questionnaires, and 81.3% of the patients had excellent and good Macnab index. The hospital stay was 22.7 hours, and the return to work was 30 days. The rate of complications with the method was 12.8%, with recurrence of disc herniation being the most common complication with 9.8% of cases. Conclusion: The endoscopic technique proved effective in treating lumbar spinal disc herniation with significant clinical improvement in the analyzed period, low incidence of complications, early postoperative rehabilitation, and results close to or superior to the gold standard technique. Level of Evidence III; Prospective cohort study

Rehabilitation after Surgical Intervention on Patients with Disc Herniation

Disc herniation is pathologically divided into four stages of herniated nucleus pulposus: 1) bulging, 2) protrusion, 3) extrusion, 4) sequestration. The most important symptom of disc herniation is pain. Patients with symptoms undergoing urgent surgical intervention are 2% of the total. The aim of this study is to establish the efficiency of the physical therapy applied to patients after disc herniation surgery. The research covered 89 patients who had undergone lumbar spine surgery – 47 (or 52,8%) women and 42 (or 47,2%) men. The data was processed through basic descriptive statistical parameters: frequencies and percentage. The non-parametric methods that were applied were the χ2 test and the Mann-Whitney U test. The following conclusions can be drawn from the obtained data: disc herniation was most often located in L5-S1 in 47,2% of the cases, then in L4-L5 in 46%, and in L3-L4 in 6,7%; in 51,68% of the cases, the disc herniation was located on the right side, and in 48,3% on the left side; the muscle grade before dorsiflexion surgery was 1 in 2,2% of the patients, 2 in 5,6%, 3 in 10,1%, and 4 in 82,0%; the muscle grade after dorsiflexion surgery was 2 in 1,1% of the respondents, 3 in 6,7%, 4+ in 22,5%, and 5 in 69,7%; the muscle grade before plantarflexion surgery was 2 in 5,6% of the respondents, 3 in 7,9%, and 4- in 86,5%; the muscle grade after plantarflexion surgery was 3 in 3,4% of the respondents, 4 in 14,6%, and 5 in 82,0%.

Letter: Neurolysis Versus Nerve Release: Is It Time for a Change in Terminology?

To the Editor: The decompression of nerves is a primary tenant of nerve surgery and represents the most common technique for improving nerve function in the setting of compressive neuropathies. Despite neuronal decompression being the most common technique used by surgeons practicing nerve surgery, the terminology regarding these procedures remains archaic and nonspecific. Specifically, the term neurolysis is a frequently used term for both decompressive procedures and destructive procedures of the nerve. The term neurolysis is derived from the Greek terms “vevpo” meaning neuro and “Λύσις” meaning loosening, breaking down, or decompensation.1 Within medicine, the term neurolysis is frequently used to describe both destructive procedures and decompressive procedures making terminology confusing to both trainees and professionals alike. For instance, although neurolysis of the median nerve for carpal tunnel syndrome is a common procedure involving decompression with intentional preservation of the nerve, neurolysis is also used to describe destructive lesioning as in cryotherapy or radiofrequency ablation.1,2 This terminology is rooted in history as well with the first report of chemical neurolysis being described by Luton in 1863 and later in 1904 by Schloesser who was the first to report an alcohol neurolysis for the treatment of trigeminal neuralgia.3 By the same token, other techniques involving the suffix ‘lysis’ have similar implication. Chemonucleolysis meant chemically dissolving the herniated nucleus pulposus.4 Hemolysis refers to destruction of red blood cells. As our knowledge and technical capabilities continue to evolve, we owe it to ourselves and the future of our field to also evolve our terminology to be accurate, precise, and minimize confusion. Given this, the authors suggest that nerve release or decompression be the preferred term and neurolysis be reserved for referencing destructive techniques. We believe that this should also be fixed in coding terminology.

Investigation of macrophage polarization in herniated nucleus pulposus of patients with lumbar intervertebral disc herniation.

Macrophage infiltration and polarization during lumbar intervertebral disc herniation (LDH) have attracted increased attention but their role remains unclear. To explore macrophage polarization in herniated nucleus pulposus (NP) tissue of patients with LDH and investigate the association between cell frequency and different clinical characteristics or symptoms, we conducted a retrospective study by analyzing NP tissue samples from 79 patients. Clinical features and symptoms, using the visual analog scale (VAS) and Oswestry disability index (ODI), were collected. The macrophage markers CD68, CCR7, CD163, and CD206; pro-inflammatory cytokine TNF-α; and anti-inflammatory factor IL-4 were analyzed by immunohistochemistry. The frequency of polarized macrophages and positivity rate of pro- and anti-inflammatory cytokines showed significant differences in some of clinical characteristics. Specifically, higher CCR7+ and TNF-α + proportions were identified in the high-intensity zone (HIZ) and the type of extrusion and sequestration NP tissue than in non-HIZ and protrude NP tissue. Higher CD206+ and IL-4+ proportion were detected in Modic changes. However, no differences in gender, age, smoking status, Pfirrmann grade, analgesic use, leg pain duration, and segments were found between groups. CD68+ , CCR7+ , and CD206+ cell proportions, and TNF-α and IL-4 showed positive associations with VAS scores preoperation. Associations between ODI and the macrophages markers were weak/insignificant. Our results indicated that macrophage polarization or macrophage-like cells contribute to LDH pathological features. Macrophage populations displaying significant associations with VAS score reflected continuous M1/M2 transition contributing to pain during LDH. These findings may contribute to enhanced/personalized pharmacological interventions for patients with LDH considering pain heterogeneity.

Gene expression profiling in nucleus pulposus of human ruptured lumbar disc herniation.

Purpose: To examine the differences in gene expression between ruptured and non-ruptured nucleus pulposus tissues of the intervertebral discs using gene chip technology. Methods: A total of 8 patients with nucleus pulposus from a lumbar disc herniation (LDH) undergoing discectomy in our hospital were selected, including 4 ruptured and 4 non-ruptured herniated nucleus pulposus cases. Total RNA was extracted from cells by using TRIzol reagent. Nucleus pulposus cDNA probes of the two groups were obtained by the single marker method and hybridized with a human gene expression profiling chip (Agilent). The fluorescence signal images were scanned by a laser, and the obtained genes were analyzed by bioinformatics. Results: There were 75 differentially expressed genes with more than 2-fold-changes, of which 56 were up-regulated and 19 were down-regulated. The differential expression of THSD7A, which was up-regulated 18 times, was the most significant, followed by CCL5, AQP3 and SDC4. Conclusion: THSD7A can be used as a characteristic differentially expressed gene in human ruptured nucleus pulposus. Moreover, CCL5, AQP3 and SDC4 may improve the chemotaxis of stem cell migration for self-healing of damaged disc tissue, increase water uptake by nucleus accumbens cells, and inhibit the inflammatory response, thus delaying the process of intervertebral disc degeneration.

Comparison between single-segment Isobar EVO dynamic stabilization and Isobar TTL dynamic stabilization in the treatment of lumbar degenerative diseases: a single center retrospective study over 4 years

ObjectivePosterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis and disc herniation. However, fusion can affect daily activities due to lumbar stiffness. In recent years, dynamic stabilization has been introduced to overcome the drawbacks of fusion, however, it is inconclusive whether dynamic stabilization requires the maintenance of a level of activity that is closer to the physiological state of activity for better clinical efficacy. The purpose of this study was to compare the effectiveness of dynamic stabilization with different levels of activity (Isobar EVO and TTL) in the treatment of spinal stenosis and disc herniation.MethodsThis study retrospectively reviewed 80 consecutive patients with lumbar degenerative diseases who were undergoing surgical treatment between March 2014 and July 2018. 41 patients (EVO group) and 39 patients (TTL group) underwent fenestrated decompression with Isobar EVO stabilization and Isobar TTL stabilization, respectively. Clinical outcomes, radiographic data, and postoperative complications were compared between the two groups.ResultsAt an average follow-up of 52.23 ± 2.97 months, there were no significant differences in the oswestry disability index (ODI) (P > 0.05). The visual analog scale for back pain (VASback) and visual analog scale for the leg pain (VASleg) of the EVO group were lower compared with the TTL group (P < 0.05). The range of motion (ROM) of operated segments were significantly higher in the EVO group as compared to the TTL group (P < 0.05). The intervertebral space height (ISH) of upper adjacent segments were significantly higher in the EVO group as compared to the TTL group (P < 0.05). The overall complications were less in the EVO group, but the difference was not statistically significant (P > 0.05).ConclusionBoth Isobar EVO dynamic stabilization and TTL dynamic stabilization can improve clinical outcomes of patients with spinal stenosis and disc herniation. Isobar EVO has advantages over Isobar TTL in terms of improving low back and leg pain, maintaining mobility of the operated segment, and preventing further degeneration of the upper adjacent segment.

Characteristics of interbody bone graft fusion after transforaminal lumbar interbody fusion according to intervertebral space division.

According to intervertebral space division, the characteristics of interbody bone graft fusion after transforaminal lumbar interbody fusion (TLIF) were assessed via computed tomography (CT) scan to provide a theoretical basis for selecting the bone grafting site of interbody fusion. The medical records of 57 patients with lumbar spinal stenosis and disc herniation treated with TLIF were analysed retrospectively. In total, 57 segments received lumbar interbody fusion. A thin-layer CT scan was performed to evaluate fusion in each zone of the fusion space. The fusion rates were 57.89% (n = 33) in the anterior cage zone, 73.68% (n = 42) in the posterior cage zone, 66.67% (n = 38) in the decompression zone, 26.32% (n = 15) in the contralateral decompression zone and 94.74% (n = 54) in the inner cage zone. There were significant differences among the fusion rates of the five zones (P < 0.001). Further pairwise comparison revealed that the fusion rates in the inner cage significantly differed from the anterior and posterior cages and decompression and contralateral decompression zones (P = 0.001, 0.002, 0.001 and 0.001, respectively). We think the central cage zone (i.e., inner cage) should be the focus of bone grafting. Although there is small volume of bone graft on the posterior cage zone, the fusion rate is relatively high, only secondary to the inner cage zone. The fusion rate is of the contralateral decompression zone is lower although there is a bone graft.

Identification of compositional and structural changes in the nucleus pulposus of patients with cervical disc herniation by Raman spectroscopy.

PurposeCervical disc herniation (CDH) is one of the most common spinal diseases in modern society; intervertebral disc degeneration (IVDD) has long been considered as its primary cause. However, the mechanism of intervertebral disc degeneration is still unclear. The aim of the study is to examine the components and structures of proteoglycan and collagen in cervical disc herniated nucleus pulposus (NP) using a validated and convenient Raman spectra technique and histological methods to further elucidate the mechanism of IVDD at the microscopic level.MethodsOur study used a burgeoning technique of Raman spectroscopy combined with in vitro intervertebral disc NP to characterize the above mentioned research purposes. Firstly, we collected cervical disc NP samples and imaging data by certain inclusion and exclusion criteria. Then, we graded the NP of the responsible segment according to the patient’s preoperative cervical magnetic resonance imaging (MRI) T2-weighted images by Pfirrmann grading criteria while measuring the T2 signal intensity value of NP. In addition, the structure of the NP samples was evaluated by histological staining (H&E staining and Safranin-O staining). Finally, the samples were scanned and analyzed by Raman spectroscopy.ResultsA total of 28 NP tissues from 26 patients (two of these patients were cases that involved two segments) with CDH were included in this study. According to the Raman spectroscopy scan, the relative content of proteoglycans which is characterized by the ratio of the two peaks (I 1,064/ I 1,004) in the NP showed a significantly negative correlation with Pfirrmann grade (P < 0.001), while the collagen content and the NP intensity value showed a positive correlation (P < 0.001). For the microstructural characterization of collagen, we found that it may have an essential role in the degenerative process of the intervertebral disc. Moreover, histological staining (H&E staining and Safranin-O staining) showed the general structure of the NP and the distribution of macromolecules.ConclusionThe present study demonstrated the possibility of characterizing the macromolecular substances inside the cervical disc NP tissue by Raman spectroscopy. It also confirmed that macromolecular substances such as proteoglycans and collagen have some degree of alteration in content and structure during degeneration, which has a further positive significance for the elucidation of CDH’s mechanism.

Disc degeneration contributes to the denser bone in the subendplate but not in the vertebral body in patients with lumbar spinal stenosis or disc herniation

BACKGROUND CONTEXTIt is commonly believed that decreased bone quality would lead to endplate degeneration and arthritic changes in the facet joints, and thus accelerated disc degeneration (DD). However, some more detailed studies of vertebral bone structure have found that bone mineral density (BMD) in the vertebral body is increased rather than decreased in moderate or greater disc degeneration. The relationship between BMD and DD still needs further study. MRI-based vertebral bone quality scores have been shown to be effective in reflecting BMD, rendering a new way to evaluate the changes of vertebral body bone with DD using MRI alone. PURPOSETo evaluate MRI-based vertebral bone quality and Pfirrmann grades in patients with lumbar spinal stenosis or disc herniation, and to identify if DD is associated with denser bone around the endplate. STUDY DESIGN/SETTINGA single-center, retrospective cohort study. PATIENT SAMPLEA total of 130 patients with lumbar disc herniation and lumbar spinal stenosis from January 2019 to November 2020 who had a complete dual-energy X-ray absorptiometry scan and noncontrast lumbosacral spine MRI data. OUTCOME MEASURESThe vertebral bone quality score (VBQ) and sub-endplate bone quality score (EBQ) was calculated as a ratio of the signal intensity of the vertebral bodies and sub-endplate regions to the signal intensity of the cerebrospinal fluid at L3 on the mid-sagittal T1-weighted MRI images, respectively. The Pfirrmann grades of the lumbar discs were assessed as well. METHODSThe age, gender, body mass index, and T-score of the lumbar spine of the patients were collected. The degeneration grades of the lumbar discs were evaluated according to the Pfirrmann classification. VBQ and EBQ were measured through T1-weighted lumbar MRI. The VBQ and EBQ scores were compared between cranial and caudal sides. The correlation between MRI-based bone quality and DD was calculated. A linear regression model was used to examine the association between DD and adjacent EBQ and VBQ. RESULTSThis study included 569 lumbar segments from 130 inpatients. Cranial and caudal EBQ decreased with the increase of the Pfirrmann grade. The discs with Pfirrmann grade 5 had significantly lower caudal EBQ than the discs with Pfirrmann grades 2, 3, and 4. In the osteoporosis patients, the Pfirrmann grades negatively correlated both with the cranial EBQ and caudal EBQ. Pfirrmann grade greater than 4 was an independent contributor to the cranial EBQ, whereas greater than 3 was an independent contributor to the caudal EBQ. CONCLUSIONSDisc degeneration grades correlated with the EBQ but not with the VBQ. In patients with lumbar spinal stenosis or disc herniation, DD contributes to the denser bone in the sub-endplate, but not in the whole vertebral body.

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&lt;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&lt;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.

Minimally invasive surgical management of symptomatic lumbar disc herniation: can the endoscope replace the microscope?

BackgroundDegenerative lumbar spine pathologies such as spinal stenosis and disc herniation constitute the most common causes of back pain and radiculopathy. After the introduction of the operative microscope in the 1970s, microscopic discectomy has become the gold standard of treatment for herniated lumbar disc by many surgeons. A tubular endoscopic approach was first described in 1997 by Foley and Smith as a new minimally invasive technique alternative to open surgical techniques. The objective of this study is to evaluate the outcome and efficacy of microscopic discectomy and endoscopic discectomy for the management of herniated lumbar disc as regard the clinical results, operation time, intraoperative blood loss, and postoperative complications.ResultsThis is a retrospective study of 40 patients, with symptomatic lumbar disc herniation managed by the authors either by microscopic discectomy (MD) (n = 20) or by endoscopic discectomy (ED) (n = 20). Patients were followed up and postoperative data was recorded at 1, 6, 12 months after surgery. Clinical scoring systems included the Visual Analog Scale (VAS) for the preoperative and the postoperative low back ache (VAS-B) as well as preoperative and postoperative sciatic pain (VAS-S), in addition to the evaluation of the modified Japanese Orthopedic Association scale (mJOA) over the same time intervals. Significant postoperative improvement in clinical and functional outcome of the two groups was noted, including a statistically significant improvement in postoperative VAS-B and VAS-S as well as the mJOA scores in comparison to the preoperative data (p = 0.001). There was a statistically significant shorter operative time, less blood loss and less rate of operative complications recorded in the microscopic discectomy group as compared with endoscopic discectomy group in our study.ConclusionsOur study concluded that microscopic lumbar discectomy is as safe and effective as endoscopic lumbar discectomy for the management of symptomatic lumbar disc herniation with a low complication rate, less operative blood loss and operative time. Larger series and further studies would be yet considered with longer follow-up periods.

P134. Nonsmokers and smokers undergoing decompression for lumbar spinal stenosis and lumbar disc herniation experience similar clinical improvement at 12 months

<h3>BACKGROUND CONTEXT</h3> Cigarette smoking has been shown to have detrimental effects on patient reported outcomes (PROs) and fusion with lumbar arthrodesis. However, the evidence is not clear as to whether smoking affects PROs in patients undergoing decompression only. <h3>PURPOSE</h3> The purpose of this study was to determine if smoking status affects PROs following decompression for lumbar disc herniation (LDH) or lumbar spinal stenosis (LSS). <h3>STUDY DESIGN/SETTING</h3> Retrospective review of prospectively collected data from Quality Outcomes Database (QOD). <h3>PATIENT SAMPLE</h3> Patients enrolled in QOD at multiple sites who underwent 1 or 2-level decompression only for LDH or LSS. <h3>OUTCOME MEASURES</h3> Back and leg pain scores (0-10), Oswestry Disability Index (ODI) and EuroQoL 5D-3L (EQ-5D) at baseline and 12 months postoperatively. <h3>METHODS</h3> Patients who underwent 1 or 2-level decompression only for LDH or LSS were identified. Standard demographics, surgical variables, smoking status and PROs at baseline and 12 months postoperatively were collected. Outcomes were compared between smokers and nonsmokers. A sub-analysis of propensity-matched cases was also performed. <h3>RESULTS</h3> Of 17,271 patients identified, 3,038 were smokers and 14,233 were nonsmokers. Smokers were younger (50.3 vs 56.7, p < 0.000), had worse ASA grades (2.3 vs 2.2, p < 0.000) and had a greater proportion of males (1663, 55% vs 7130, 50%, p < 0.000) compared to the nonsmokers. The mean number of levels decompressed was similar between the two groups (1.7, p=0.169). For all PROs, both smokers and nonsmokers improved following surgery. Preoperative PROs in smokers were significantly worse (p < 0.000) for back pain (7.0 vs 6.1), leg pain (7.4 vs 6.9), ODI (52.2 vs 45.9) and EQ-5D (0.5 vs 0.6). PRO improvement in smokers was statistically less than in nonsmokers at 12-month follow-up (p < 0.001), but the differences may not be clinically relevant: back pain (3.2 vs 3.3), leg pain (4.3 vs 4.6), ODI (25.0 vs 26.8) and EQ-5D (0.24 vs 0.26). The percentage of patients reaching minimally clinically important difference (MCID) were significantly less in smokers for ODI (68% vs 74%, p < 0.001), leg pain (73% vs 79% p < 0.001) and back pain (75% vs 78%, p=0.005). Consistent with the differences at baseline, only 60 LSS cases and 38 LDH cases could be propensity matched. In this sub-analysis, there were no statistically significant differences in the improvements in PROs in the LSS group between smokers and nonsmokers (δBP:3.2 vs 3.5, p=0.577; δLP:3.3 vs 4.5, p=0.097; δODI:18.1 vs 23.5, p=0.155; δEQ5D: 0.2 vs 0.2, p=0.948). There were no statistically significant differences in the improvements in PROs in the LDH group between smokers and nonsmokers (δBP:3.1 vs 3.7, p=0.530; δLP:3.7 vs 5.3, p=0.050; δODI:24.6 vs 28.6, p=0.463; δEQ5D: 0.2 vs 0.3, p=0.301). There were no statistically significant differences in the proportion of smokers vs nonsmokers reaching MCID, except for leg pain in the LSS cohort (53% vs 75%p=0.022). <h3>CONCLUSIONS</h3> Although nonsmokers demonstrated statistically greater improvement in all PROs and were more likely to reach MCID, these differences are relatively small. These differences became even less evident in a small propensity-matched sub-analysis. As compared to fusion surgery, both smokers and nonsmokers treated with decompression only for LDH or LSS exhibit significant clinical improvement in PROs. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

90. Decision-making factors leading to fusion vs decompression for one-level degenerative spondylolisthesis: survey results from members of the Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery

<h3>BACKGROUND CONTEXT</h3> Degenerative spondylolisthesis is one of the most common pathologies spine surgeons treat. While a number of potential factors have been identified, there is no current consensus on which variables most impact the decision to fuse vs decompress alone in this population. <h3>PURPOSE</h3> The aim of this study was to identify radiographic and clinical factors leading to the decision to fuse segments for one-level degenerative spondylolisthesis. <h3>STUDY DESIGN/SETTING</h3> We performed a descriptive cross-sectional study utilizing a survey consisting of questions pertaining to decision-making factors leading to fusion or decompression alone in the setting of degenerative spondylolisthesis. <h3>OUTCOME MEASURES</h3> Radiographic parameters included grade of spondylolisthesis, instability, facet orientation >60°, facet diastasis, laterolisthesis or scoliosis, synovial cysts, vacuum disc, vertical disc space, preserved disc height, concomitant herniated nucleus pulposus, and symptomatic foraminal stenosis. Clinical factors included age >70 years, activity level, patient sex, body mass index >35, osteoporosis, primary complaint of low back pain, primary complaint of neurogenic claudication, smoking, and anxiety/depression. <h3>METHODS</h3> A survey was administered to the Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery. The primary analysis was limited to completed surveys. Baseline characteristics were summarized. Clinical and radiographic parameters were ranked and compared using chi-square, Fisher's exact test, Kruskal-Wallis, or two-sample t-test as appropriate. <h3>RESULTS</h3> A total of 381 (67.9%) surveys were returned completed. Respondents' mean years in practice was 17.8 ± 9.4 years and 296 (77.7%) had undergone a formal spine fellowship. The majority of respondents were from the US (45.9%) followed by Europe (24.1%), and Asia/Pacific (17.1%). The practice setting included academics (32.5%), private practice (31.0%), hospital-employed (17.1%), or a combination (19.4%). The mean number of degenerative spondylolisthesis cases performed was 53.8 ± 46.7 cases per year with 49.9% of the cohort performing these cases utilizing minimally invasive techniques. With regard to fusion vs decompression: 19.9% fuse all cases, 39.1% fuse >75%, 17.8% fuse 50%-75%, and 23.2% fuse <25%. The most common decompressive technique was a partial laminotomy (51.4%), followed by full laminectomy (28.9%). Among respondents, 82.2% instrument all fusion cases. Instability (93.2%), spondylolisthesis grade (59.8%) and laterolisthesis (37.3%) were the most common radiographic factors impacting the decision to fuse. Instability did not fall below the sixth rank with 75% of surgeons ranking it as the most important parameter. The top parameters also included spondylolisthesis grade, laterolisthesis, facet diastasis, and symptomatic foraminal stenosis. With regard to the clinical factors leading to fusion, mechanical low back pain (83.2%), activity level (58.3%) and neurogenic claudication (42.8%) were the top three clinical parameters. When ranked, the top parameters were mechanical low back pain, activity level, neurogenic claudication, bone mineral density and anxiety/depression. <h3>CONCLUSIONS</h3> There is little consensus on the treatment of degenerative spondylolisthesis, with society members showing substantial variation in treatment patterns. The most common radiographic parameters impacting treatment are instability, spondylolisthesis grade, and laterolisthesis while mechanical low back pain, activity level and neurogenic claudication are the most common clinical parameters. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

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.

Predicting Acute Changes in Depressive Symptoms Following Lumbar Decompression.

While depressive symptoms improve for most patients following minimally invasive lumbar decompression (MIS LD), for some, symptoms may worsen. This study aimed to investigate predictors of change in depressive symptoms in the short-term postoperative period following MIS LD. We retrospectively analyzed a prospective surgical database for patients undergoing primary MIS LD procedures from 2016 to 2020. Preoperative pain (visual analog scale back and leg) scores were recorded, and the 9-Item Patient Health Questionnaire (PHQ-9) was administered at the preoperative and postoperative (6 weeks, 12 weeks, 6 months, and 1 year) timepoints. Patients were grouped into 1 of 3 categories of depression severity based on preoperative PHQ-9 scores: minimal (0-4), mild (5-9), and moderate to severe (10-27). Postoperative change in depressive symptoms was calculated by determining differences from baseline scores to scores at 6 weeks, 12 weeks, and 6 months. Analysis of demographics, perioperative characteristics, and spinal pathologies was conducted using χ 2 test. Significant factors contributing to postoperative changes in depression were analyzed using multiple linear regression analysis. Significance was set at P = 0.05. The 216 patients included had a mean age of 48 years, and a majority were men (70.4%). Most patients had a preoperative diagnosis of spinal stenosis (90.3%) or herniated nucleus pulposus (69.9%). Univariate analysis identified age, ethnicity, insurance, and diabetes as significant variables among depression severity groups. Patients demonstrated significant improvements in depressive symptoms at all postoperative timepoints (P < 0.001). Multivariate analysis identified several significant predictors of postoperative change in PHQ-9, which included moderate to severe preoperative depression for all postoperative timepoints (all P ≤ 0.038), mild preoperative depression for 6 weeks and 12 weeks (both P ≤ 0.029), and private insurance (P = 0.002) and smoking status (P = 0.047) at 12 weeks. Depression improved at all postoperative timepoints following LD. Insurance type, smoking status, and preoperative depression severity were all identified as significant predictors of postoperative changes in depressive symptoms. This study explores predictors of changes in depressive symptoms following LD.

A case report of Scoliosis secondary to herniated lumbar disc in an adolescent: A case report

Background: Herniated nucleus pulposus 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 current case report is of a 15-year-old girl with no history of spinal ailment, who presented with a large disc herniation in the L4–L5 region, associated with reactive secondary scoliosis and resolved following a successful surgical intervention.&#x0D; Case Description: A 15-year-old female with a known case of scoliosis and a history of lower back pain for nine months following a fall while playing football, without any past account of the spinal disease, was presented at the outpatient clinic. After a series of proper imaging, a large L4/5 HNP with positional secondary scoliosis was diagnosed. However, due to the persistence of symptoms for more than two months in radiculopathy and reactive scoliosis, the decision was made to proceed with L4/5 microscopic discectomy. After six months, the neurological examination was normal, with a significant improvement of scoliosis with the restoration of normal spine alignment seen in plain X-ray films. The right leg radiculopathy improved as well.&#x0D; Conclusion: Lumbar disc herniation in association with scoliosis needs a vigilant evaluation of signs and symptoms and appropriate diagnostic imaging. Imaging is vital in diagnosing underlying disease states and helps in clinical management and surgical planning. The appropriate treatment is a discectomy.