Symptoms Of Lumbar Disc Herniation Research Articles

Common Peroneal Nerve Entrapment Masked by Acute Lumbar Disc Herniation: Integrated Korean Medicine Treatment with Ultrasound-Guided Pharmacopuncture

The symptoms of common peroneal nerve (CPN) entrapment are similar to the symptoms of lumbar herniated intervertebral disc. We present the successful treatment of CPN entrapment masked by acute lumbar disc herniation. A 49-year-old man presented with low back pain and numbness in his left leg. Following admission, patient history, physical examination, and radiology findings, the patient received integrated Korean medicine (KM) treatment (acupuncture, pharmacopuncture, ultrasound-guided pharmacopuncture, moxibustion and cupping, herbal medicine, and chuna therapy) for lumbar disc herniation. Outcome measures included the numeric rating scale, the European quality of life five dimensions, and the Oswestry disability index. Symptoms persisted, and CPN compression was consequently suspected. On Day 12 of 23, in addition to KM treatment, an ultrasound-guided Shinbaro2 pharmacopuncture (4 mL) was performed on the CPN entrapment site. Significant symptom relief resulted after CPN treatment on Day 12. Improvement was particularly evident in the lower leg and ankle, areas where the pain had previously been misattributed to symptoms of lumbar disc herniation. His low back pain and radiating pain to the back of the left femur started to improve from Day 20 and were mild at discharge. This case highlights the importance of considering peripheral nerve entrapment in patients presenting with symptoms similar to lumbar disc herniation. It also suggests that combining traditional KM with modern diagnostic techniques such as ultrasonography, may be beneficial in the precise location for pharmacopuncture treatment. Further studies are recommended to validate these findings and explore the broader applicability of this approach.

Brain effect mechanism of lever positioning manipulation on LDH analgesia based on multimodal MRI: a study protocol

IntroductionThe clinical symptoms of Lumbar Disc Herniation (LDH) can be effectively ameliorated through Lever Positioning Manipulation (LPM), which is closely linked to the brain's pain-regulating mechanisms. Magnetic Resonance Imaging (MRI) offers an objective and visual means to study how the brain orchestrates the characteristics of analgesic effects. From the perspective of multimodal MRI, we applied functional MRI (fMRI) and Magnetic Resonance Spectrum (MRS) techniques to comprehensively evaluate the characteristics of the effects of LPM on the brain region of LDH from the aspects of brain structure, brain function and brain metabolism. This multimodal MRI technique provides a biological basis for the clinical application of LPM in LDH.Methods and analysisA total of 60 LDH patients and 30 healthy controls, matched by gender, age, and years of education, will be enrolled in this study. The LDH patients will be divided into two groups (Group 1, n = 30; Group 2, n = 30) using a random number table method. Group 1 will receive LPM treatment once every two days, for a total of 12 times over 4 weeks. Group 2 will receive sham LPM treatment during the same period as Group 1. All 30 healthy controls will be divided into Group 3. Multimodal MRI will be performed on Group 1 and Group 2 at three time points (TPs): before LPM (TP1), after one LPM session (TP2), and after a full course of LPM treatment. The healthy controls (Group 3) will not undergo LPM and will be subject to only a single multimodal MRI scan. Participants in both Group 1 and Group 2 will be required to complete clinical questionnaires. These assessments will focus on pain intensity and functional disorders, using the Visual Analog Scale (VAS) and the Japanese Orthopaedic Association (JOA) scoring systems, respectively.DiscussionThe purpose of this study is to investigate the multimodal brain response characteristics of LDH patients after treatment with LPM, with the goal of providing a biological basis for clinical applications.Trial registration numberhttps://clinicaltrials.gov/ct2/show/NCT05613179, identifier: NCT05613179.

Prediction and Mechanisms of Spontaneous Resorption in Lumbar Disc Herniation: Narrative Review.

The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from great distress in their daily life accompanied by severe economic hardship and difficulty in self-care, with an increasing tendency in the aging population. PubMed and the Cochrane Central Register of Controlled Trials were searched for relevant studies of spontaneous resorption or regression in LDH after conservative treatment and for other potential studies, which included those from inception to June 30, 2023. The objective of this narrative review is to summarize previous literatures about spontaneous resorption in LDH and to discuss the mechanisms and influencing factors in order to assess the probability of spontaneous resorption by conservative treatment. Spontaneous resorption without surgical treatment is influenced by the types and sizes of the LDH, inflammatory responses, and therapeutic factors. If the lumbar disc herniated tissue comprises a higher percentage of cartilage or modic changes have been shown on magnetic resonance imaging (MRI), resorption in LDH is prevented. The bull's eye sign on enhanced MRI, which is a ring enhancement around a protruding disc, is a vital indicator for easy reabsorption. In addition, the type of extrusion and sequestration in LDH could forecast the higher feasibility of natural reabsorption. Moreover, the higher the proportion of protrusion on the intervertebral disc tissue within the spinal canal, the greater the likelihood of reabsorption. Therefore, which illustrates the feasibility of conservative treatments for LDH. Nonsurgical management of LDH with clinical symptoms is recommended by the authors.

Mechanism exploration of Osteoking in the treatment of lumbar disc herniation based on network pharmacology and molecular docking

ObjectiveLumbar disc herniation (LDH) is a common spinal surgical disease. Low back and leg pain caused by LDH is the main factor leading to functional disability, which has caused a serious burden to patients and society. Osteoking can delay the progression of osteoporosis and osteoarthritis, and even has a significant effect on the prevention of deep vein thrombosis after fracture surgery. In recent years, it has been gradually used in the treatment of LDH and has received significant results. However, the underlying mechanism remains unclear. The aim of this study was to predict the mechanism of Osteoking in the treatment of LDH through network pharmacology and verify it by molecular docking method.MethodsThe TCMSP database was used to collect the relevant active components and targets of Osteoking, while the GeneCards, OMIM and DisGeNET databases were utilized to collect the relevant disease targets of LDH. The Venny 2.1.0 software was employed to obtain the intersecting gene targets of Osteoking and LDH. PPI network construction and core target selection were performed using Cytoscape 3.9.0 software. The Metascape database was used for GO and KEGG enrichment analysis of the relevant targets. Finally, molecular docking was conducted using AutoDock software.ResultsThe study identified 116 potential targets and 26 core targets for the treatment of LDH with Osteoking. Pathways in cancer, Alzheimer's disease, microRNAs in cancer and the IL-17 signalling pathway were among the main involved signalling pathways. Molecular docking results demonstrated that the key targets AKT1, IL-6, ALB, TNF and IL-1β exhibited relatively stable binding activities with the main active components of Osteoking.ConclusionsOsteoking can alleviate the symptoms of lumbar disc herniation through the modulation of multiple targets and signalling pathways.

Retrospective Study of Minimal Three-Year Follow-Up of Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation: 5000 Multicenter Cases.

Objective The objective of this study was to investigate the long-term effects of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) and clarify the differences between outside-in and inside-out techniques. Methodology This was a multicenter retrospective study with a chart review of questionnaires about patients' quality of life. Patients were recruited from three hospitals in China. Based on certain inclusion and exclusion criteria, we enrolled in the study 5000 patients aged ≥18 years diagnosed with lumbar disc herniation who received PTELD from September 2015 to September 2019. The outside-in technique (n=2039) was compared with the inside-out technique for PTELD (n=1890) on the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the Short Form 36 (SF-36) of the Health Survey Questionnaire (physical component)both pre-operatively and post-operatively. Results VAS, ODI, andSF-36 significantly improved just after surgery for both techniques compared with pre-operative status. Nevertheless, significant differences existed between the two techniques concerning VAS for leg pain, VAS for back pain, ODI, and SF-36 at 0.5 monthspost-operatively. The above indices steadily improved within six months after both techniques, after which they did not significantly improve. In detail, outside-in patients suffered more back pain and worse ODI and SF-36 (physical) but had more relief from leg pain 0.5 months after surgery in terms of VAS. As for recovery rate from symptoms, there were only significant differences in recovery rate for leg pain and back pain at the first 1.5 months post-operatively. As for satisfaction rates, the outside-in technique had better results than the inside-out technique at both 0.5 months and 12 months. Conclusion Both techniques could relieve the symptoms of lumbar disc herniation. However, patients in the outside-in group suffered more back pain and a bigger risk of nerve injury than those in the inside-out group.

Does the L4 nerve root extend during femoral nerve stretch test? A cadaveric study of four cases analyzing the extension rates of the lumbar nerve root

BackgroundLumbar radicular pain is a common symptom of lumbar disc herniation and spinal canal stenosis, and L4 nerve root impingement is difficult to diagnose. This study aimed to elucidate the extension rate of L4 nerve roots in Thiel-embalmed specimens using both classic and new femoral nerve stretch test (FNST), as well as straight leg raising test (SLRT). Additionally, the extension rate of the L2 and L3 nerve roots and L5 and S1 roots were determined using FNST (both classic and new) and SLRT, respectively. MethodsFour Thiel-embalmed specimens were used. The extension rate data of the nerve root were obtained using a displacement sensor under the following conditions: knee joint flexed to 0°/45°/90°/135° with either the hip extension/flexion of 0° (classic FNST) or extension of 15° (new FNST); and hip joint flexed to 0°/30°/60°/90° with the knee flexion of 0° (SLRT). ResultsCase A had almost no L4 nerve root lengthening at 45° and 90° knee joint flexion; however, at 135° of knee flexion, the nerve root was lengthened. In Case B, the L4 nerve root was hardly extended by the classic FNST, but it was extended at 135° of knee flexion and 15° of hip extension. In Case C, the L4 nerve root showed little change by classic FNST and it was shortened by new FNST, whereas, it was extended by SLRT. Case D showed a shortened L4 nerve root at 135° of knee flexion in classic FNST and at 0°/45°/90°/135° of knee flexion and 15° of hip extension. Further, no root shortening was observed for L2 and L3 nerve roots according to both classic and new FNST. In contrast, the extension of L2 and L3 nerve root with the new FNST was high. In all cases, nerve roots were lengthened by the SLRT. Further, as the hip flexion angle increased, the rate of nerve elongation also increased. ConclusionsIt was shown that in patients in whom L4 nerve root was extended by FNST, it was shortened by SLRT. The opposite pattern was also observed. Further, it is believed that FNST and SLRT are reliable tests for L2 and L3 radiculopathy and L5 and S1 radiculopathy, respectively, and that more tension on the femoral and sciatic nerves is better. Furthermore, we recommend that FNST should be performed with 15° hip extension and 135° knee flexion to improve the diagnostic accuracy.

A Prospective Study to Evaluate the Clinical and Diffusion Tensor Imaging (DTI) Correlation in Patients with Lumbar Disc Herniation with Radiculopathy.

Conventional magnetic resonance imaging findings frequently do not correlate with the symptoms of lumbar disc herniation (LDH). Diffusion-weighted imaging can reveal important details about the microstructure of tissues. This study assessed the role of diffusion-weighted imaging (DTI) in LDH with radiculopathy and explored the relationship between DTI values and clinical scores. Forty-five patients with LDH with radiculopathy were evaluated via DTI at the intraspinal (IS), intraforaminal (IF), and extraforaminal (EF) levels. A visual analog scale (VAS) was used for low back and leg pain. The Japanese Orthopaedic Association (JOA) scoring system, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were used for functional evaluation. There was a statistically significantly (p<0.05) difference between the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values on the affected side compared with those on contralateral normal side. The VAS score had a weak positive correlation with RMDQ score (r=0.279, P=0.050). The JOA score had a moderate negative correlation with RMDQ score (r=-0.428, P=0.002), whereas the ODI score had a moderate positive correlation with RMDQ score (r=0.554, P<0.001). There was a moderate positive correlation between ADC values at the IF level and the RMDQ score on the affected side (r=0.310, P=0.029). There was no correlation between FA values and JOA score. ODI had a significantly positive correlation with the contralateral normal side FA values at the IF (r=0.399, P=0.015), EF (r=0.368, P=0.008) and IS (r=0.343, P=0.015) levels. RMDQ had a weak positive correlation with the contralateral normal side FA values at the IF (r=0.311, P=0.028), IS (r=0.297, P=0.036) and EF (r=0.297, P=0.036) levels. The decrease in FA values and the increase in ADC values are useful markers of compression. ADC correlates well with the patient's neurological symptoms and functional status. Conversely, FA correlates well with the patient's neurological symptoms, but is not correlated well with the functional status.

Effect of Shampakadi Niruha Basti in the management of Katigraha w.s.r. to Lumbar Disc Herniation - A Pilot Clinical Study

Lumbar disc herniation (LDH) is the most common lumbar spinal disorder that produces low back pain and/or leg pain. A herniated disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. LDH may be correlated with Katigraha in Ayurveda on the basis of clinical features of the disease where Vatadosha with or without Aamadosha settles in Katipradesh (lumbar region). and cause pain and stiffness. In the present study 6 patients of lumbar disc herniation were advised the treatment modalities like Shampakadi Niruha Basti along with Rasnaerandadi Kashayam and Trayodasang Guggulu orally for 16 days which was found very effective in relieving the sign and symptoms of LDH.

Functional Capacity of Patients Operated on Due to Lumbar Discopathy in the Early Postoperative Period

Introduction. The main symptom of lumbar disc herniation is pain, which particularly hinders the functioning of the patient. Functional capacity should be understood as the ability to be independent of other people in meeting basic needs, such as: movement, nutrition, controlling the body’s physiological activities or performing hygiene activities.&#x0D; Aim. The aim of the study was to assess the functioning of patients after lumbar spine surgery in the early postoperative period.&#x0D; Material and Methods. The study included a group of 52 adult patients after lumbar spine surgery performed at the Department of Neurosurgery of the 10th Military Clinical Hospital with the Polyclinic of the SP ZOZ in Bydgoszcz. The method of diagnostic survey was used, the tools were: interview questionnaire, VAS scale, Roland-Morris Low Back Pain Questionnaire, Oswestry Questionnaire and Beck Depression Scale.&#x0D; Results. More than half of the examined patients after lumbar spine surgery felt the intensity of pain at the average level, very strong pain affected nearly 10% (mean 4.44; SD 2.03). According to the Roland-Morris Low Back Pain Questionnaire, nearly 60% of patients showed a moderate level of disability and 35% a high level of disability (mean 15.33; SD 3.85). According to the Oswestry Questionnaire, 53% of patients had moderate disability, 31% had severe disability (mean 54.7%, SD 11.3%). 83% of respondents did not show symptoms of depression (mean 6.98; SD 5.63).&#x0D; Conclusions. The functional capacity of patients after surgery of the lumbar spine turned out to be low, a large part of the respondents showed a medium and high degree of disability. The degree of disability increased with the severity of pain. (JNNN 2022;11(4):147–153)

The morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation

ObjectiveThe objective of this study was to explore the morphological characteristics of paraspinal muscles in young patients with unilateral neurological symptoms of lumbar disc herniation.MethodsThis study retrospectively analyzed young patients aged 18–40 years who were hospitalized for lumbar disc herniation in our hospital from June 2017 to June 2020. Data on sex, age, body mass index (BMI), subcutaneous fat tissue thickness (SFTT) at the L1-L2 level, duration of symptoms, degree of lumbar disc herniation, visual analog scale (VAS) for the lower back, Mo-fi-disc score, relative cross-sectional area (RCAS) of the paravertebral muscles (psoas major [PM], multifidus [MF], and erector spinae [ES]), and degree of fat infiltration (DFF) of the paravertebral muscles were collected. The VAS was used to evaluate the intensity of low back pain. Patients with VAS-back >4 points were defined as the low back pain group, and patients with ≤4 points were defined as the control group. The demographic characteristics, as well as the bilateral and ipsilateral paravertebral muscles, of the two groups were compared and analyzed.ResultA total of 129 patients were included in this study (52 patients in the LBP group and 77 patients in the control group). There were no significant differences in sex, BMI, or Pfirrmann grade of lumbar disc herniation between the two groups (P > 0.05). The age of the LBP group (33.58 ± 2.98 years) was greater than that of the control group (24.13 ± 2.15 years) (P = 0.002), and the SFTT at the L1-L2 level (13.5 ± 7.14 mm) was higher than that of the control group (7.75 ± 6.31 mm) (P < 0.05). Moreover, the duration of symptoms (9.15 ± 0.31 months) was longer than that of the control group (3.72 ± 0.48 months) (P < 0.05), and the Mo-fi-disc score (8.41 ± 3.16) was higher than that of the control group (5.53 ± 2.85) (P < 0.05). At L3/4 and L5/S1, there was no significant difference in the RCSA and DFF of the bilateral and ipsilateral paraspinal muscles between the LBP group and the control group. At L4/5, there was no significant difference in the RCSA and DFF of the paraspinal muscles on either side in the LBP group (P > 0.05). In the control group, the RCSA of the MF muscle on the diseased side was smaller than that on the normal side (P < 0.05), and the DFF of the MF muscle on the diseased side was larger than that on the normal side (P < 0.05). In addition, there was no significant difference in the ES and PM muscles on both sides (P > 0.05). At L4/5, the RCSA of the MF muscle on the normal side was significantly smaller in the LBP group than in the control group (P < 0.05), and the DFF of the MF muscle on the normal side was significantly larger in the LBP group than in the control group (P < 0.05). There was no significant difference in the ES and PM muscles on the same side between the two groups (P > 0.05).ConclusionIn young patients with unilateral neurological symptoms of lumbar disc herniation, symmetrical atrophy of the bilateral MF muscle is more prone to causing low back pain. Older age, higher SFTT at the L1-L2 levels, longer symptom duration, higher Mo-fi-di score, and greater muscle atrophy on the normal side of the MF increased the incidence of low back pain in young patients with unilateral lumbar disc herniation.

3D-printed auxetic-structured intervertebral disc implant for potential treatment of lumbar herniated disc.

In this study, a novel artificial intervertebral disc implant with modified “Bucklicrystal” structure was designed and 3D printed using thermoplastic polyurethane. The new implant has a unique auxetic structure with building blocks joined “face-to-face”. The accompanied negative Poisson’s ratio enables its excellent energy absorption and stability under compression. The deformation and load distribution behavior of the implant under various loading conditions (bending, torsion, extension and flexion) has been thoroughly evaluated through finite element method. Results show that, compared to natural intervertebral disc and conventional 3D implant, our new implant exhibits more effective stress transfer and attenuation under practical loading conditions. The implant's ability to contract laterally under compression can be potentially used to alleviate the symptoms of lumbar disc herniation. Finally, the biocompatibility of the implant was assessed in vitro and its ability to restore the physiological function of the disc segment was validated in vivo using an animal model.

A Case of Lumbar Disc Herniation Penetrating the Ventral and Dorsal Dura Mater with Notable Osteophytes

Introduction : The most common symptoms of lumbar disc herniation are low back and lower limb pain, but emergency surgery is generally only required in cases with severe lower limb muscle weakness and bladder and rectal disorder. A herniated disc that penetrates the dura mater can trigger an intradural herniation (IDH). Although there are no specific symptoms of IDH, it often causes acute and severe neuropathy. Here, we report a case with residual postoperative dysuria due to IDH.

The diagnostic pitfalls of lumbar disc herniation---- malignant sciatic nerve tumour: two case reports and literature review

BackgroundSciatica pain is a typical symptom of lumbar disc herniation (LDH), but some neurogenic and malignant tumours surrounding the sciatic nerve can also cause similar symptoms. These tumours are often misdiagnosed or even mistreated as LDH in clinical practice.Case presentationIn our clinical practice, we found two patients with malignant tumours who were misdiagnosed with LDH. One patient complained of pain and numbness in the right lower limb. The primary diagnosis was LDH, and the patient underwent posterior lumbar interbody fusion surgery. After the operation, the symptoms were not alleviated. Then, diffuse large B-cell lymphoma involving the soft tissue and the sciatic nerve was identified. Another patient who manifested with radiating pain in the right lower limb was diagnosed with LDH at Chengde Central Hospital. He received regular conservative treatment for approximately 6 months, but his symptoms were not relieved, and then he was referred to our hospital. A malignant peripheral nerve sheath tumour (MPNST) of the sciatic nerve was diagnosed, and he received cisplatin (DDP) chemohyperthermia.ConclusionsDescriptions of tumour lesions involving the sciatic nerve and misdiagnosed as LDH in the literature are rare. In the reported literature, 7 patients were misdiagnosed with LDH, and all patients presented with sciatica. Among them, 4 patients only received surgical treatment, 1 patient only underwent neurolysis, and 2 patients received both surgical and chemotherapy treatment. Their low incidence and similar clinical manifestations to LDH make malignant tumours involving the sciatic nerve easy to misdiagnose. When the clinical symptoms and signs are inconsistent with the imaging findings, we need to be aware of non-discogenic sciatica, including tumours involving the sciatic nerve. Furthermore, tumours that grow near the exit of the sciatic notch may be misdiagnosed because of their deeper location and because they are covered with gluteal muscles. Sometimes sciatica caused by sciatic nerve tumours is only distal, without any radicular distribution. This pain is more severe than that caused by LDH, and this pain is not related to the position of the lumbar spine. Thus, it is beneficial to perform a detailed physical examination of the sciatic nerve to avoid this kind of misdiagnosis.

Effect of Comprehensive Rehabilitation Care on the Rehabilitation of Patients with Lumbar Disc Herniation Surgery

The clinical symptoms of lumbar disc herniation, one of the most common low back pain diseases, are a series of manifestations of low back pain, sciatica, and cauda equina compression, and the recurrence rate after treatment is high, which seriously affects work and life. Surgery is a serious physiological stress in patients with degenerative changes in the lumbar spine and symptoms of nerve damage. If the corresponding nursing work cannot be performed effectively and timely after the operation, it may affect the recovery of postoperative function, cause complications, and cause motor dysfunction. It may also be accompanied by psychological problems such as depression, which seriously affect the quality of life of the patient. In addition, training can enhance the strength of the back muscles, thereby making up for the destruction of the surgery, helping to consolidate and improve the treatment effect. However, clinicians often overlook postoperative functional recovery. Therefore, this paper studies the effect of comprehensive rehabilitation nursing on the rehabilitation of patients with lumbar disc herniation, and discusses the comprehensive rehabilitation nursing intervention measures for patients with lumbar disc herniation. Thereby promoting patients to receive comprehensive rehabilitation care increase health behaviors and improve the quality of life. The proposed method is very effective in the rehabilitation of patients with lumbar disc herniation.

Establishing a critical pathway for Korean medical management of lumbar disc herniation: A modified Delphi consensus process.

A modified Delphi method was used to establish a consensus. Stakeholders and experts were invited to participate in the expert panel. Best practice statements and decision-making questionnaires were distributed to the panel. Panel members were asked to mark “Strongly disagree” to “Strongly agree” after a series of statements over several rounds until either a consensus was reached or the decision-making method was deemed unsuitable for reaching a consensus.The most common cause of lumbar pain is intervertebral degeneration, which leads to degenerative disc disease and lumbar disc herniation. There is a lack of unanimity regarding appropriate patient protocols and rehabilitation expectations for Korean medical care. The long-term viability of Korean medical treatment, further adoption in the institutional setting, and specific patient outcomes are contingent on the existence of appropriate Korean medical programs.A Korean medical expert panel of 17 practitioners employed a modified Delphi method to achieve consensus on Korean medical care for lumbar disc herniation. The panel first reviewed the literature and guidelines relevant to Korean medical treatment for lumbar disc herniation. The panel members considered questionnaires intended to determine “standardized” Korean medical care recommendations for patients with a wide range of symptoms of lumbar disc herniation. Each panel member participated in a round of voting, which was followed by an opinion-collecting session online. Consensus was defined as a ≥75% agreement among the respondents.In the first round, 144 questionnaires across 5 domains were administered to the expert panels. After reviewing the responses and open-ended comments collected in the first round, the authors modified the questionnaires to 53 items and proceeded. In round 2, consensus was achieved in all 53 survey questions. The final treatment pathway comprised a standardized and comprehensive care approach for lumbar disc herniations in 4 types of medical institutions.This study identified a core set of evidence- and consensus-based principles that are essential to a comprehensive model of care, incorporating identification, referral, and management of patients with lumbar disc herniation.

Lactobacillus paracasei S16 Alleviates Lumbar Disc Herniation by Modulating Inflammation Response and Gut Microbiota.

Lumbar disc herniation (LDH) is a common cause for low back pain. In this study, we aimed to explore the effects of a specific Lactobacillus paracasei (L. paracasei), L. paracasei S16, on the symptoms of LDH using a mouse model of LDH. The results showed that L. paracasei S16 treatment improved the behavior, increased the cell proliferation, and decreased the apoptosis in LDH mice. Moreover, L. paracasei S16 treatment alleviated the aberrant inflammation response in the LDH mice, which is characterized by the decreased anti-inflammatory cytokines, increased pro-inflammatory cytokines, and decreased percentage of Th1 and Th2 cells and Th17/Treg ratio. 16S rRNA sequencing results showed that the LDH mice treated with L. paracasei S16 have higher relative abundance of Lachnospiraceae and Ruminococcaceae and lower abundance of Lactobacillaceae than mice in the LDH group. Additionally, the serum metabolites involved in the linoleic acid metabolism, alanine. aspartate, and glutamate, glycerophospholipid, and TCA cycle were significantly decreased and the metabolite involved in purine metabolism was significantly increased after the L. paracasei S16 treatment in the LDH mice. These results showed that administration of L. paracasei S16 can improve inflammation response, alter gut microbiota, and modulate serum metabolomics in a mouse model of LDH.

Comparison of treatments for lumbar disc herniation: Systematic review with network meta-analysis.

Systematic review with network meta-analysis. To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD + AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management. Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is unclear. A systematic review was performed to compare efficacy of LD + AC, LD, and CC for treatment of lumbar disc herniation. Outcomes included leg pain, back pain, disability (each reported on a 0-100 scale), reherniation, and reoperation. Data were analyzed using random effects network meta-analysis. This review included 14 comparative studies (8 randomized) involving 3947 patients-11 studies of LD versus CC (3232 patients), 3 studies of LD + AC versus LD (715 patients), and no studies of LD + AC versus CC. LD was more effective than CC in reducing leg pain (mean difference [MD] -10, P < .001) and back pain (MD -7, P < .001). LD + AC was more effective than LD in reducing risk of reherniation (odds ratio 0.38, P < .001) and reoperation (odds ratio 0.33, P < .001). There was indirect evidence that LD + AC was more effective than CC in reducing leg pain (MD -25, P = .003), back pain (MD -20, P = .02), and disability (MD -13, P = .02) although the treatment effect was smaller in randomized trials. Results of a network meta-analysis show LD is more effective than CC in alleviating symptoms of lumbar disc herniation refractory to initial conservative management. Further, LD + AC lowers risk of reherniation and reoperation versus LD and may improve patient symptoms more than CC.

Effect of combination of lateral recess decompression by Tessys technique and PTED in patients suffering from contralateral symptoms of lumbar disc herniation

The aim was to explore the effect of lateral recess decompression by percutaneous transforaminal endoscopic spine system (Tessys) technique combined with percutaneous transforaminal endoscopic discectomy (PTED) on pain medium, nerve function and stress response in patients suffering from contralateral symptoms of lumbar disc herniation. A total of 96 patients with contralateral symptoms of lumbar disc herniation treated in our hospital from February 2015 to April 2017 were randomly divided into control group and study group, with 48 cases in each group. The control group underwent PTED, and the study group underwent lateral recess decompression by Tessys technique combined with PTED. The visual analogue scale (VSA) score and Japanese Orthopaedic Association (JOA) score before surgery and 3 months after surgery were compared between the two groups. The levels of serum pain medium (prostaglandin E2 (PGE2), histamine (HA), 5-hydroxytryptamine (5-HT)) and oxidative stress indexes (malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), total antioxidant capacity (TAC)) before surgery and 7 days after surgery were compared. The clinical efficacy of the two groups was compared at 1 month after treatment. One month after treatment, the excellent and good rate in the study group was significantly higher than that in the control group (85.4% vs 56.3%; P &lt; 0.05). There was no significant difference between VAS and JOA score in the two groups preoperatively ( P &gt; 0.05). At 3 months after surgery, the VAS score in the study group was significantly lower than that in the control group ( P &lt; 0.05), and the JOA score in the study group was significantly higher than that in the control group ( P &lt; 0.05). There was no significant difference in serum PGE2, HA and 5-HT levels between the two groups preoperatively ( P &gt; 0.05). At 7 days after surgery, the serum PGE2, HA and 5-HT levels in the study group were significantly lower than those in the control group ( P &lt; 0.05). Preoperatively, the levels of serum MDA, MPO, SOD and TAC were not significantly different between the two groups ( P &gt; 0.05). On the seventh day after surgery, the levels of serum MDA and MPO in the study group were significantly lower than those in the control group ( P &lt; 0.05), and the levels of SOD and TAC were significantly higher than those in the control group ( P &lt; 0.05). In conclusion, the combined therapy of lateral recess decompression by Tessys technique and PTED in patients suffering from contralateral symptoms of lumbar disc herniation has a definite clinical effect, which can significantly alleviate the symptoms of low back pain and motor nerve function and reduce the contents of serum pain medium and the levels of oxidative stress. It is worthy of clinical promotion.

Warming Needle Moxibustion Relieves Symptoms of Lumbar Disc Herniation Patients and Upregulates Plasma β-endorphin

To analyze the effect of warming needle moxibustion of Jiaji (EX-B 2), Huantiao (GB 30), etc. on lumbago and other symptoms of lumbar disc herniation (LDH) patients and changes of plasma β-endorphin (β-EP) content. A total of 60 LDH patients were equally randomized into warming needle moxibustion group and conventional acupuncture group. Patients of the conventional acupuncture group were treated by puncturing lumbar Jiaji (EX-B 2), Huantiao (GB 30), Weizhong (BL 40), and Yanglingquan (GB 34) with filiform acupuncture needles. Patients of the warming needle moxibustion group were treated by puncturing the same 4 acupoints, and with the acupuncture needle in lumbar EX-B 2 attached an ignited moxa-stick segment. The treatment in both groups lasted for 30 min every time, once every other day for 15 times, with 5 times being a therapeutic course and two days' rest between every two courses. The therapeutic effect was evaluated according to the "Criteria for Evaluating the Therapeutic Effect of Disorders of Traditional Chinese Medicine". The lumbago severity was assessed using visual analogue scale (VAS), and the lumbar functional activity assessed using modified Oswestry dysfunction (in objects-lifting, sitting, standing, walking, sleeping, pain, activity of daily living, social activity, outing, etc.) index (ODI). The plasma β-EP content was assayed using ELISA. After the treatment, of the two 30 cases in the conventional acupuncture and warming needle moxibustion groups, 8 (26.67%) and 12 (40.00%) were under control, 8 (26.67%) and 10 (33.33%) had a marked improvement, 3 (10.00%) and 4 (13.33%) were effective, and 11 (36.66%) and 4 (13.33%) ineffective, with the effective rates being 63.34% and 86.66%, respectively. The effective rate of the warming needle moxibustion was significantly higher than that of the conventional acupuncture (P<0.05). The VAS scores and ODI values of the two groups were gradually decreased along with the prolongation of treatment, and significantly lower in the warming needle moxibustion group than in the acupuncture group at the 1st, 2nd and 3rd course of treatment (P<0.01). The levels of plasma β-EP were gradually increased in the two groups at the 1st, 2nd and 3rd course of treatment, and were obviously higher in the warming needle moxibustion group than in the conventional acupuncture group at each of the 3 courses (P<0.01). No obvious adverse reactions were observed in the two groups. Warming needle moxibustion has a better therapeutic effect in relieving lumbago and lumbar dysfunction, and can up-regulate blood β-EP level.

Annular closure in lumbar microdiscectomy for prevention of reherniation: a randomized clinical trial

Background ContextPatients with large annular defects after lumbar discectomy for disc herniation are at high risk of symptomatic recurrence and reoperation. PurposeThe present study aimed to determine whether a bone-anchored annular closure device, in addition to lumbar microdiscectomy, resulted in lower reherniation and reoperation rates plus increased overall success compared with lumbar microdiscectomy alone. DesignThis is a multicenter, randomized superiority study. Patient SamplePatients with symptoms of lumbar disc herniation for at least 6 weeks with a large annular defect (6–10 mm width) after lumbar microdiscectomy were included in the study. Outcome MeasuresThe co-primary end points determined a priori were recurrent herniation and a composite end point consisting of patient-reported, radiographic, and clinical outcomes. Study success required superiority of annular closure on both end points at 2-year follow-up. MethodsPatients received lumbar microdiscectomy with additional bone-anchored annular closure device (n=276 participants) or lumbar microdiscectomy only (control; n=278 participants). This research was supported by Intrinsic Therapeutics. Two authors received study-specific support morethan $10,000 per year, 8 authors received study-specific support less than $10,000 per year, and 11 authors received no study-specific support. ResultsAmong 554 randomized participants, 550 (annular closure device: n=272; control: n=278) were included in the modified intent-to-treat efficacy analysis and 550 (annular closure device: n=267; control: n=283) were included in the as-treated safety analysis. Both co-primary end points of the study were met, with recurrent herniation (50% vs. 70%, P<.001) and composite end point success (27% vs. 18%, P=.02) favoring annular closure device. The frequency of symptomatic reherniation was lower with annular closure device (12% vs. 25%, P<.001). There were 29 reoperations in 24 patients in the annular closure device group and 61 reoperations in 45 control patients. The frequency of reoperations to address recurrent herniation was 5% with annular closure device and 13% in controls (P=.001). End plate changes were more prevalent in the annular closure device group (84% vs. 30%, P<.001). Scores for back pain, leg pain, Oswestry Disability Index, and health-related quality of life at regular visits were comparable between groups over 2-year follow-up. ConclusionsIn patients at high risk of herniation recurrence after lumbar microdiscectomy, annular closure with a bone-anchored implant lowers the risk of symptomatic recurrence and reoperation. Additional study to determine outcomes beyond 2 years with a bone-anchored annular closure device is warranted.