Treatment Of Lumbar Disc Herniation Research Articles

Effects of suspension exercise training in the treatment of lumbar disk herniation: a systematic review and meta-analysis

ObjectiveThe study aimed to systematically evaluate the efficacy of suspension exercise training (SET) in the treatment of lumbar intervertebral disk herniation and provide a scientific basis for clinical treatment.MethodsDatabases such as CNKI, Chinese Wanfang, PubMed, Cochrane, the Web of Science, and Embase were searched up to June 2024. A quality assessment was performed using the Cochrane Collaboration’s risk-of-bias guidelines, and a meta-analysis was conducted using RevMan 5.4 and Stata 17.0.ResultsA total of 11 studies involving 943 patients were included. Suspension exercise training significantly improved the lumbar disk herniation (LDH) visual analog scale (VAS) score (mean difference (MD) = −0.96; 95% confidence interval (CI), −1.10 to-0.82; p < 0.00001, I2 = 23%), the Japanese Orthopedic Association (JOA) score (MD = 3.29, 95% CI, 1.67 to 4.90; p < 0.0001, I2 = 92%), and the Oswestry Disability Index (ODI) score (MD = −5.41, 95% CI, −7.41 to −3.40; p < 0.00001, I2 = 86%). Subgroup analysis of the JOA score showed better efficacy with suspension exercise training combined with traditional Chinese medicine (TCM) (MD = 4.29, 95% CI, 2.73 to 5.86; p < 0.00001, I2 = 80%) compared to suspension exercise training combined with non-TCM (MD = 0.96, 95% CI, 0.49 to 1.43; p < 0.0001, I2 = 0%).ConclusionSuspension exercise training significantly improved the VAS score, JOA score, and ODI score of the patients with lumbar disk herniation; however, there was a high degree of heterogeneity in the JOA score and ODI score. Further validation is needed in the future for different populations with lumbar disk herniation, the specific locations of its occurrence, and the combined modality of suspension exercise training.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024554074.

Comparative analysis of the efficacy of oblique lateral interbody fusion versus transforaminal lumbar interbody fusion in the treatment of lumbar disc herniation

Lumbar disc herniation (LDH) often necessitates surgical intervention when conservative treatments fail. Oblique Lateral Interbody Fusion (OLIF) and Transforaminal Lumbar Interbody Fusion (TLIF) are two commonly used techniques for treating LDH, each offering distinct surgical approaches. This study aimed to compare the efficacy of OLIF versus TLIF in terms of pain relief, functional outcomes, spinal alignment correction, fusion success, and postoperative recovery. A retrospective study was conducted on 133 patients who underwent either OLIF (n = 68) or TLIF (n = 65) between January 2020 and December 2022. Data on patient demographics, pain and functional outcomes (measured by Visual Analogue Scale [VAS] and Oswestry Disability Index [ODI]), radiological outcomes (sagittal and coronal Cobb angles, apical vertebra deviation), fusion and collapse rates, and postoperative recovery (ambulation time and hospitalization duration) were collected. Statistical analysis was performed using t-tests and chi-square tests, with significance set at P < 0.05. Both groups demonstrated significant postoperative improvements in pain and functional outcomes. OLIF resulted in significantly better long-term pain reduction (VAS 1.99 ± 0.67 vs. 2.29 ± 0.92, P = 0.03) and greater spinal alignment correction, particularly in sagittal Cobb angle and apical vertebra deviation (P < 0.001). The fusion rate was similar between OLIF (97.92%) and TLIF (96.61%, P = 0.56), but OLIF had a lower collapse rate (8.33% vs. 18.64%, P < 0.001). OLIF also facilitated faster postoperative recovery, with earlier ambulation and shorter hospitalization time (P < 0.001 for both). While both OLIF and TLIF are effective for treating LDH, OLIF offers superior long-term pain relief, better spinal alignment correction, reduced collapse rates, and faster recovery. These findings suggest that OLIF may be a more advantageous option for patients requiring lumbar interbody fusion.

Reevaluating clinical significance in lumbar disc herniation treatment: insights from Cohen’s d analysis

Reevaluating clinical significance in lumbar disc herniation treatment: insights from Cohen’s d analysis

Conservative therapy for lumbar disc herniation

Herniated discs are acommon cause of neurological symptoms that often lead to reduced quality of life. They affect around 20% of 45-56-year olds and, therefore, represent acorrespondingly major challenge for healthcare. Conservative therapy methods are usually used as the first treatment option; surgical interventions should only be considered in special symptom constellations. This study aims to evaluate the effectiveness of conservative therapy methods in the treatment of lumbar disc herniation and to demonstrate their influence on pain reduction and functional improvement. The current valid AWMF guideline was analyzed, and asystematic literature search was conducted to identify relevant information on the conservative treatment of herniated discs. The therapeutic approaches analyzed included physiotherapy, drug treatment, manual therapy and injection therapies. Inclusion criteria covered reviews and meta-analyses from 2019 to 2024. The analysis showed that conservative treatment methods led to asignificant reduction in pain and improvement in functional abilities in the majority of patients. Not all frequently clinical used forms of therapy have been well proven. The results of this study underline the importance of conservative treatment methods as an effective treatment option for herniated discs. In particular, the combination of different treatment approaches can improve treatment outcomes. However, further long-term studies are needed to determine the long-term effects and optimal treatment protocols.

Percutaneous endoscopic lumbar discectomy versus open fenestration discectomy for lumbar disc herniation: a retrospective propensity score-matched study with more than 5 years of follow-up

ObjectiveWe compared the long-term outcomes of percutaneous endoscopic lumbar discectomy (PELD) with those of open fenestration discectomy (OFD) in treating lumbar disc herniation (LDH).Methods281 patients were included from January 2013 to December 2018, of whom 228 underwent PELD and 53 underwent OFD. General information of patients was collected and imbalances in covariates between groups were corrected using propensity score matching (PSM). Then, the clinical function scores, imaging data, and complications were compared.ResultsAmong participants, 102 patients were successfully matched and were followed for 62–128 months. Compared to the OFD group, the PELD group indicated greater improvements in visual analog scale score of low back pain (VAS-BP), Japanese orthopedic association (JOA), and Oswestry disability index (ODI) at 7 days postoperatively and the last follow-up (P < 0.05). At 24 months postoperatively and the last follow-up, the disc height index (DHI), ratio of grays (RVG), and range of motion (ROM) were higher and the compass value was lower (P < 0.05) in the PELD group compared to the OFD group, suggesting that the PELD procedure better maintained the mobility and stability of the responsible segment after surgery. The recurrence rates between the PELD (9.80%) and OFD (7.84%) groups did not reveal statistical differences (P > 0.05).ConclusionPELD and OFD both provide acceptable clinical outcomes for LDH. However, PELD is superior to OFD in terms of relieving low back pain, delaying disc degeneration, and maintaining segmental stability.

Collagenase Chemonucleolysis for Treating Cervical Disc Herniation: An Exploratory, Single-Arm, Open-Label, Multicenter Clinical Trial.

Cervical disc herniation (CDH) is the most common cause of cervical radiculopathy and causes persistent neck pain and neurological deficits. Collagenase chemonucleolysis has been successfully applied to treat lumbar disc herniation, which has a similar pathological mechanism to CDH. However, its application for CDH remains under-researched, and there is an even greater lack of high-quality clinical evidence. This study aims to evaluate the efficacy and safety of collagenase chemonucleolysis for treating CDH. Eligible patients with CDH underwent collagenase chemonucleolysis via anterior cervical intradiscal injection or epidural injection. The primary efficacy endpoint showed an excellent and good rate regarding the Odom criteria, which was not lower than the reference value (≥ 78%) at 6 months postoperatively. The secondary efficacy endpoints were the percentage reduction in Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores from baseline, which were not lower than the reference values (≥ 40%, ≥ 30%), and improvement in the 36-Item Short Form Health Survey (SF-36) score compared to the preoperative value. The pre- and postoperative CDH index of patients were also compared. Safety endpoints included the incidence of adverse events (AEs) and serious adverse events (SAEs). An excellent and good rate regarding the Odom criteria 6 months postoperatively was 90.5% (133/147), which was significantly higher than 78% (P < 0.004, 95% confidence interval 85.7-95.2%). The reduction in NRS and NDI scores exceeded 40% (P < 0.001) and 30% (P < 0.001), respectively. The SF-36 scores at 3 months and 6 months postoperatively were significantly higher than those preoperatively (P < 0.001). A significant difference was observed in the pre- and postoperative CDH index (109.6 ± 119.1 vs. 70.8 ± 74.8, P < 0.001). The incidence of AEs was 22.5% (33/147), of which 97.8% were grade 1-2. No collagenase-related AEs and SAEs occurred. Collagenase chemonucleolysis treatment for CDH exhibited favorable efficacy and safety and may be a better choice for patients in whom conservative treatment is ineffective. The trial was registered on www.Chictr.org.cn (ChiCTR2200063043).

Development of a Dual-Plane MRI-Based Deep Learning Model to Assess the 1-Year Postoperative Outcomes in Lumbar Disc Herniation After Tubular Microdiscectomy.

Tubular microdiscectomy (TMD) is a treatment for lumbar disc herniation (LDH). Although the combination of MRI and deep learning (DL) has shown promise, its application in evaluating postoperative outcomes in TMD has not been fully explored. To evaluate whether integrating preoperative dual-plane MRI-based DL features with clinical features can assess 1-year outcomes in TMD for LDH. Retrospective. The study involved 548 patients who underwent TMD between January 2016 and January 2021. Training set (N = 305, mean age 51.85 ± 13.84 years, 56.4% male). Internal validation set (N = 131, mean age 51.85 ± 13.84 years, 54.2% male). External validation set (N = 112, mean age 51.54 ± 14.43 years, 50.9% male). 3 T MRI with sagittal and transverse T2-weighted sequences (Fast Spin Echo). Ground truth labels were based on improvement rate in 1-year Japanese Orthopaedic Association (JOA) scores. Information on 42 preoperative clinical features was collected. The largest protrusions were identified from T2 MRI by three clinicians and were used to train deep learning models (ResNet50, ResNet101, and ResNet152) to extract DL features. After feature selection, three models were built, namely, clinical, DL, and combined models. Chi-square or Fisher's exact tests was used for group comparisons. Quantitative differences were analyzed using the t-test or Mann-Whitney U test. P-values <0.05 were considered significant. Models were validated on internal and external datasets using metrics such as the area under the curve (AUC). The AUCs of the clinical models achieved 0.806 (internal) and 0.779 (external). ResNet152 performed best in three DL models, with AUCs of 0.858 (internal) and 0.834 (external). The combined model achieved AUCs of 0.889 (internal) and 0.857 (external). A model combining preoperative dual-plane MRI DL features and clinical features can assess 1-year outcomes of TMD for LDH. 4 TECHNICAL EFFICACY: Stage 2.

Transforaminal Endoscopic Lumbar Discectomy versus Coblation Nucleoplasty Combined with Collagenase Chemonucleolysis for Lumbar Disc Herniation with Grade I Degenerative Spondylolisthesis.

To investigate the short-term clinical effect of transforaminal endoscopic lumbar discectomy (TELD) versus coblation nucleoplasty (CN) combined with collagenase chemonucleolysis (CCNL) in the treatment of lumbar disc herniation (LDH) with grade I degenerative spondylolisthesis. From January 2019 to December 2020, 60 patients who had LDH with grade I degenerative spondylolisthesis were divided into two groups. Group A adopted TELD while Group B adopted CN combined with CCNL. The surgical efficacy was evaluated according to the visual analogue scale (VAS), oswestry disability index (ODI), quality of recovery-15 (QoR-15), and modified MacNab criteria. Imaging findings including lumbar lordosis (LL), segmental lordosis angle (SL), slip percentage (SP), and disc height (DH) were compared between the two groups pre-operation and at the last follow-up. VAS (back and leg), ODI, and QoR-15 were significantly decreased at each time point after operation in all groups. There were significant differences in VAS (back and leg), ODI, and QoR-15 between the two groups at 3days post-operation (P<0.05), VAS (leg), ODI, and QoR-15 at 3months post-operative (P<0.05), and QoR-15 at 6months post-operative (P<0.05). There was no significant difference in LL, SL, SP, and DH between the two groups at the last follow-up (P>0.05). Both the two operations can relieve the symptoms of lower back and leg pain in patients, and neither of the two operations caused further progress of lumbar spondylolisthesis. Compared with CN combined with CCNL, TELD had more significant improvement in early lower back and leg pain and shorter post-operative duration of hospitalization. The trial was registered on ClinicalTrials.gov (ChiCTR2300076809).

Is Endoscopic Surgery a Safe and Effective Treatment for Lumbar Disc Herniation? A Meta-Analysis of Randomized Controlled Trials.

Systematic Review. This meta-analysis systematically evaluates the safety and effectiveness of endoscopic techniques in the treatment of lumbar disc herniation (LDH). A comprehensive computerized search was conducted on PubMed, Embase, Cochrane Library, China National Biomedical Literature Database (CBM), VIP Database, China National Knowledge Infrastructure (CNKI) and Wanfang Database. Randomized controlled trials (RCTs) comparing endoscopic techniques with non-endoscopic techniques for the treatment of LDH were identified. Meta-analysis was performed using RevMan 5.4 software. Seventeen RCTs involving 1748 LDH patients were analyzed. The meta-analysis revealed that, compared to the non-endoscopic discectomy (NED) group, the endoscopic discectomy (ED) group exhibited significantly lower intraoperative blood loss [MD = -74.45mL, 95% CI (-124.88, -24.02), P = .004], shorter hospitalization duration [MD = -4.07days, 95% CI (-6.67, -1.48), P = .002], lower Visual Analogue Scale (VAS) pain scores at the last follow-up [MD = -.35, 95% CI (-.63, -.07), P = .01], and a lower incidence of complications [RR = .35, 95% CI (.25, .48), P < .00001]. Moreover, the ED group exhibited a higher ratio of excellent and good therapeutic effects postoperatively [RR = 1.05, 95% CI (1.01, 1.10), P = .01]. However, there were no statistically significant differences between the 2 groups in terms of the Oswestry Disability Index (ODI) scores at the last follow-up [SMD = -.49, 95% CI (-1.14, .17), P = .14] and operation time [MD = -10.17min, 95% CI (-27.05, 6.71), P = .24]. Endoscopic techniques in the treatment of LDH exhibit significant superiority in intraoperative blood loss, hospitalization duration, postoperative pain, complication rates, and postoperative therapeutic effects. This provides patients with a safer and more effective treatment option.

Study on the clinical effect of meridian massage in the treatment of lumbar disc herniation

To observe the clinical efficacy of meridian massage in the treatment of lumbar disc herniation(LDH). Between July 2020 and April 2023, 82 patients with lumbar disc herniation were selected, including 58 males and 24 females, aged from 23 to 55 years old with an average of (43.76±6.64) years old. According to the different treatment methods, they were divided into observation group and control group with 41 cases in each group. The control group was treated with routine treatment, and the observation group was treated with meridian massage on the basis of routine treatment. In the control group, there were 30 males and 11 females;aged from 22 to 52 years old with an average of (42.27±9.34) years old;the Body mass index (BMI) ranged from 19 to 28 kg·m-2 with an average of(23.82±1.08) kg·m-2;the course of disease ranged from 0.5 to 3.0 years (2.40±0.48) years. There were 28 cases in L4,5 segment and 13 cases in L5S1 segment. In the observation group, there were 28 males and 13 females;the age ranged from 19 to 54 years old (42.19±9.26) years old;the BMI ranged from 18 to 29 kg·m-2 with an average of(23.73±1.15) kg·m-2;the course of disease ranged from 0.6 to 2.8 with an average of(2.56±0.45) years;there were 26 cases in L4,5 segment and 15 cases in L5S1 segment. Visual analogue scale(VAS), Oswestry disability index(ODI), M-JOA score and TCM syndrome score were measured before and after 3 courses of treatment, and the clinical efficacy was evaluated by the standard of curative effect evaluation. After treatment, VAS [(3.24±1.45) vs(4.46±0.64)], ODI [(11.45±1.98)% vs (17.21±2.74)%] and TCM symptom score [(2.03±0.27) vs (3.99± 0.54)] of the observation group were lower than those of the control group. The score of M-JOA [(23.43±2.61) vs (19.37±1.62)] increased (P<0.05). The scores of VAS, ODI and TCM symptoms in the observation group were lower than those in the control group, while the scores of M-JOA were higher than those in the control group (P<0.05). Meridian massage is effective in the treatment of LDH, which can effectivelyrelieve low back pain, improve clinical symptoms and increaselumbar function, which is worthy of clinical promotion.

Clinical efficacy of single-channel percutaneous endoscopic nucleotomy with annulus fibrosus suturing for lumbar disc herniation: A retrospective study.

This retrospective study aimed to investigate the clinical efficacy of single-channel percutaneous endoscopic nucleotomy combined with annulus fibrosus suturing for treating lumbar disc herniation (LDH). The study included 86 patients with LDH treated in our spinal department from August 2020 to January 2022. The suture group consisted of 26 males and 18 females, while the control group (nucleotomy alone) included 25 males and 17 females. All patients were followed for at least 1 year, with follow-up points at 3 days, 3 months, and 12 months postoperatively. Various clinical and radiological indicators were used to evaluate and compare the efficacy and safety of the 2 procedures. No statistically significant differences were observed in age, sex, BMI, surgical segments, degree of disc degeneration, or postoperative length of hospital stay. However, the suture group had a longer operative time (63.28 ± 4.17 minutes vs 54.71 ± 4.89 minutes, t = 8.759, P < .05). At 12 months postoperatively, neither group showed aggravated disc degeneration. There was also no significant difference in excellent rates between the 2 groups (95.45% vs 92.86%, X2=0.265, P = .607). However, the suture group had a lower intervertebral disc height loss rate compared to the control group (22.3% ± 4.6% vs 29.8% ± 6.2%, X2=6.390, P < .001). In conclusion, single-channel percutaneous endoscopic nucleotomy combined with annulus fibrosus suturing is a safe and reliable treatment for LDH. It effectively reduces the recurrence rate, slows disc degeneration and loss of disc height, and achieves excellent early outcomes.

Evaluating the impact of platelet-rich plasma injection in spinal endoscopic nucleotomy on MRI pfirrmann grading and clinical outcomes in lumbar disc herniation

BackgroundThis study investigates the clinical efficacy and safety of percutaneous endoscopic nucleotomy combined with platelet-rich plasma (PRP) injection in treating lumbar disc herniation (LDH) in young and middle-aged adults.MethodsFrom April 2022 to September 2023, 60 patients diagnosed with LDH were randomly divided into two groups (n = 30/group). The observation group underwent percutaneous endoscopic nucleotomy combined with autologous PRP gel injection into the disc, while the control group underwent percutaneous endoscopic nucleotomy alone. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores were recorded preoperatively and at three time points postoperatively: three days, three months, and six months. The modified Macnab criteria were employed to evaluate efficacy at the final follow-up. Additionally, MRI Pfirrmann grading of the operated disc segment and potential complications were assessed both preoperatively and at the final follow-up.ResultsAll patients were followed for a minimum of six months. VAS and ODI scores at all postoperative time points (three days, three months, and six months) exhibited significant differences compared to preoperative scores in both groups (P < 0.05). Notably, a significant difference was observed in VAS and ODI scores between the two groups at three days postoperatively (P < 0.05). Preoperative MRI Pfirrmann grading indicated no significant difference between groups (P = 0.669). However, at the final follow-up, the observation group demonstrated superior recovery compared to the control group (P = 0.013). The modified Macnab criteria revealed no significant difference in the rates of excellent and good outcomes between the observation group (96.67%) and the control group (93.33%) (P > 0.05). Furthermore, no patients experienced complications such as dural tears, nerve root injury, infection, or hematoma.ConclusionThe combination of percutaneous endoscopic nucleotomy and PRP injection could be a safe and effective treatment for LDH in young and middle-aged adults to promote disc repair following endoscopic procedures.

Comparative analysis of operative time, blood loss, and X-ray parameters: Two-dimensional navigation guided percutaneous endoscopic transforaminal discectomy vs. conventional microscopic surgery for lumbar disc herniation

PurposeThis retrospective comparative study aims to evaluate the clinical efficacy of two-dimensional (2D) navigation-guided percutaneous endoscopic transforaminal discectomy in comparison to conventional microscopic surgery for the treatment of lumbar disc herniation (LDH), based on operative time, blood loss, and X-ray examination parameters. MethodsClinical data of patients who underwent either 2D navigation-assisted endoscopic (2D-NAE) discectomy or conventional microscopic surgery for LDH were retrospectively reviewed. Baseline characteristics, perioperative data, clinical outcomes (including visual analog scale [VAS] scores, Oswestry Disability Index [ODI] scores, and Modified MacNab criteria), and complications were compared between the two groups. ResultsA total of 95 patients were included, with 80 having complete follow-up data. The 2D navigation group comprised 47 patients, while the conventional microscopic surgery group had 33 patients. Both groups showed significant improvement in VAS and ODI scores at each follow-up time point (P < 0.05). The perioperative analysis favored the 2D navigation-assisted group, with a significantly shorter operative time (42.77 ± 7.56 vs. 59.33 ± 3.30 min; p < 0.01) and lower blood loss (10.34 ± 2.24 vs. 11.55 ± 2.20 ml; p = 0.02). The number of X-ray examinations required was similar between the two groups (2.34 ± 0.48 vs. 2.39 ± 0.56; p = 0.65), and post-operative hospitalization durations were comparable (p = 0.5). Clinical efficacy, as reflected by VAS scores for legs and ODI scores, showed no significant differences between the groups. Additionally, the Modified MacNab criteria indicated similar rates of excellent and good outcomes. ConclusionBoth 2D-NAE discectomy and conventional microscopic surgery demonstrated comparable therapeutic outcomes for LDH, with favorable clinical efficacy and safety profiles. However, 2D-NAE surgery may offer additional benefits, including shorter operative times, reduced blood loss, and fewer X-ray examinations.

C-arm-guided versus ultrasound volumetric navigation-guided percutaneous transforaminal endoscopic discectomy for the treatment of lumbar disc herniation: A retrospective study.

To compare the clinical efficacy of lumbar percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH) guided by C-arm fluoroscopy and ultrasound volumetric navigation (UVN). Fifty patients with LDH treated with PTED were retrospectively evaluated in this study. Groups A (n = 25) and B (n = 25) had intervertebral foramina punctures guided by C-arm fluoroscopy and UVN, respectively. The age, gender, height, weight, and body mass index of patients were recorded. We compared the puncture time, number of punctures, and puncture accuracy of patients in both groups. We also evaluated the clinical effectiveness of PTED surgery using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). In addition, we recorded the duration of surgery, hospitalization, medical costs, and surgical complications in both groups. The average follow-up time of the 50 patients was 18.5 ± 4.3 months. The mean puncture time in groups A and B was 25.76 ± 5.28 and 14.34 ± 4.96 minutes, respectively, and the difference was statistically significant (P < .05). The mean number of fluoroscopies was significantly lower in group B than in group A, with 15.82 ± 2.29 versus 4.52 ± 0.51 times (P < .05). The puncture accuracy rate was 100% in both groups, with no statistical difference (P > .05). The VAS and ODI scores of patients in group A were similar to group B at all 3-time points: preoperatively, at 3 months postoperatively, and at 1 year postoperatively. However, both VAS and ODI were significantly improved postoperatively compared to preoperatively (P < .05). Moreover, group B has shorter operative time and higher medical cost than group A (P < .05). There was no significant difference in the length of hospitalization and surgical complication rate (P > .05). Both C-arm-guided and the UVN-guided PTED are safe and effective methods for the treatment of LDH. UVN-guided technique has the advantage of reducing puncture time and the number of punctures. However, UVN also has the disadvantage of high hospitalization costs.

Clinical Outcomes of Full-Endoscopic Visualized Foraminoplasty and Discectomy for Lumbar Disc Herniation with Bilateral Radiculopathy.

The treatment of lumbar disc herniation (LDH) with bilateral radiculopathy using transforaminal endoscopic lumbar discectomy (TELD) remains challenging, especially at the L5/S1 level with narrow foramen or high iliac crest. Full-endoscopic visualized foraminoplasty and discectomy (FEVFD) is a newly developed technique for LDH and lumbar stenosis. However, there is limited evidence on the efficacy of FEVFD technique in the treatment of LDH with bilateral radiculopathy. This study was to assess the clinical outcomes and safety of using FEVFD in the treatment of LDH with bilateral radiculopathy. This retrospective study enrolled 63 patients with LDH presenting with bilateral radiculopathy between January 2018 and January 2022. Patients enrolled before January 2020 were treated using a conventional transforaminal endoscopic surgical system (TESSYS) technique (TESSYS, n = 33) and treated using a FEVFD technique after that (FEVFD, n = 30). The total operation time and the number of intraoperative fluoroscopies were recorded. The Oswestry Disability Index (ODI) and visual analog scale (VAS) were evaluated preoperatively and postoperatively (at 1-month, 3-month, 6-month, and final follow-ups). Global outcomes at final follow-up were assessed using modified MacNab criteria. Compared with TESSYS, patients in FEVFD group had a shorter operation time (92.9 vs. 78.0 min). The intraoperative fluoroscopies in FEVFD group were significantly lower than those in TESSYS group (18.7 vs. 4.9). After the operation, the VAS and ODI scores at all follow-ups in the two groups were significantly lower than those before operation. For the L5/S1 level, the values of VAS and ODI scores in FEVFD group were significantly lower than those of in TESSYS group at 3-month, 6-month, and final follow-up. For the L4/5 level, however, no significant difference was found in VAS and ODI scores between these two groups at the follow-ups. According to the modified MacNab criteria, the excellent-to-good rate in TESSYS and FEVFD groups was 84.8% and 90.0%, respectively. For LDH with bilateral radiculopathy, using the FEVFD technique could not only reduce the operation time and radiation, but also improve the clinical outcomes at the L5/S1 level.

Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Linked with Posterior Ring Apophysis Separation: A Retrospective Study

ObjectivesPosterior ring apophysis separation (PRAS) associated with lumbar disc herniation (LDH) is a relatively rare form of disc herniation. This study aims to evaluate the clinical effectiveness of unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of PRAS with LDH. MethodsWe enrolled 41 patients who met the inclusion criteria to undergo either unilateral biportal endoscopic discectomy (UBE) (15 cases) or percutaneous endoscopic lumbar discectomy (PELD) (26 cases) between October 2022 and October 2023. Perioperative evaluation parameters included mean operative time, hemoglobin (Hb) loss, length of stay (LOS), and postoperative complications. Outcomes were assessed at admission, as well as at 1, 3, and 6 months post-surgery using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). Additionally, we evaluated the results according to the modified MacNab criteria. ResultsBoth groups demonstrated improvements in postoperative VAS and ODI scores. However, there were no significant differences between the two groups in VAS and ODI scores before surgery, or at 1, 3, and 6 months post-surgery. Additionally, no notable differences were observed in the modified MacNab criteria. The UBE group experienced greater hemoglobin (Hb) loss, longer mean operative time, and increased length of stay (LOS) compared to the PELD group. Furthermore, two patients in the PELD group reported recurrence, while one patient in the UBE group experienced a dural tear. ConclusionsUBE and PELD possess strong clinical effectiveness for treating PRAS with LDH. Although the UBE group had a longer mean operative time and LOS, with more Hb loss, the UBE group had a lower recurrence rate. Therefore, UBE remains safe and innovative for the treatment of PRAS with LDH.

Comparison of the Results of Combined Epidural Steroid Injection with Other Approaches in Lumbar Disc Herniation: A Retrospective Study

Background: Epidural steroid injection (ESI) is a minimally invasive treatment for lumbar disc herniation (LDH). It can be applied using a transforaminal (TFESI), interlaminar (ILESI), caudal (CESI), or combined (TFESI + CESI) approach. Aim: To compare the effectiveness of the three ESI approaches and the combined ESI application in reducing pain in patients with single or multi-level LDH. Methods: In this retrospective study, we included 239 patients diagnosed with LDH (who complained of low back pain for at least 3 months, had no neurological deficit or history of lumbar surgery, and were not contraindicated for ESI application) who received ESI and were followed up clinically for 2 years. Demographic (age, sex, body mass index (BMI)) and clinical data (duration of low back pain, visual analog scale (VAS) scores before and after ESI, and procedure-related information) were obtained from medical records. The VAS scores noted before treatment and at 3 months, 1 year, and 2 years after ESI were compared. Results: The post-treatment VAS scores of the combined ESI (TFESI + CESI) group were significantly lower than those of other approaches applied alone (P &lt; 0.05). Furthermore, VAS scores of the ILESI and CESI groups were significantly lower than those of the TFESI group at all three post-treatment time points (P &lt; 0.05). The patient’s age and BMI were weakly correlated with the post-treatment VAS scores. Conclusion: Combined ESI is more effective than any single-approach ESI in LDH and should be considered in suitable patients to increase treatment effectiveness.

Modified transforaminal lumbar endoscopic discectomy for surgical management of extraforaminal lumbar disc herniation: case series and technical note.

Extraforaminal lumbar disc herniation (ELDH) represents a unique clinical entity, presenting particular challenges in surgical management. Transforaminal lumbar endoscopic discectomy (TLED) represents a minimally invasive, full-endoscopic procedure that is increasingly selected for surgical treatment of lumbar disc herniation, being theoretically ideal in patients with ELDH. Performance of TLED for management of ELDH has been reported in specific studies in the recent literature. However, foraminal anatomy is significantly disrupted in cases of ELDH, a fact that may represent a true challenge for the operating surgeon, in terms of proper endoscopic visualization. Hence, the aim of this study was to investigate midterm clinical outcomes of a unique modification of the TLED technique in patients with ELDH, in an attempt to enhance endoscopic visualization of foraminal structures and to facilitate safe and effective decompression in these cases. Twenty-five patients with ELDH were enrolled in this study. All patients underwent modified TLED (mTLED) in the authors' center and were retrospectively assessed. Clinical evaluation was performed via the visual analog scale at 6 weeks; at 3, 6, and 12 months; and at 2 and 5 years postoperatively on an outpatient basis. Moreover, the functional status of enrolled individuals was evaluated with modified Macnab criteria at the end of follow-up. All patients underwent successful mTLED; the mean operative time was 23.7 ± 3.4 minutes. All patients were discharged on the same day as their operation, exhibiting no major perioperative complications. Three patients (12%) reported transient postoperative dysesthesia, which was completely resolved 6 weeks postoperatively. Recorded visual analog scale values were significantly ameliorated up to the end of follow-up, featuring maximal improvement at 6 weeks, with subsequent minimal amelioration and stabilization. According to modified Macnab criteria, excellent or good outcomes were observed in 23 patients (92%), whereas the outcome was fair in 2 patients (8%). mTLED represents a feasible, safe, and effective alternative to conventional TLED and conventional open procedures for the management of ELDH. However, the precise role of this technical modification should be further investigated in future studies.

A retrospective comparative study of robot-assisted unilateral biportal endoscopic lumbar decompression and fusion surgery versus percutaneous endoscopic lumbar decompression and fusion surgery.

The objective of this study is to illustrate the advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression fusion and internal fixation surgery. According to the different surgical methods, we divided the 26 patients into 2 groups, robot-assisted unilateral biportal endoscopy for lumbar interbody fusion (R-ULIF) group and percutaneous endoscopic lumbar decompression and interbody fusion (Endo-LIF) group, with a 1:1 ratio. Gender, disease course, lesion site, fluoroscopy times, operative time, blood loss, postoperative hospital stay, screw placement success rate, fusion rate, complications rate, postoperative pain visual analog scale (VAS) (The VAS score is used only to evaluate pain in the lower back and legs.) Oswestry Disability Index (ODI) (The ODI score can serve as a reference indicator for evaluating the effectiveness of treatment for patients with low back pain, and has good responsiveness in assessing patients with chronic low back pain), and MacNab (The MacNab standard is divided into 4 levels: excellent, good, fair, and poor, which can be used to evaluate the therapeutic efficacy of certain spinal surgeries) standard efficacy evaluation were analyzed and compared between the 2 groups. All patients successfully completed the surgery. Compared with the Endo-LIF group, the R-ULIF group had fewer fluoroscopy procedures, less intraoperative blood loss, and shorter postoperative hospital stay (P < .05). The VAS scores and ODI scores of both groups significantly decreased at all-time points (P < .05). The ODI scores of the R-ULIF group were better than the Endo-LIF group at 1 month and 3 months after surgery (P = .017/P = .047), but there was no statistically significant difference between the groups before surgery and 1 week after surgery (P > .05). The efficacy was evaluated using the MacNab criteria at 6 months after surgery. The R-ULIF group has an excellent and good rate of 84.6%, while the Endo-LIF group has an excellent and good rate of 76.9% (P = 1.000). Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has shown short-term clinical efficacy in the treatment of lumbar disc herniation combined with lumbar instability, surpassing endoscopic lumbar interbody fusion surgery. Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has demonstrated high success rate in screw placement, minimal radiation exposure, less intraoperative blood loss, shorter hospital stay, and thus deserves further clinical promotion.

Impact of Lumbar Fusion Internal Fixation on Lumbar Disc Herniation in Young Patients: A Retrospective Study.

BACKGROUND Lumbar fusion and internal fixation techniques have shown promise in treating lumbar disc herniation (LDH), yet the impact on lumbar function in young patients remains unclear. This study aimed to investigate the impact of lumbar fusion on lumbar function in young patients. MATERIAL AND METHODS A retrospective analysis was conducted on 330 patients diagnosed with LDH admitted to our hospital. Patients were divided into 2 groups: a control group (n=264) that underwent a minimally invasive procedure with a keyhole lens, and a research group (n=66) that underwent lumbar fusion internal fixation. Clinical features and therapeutic outcomes were assessed using Oswestry Disability Index (ODI) and Japanese Orthopedic Association (JOA) Lumbar Scores before surgery and 12 months postoperatively. Additionally, intervertebral space height, degree of vertebral spondylolisthesis (grades I, II, and III), incidence of adverse effects, and treatment efficacy were measured pre-and post-surgically. RESULTS No significant difference in ODI and JOA scores was found between the groups before surgery (P>0.05). Postoperatively, the research group had lower ODI scores, higher JOA scores, and lower intervertebral space heights compared to the control group (P=0.001). While grade 1 and 2 spondylolisthesis showed slight improvement (P>0.05), a significant difference was observed in grade III spondylolisthesis between the 2 groups (P=0.001). Additionally, the research group had a lower incidence of adverse effects (P=0.049) and higher treatment efficacy, although the difference was not statistically significant (P>0.05). CONCLUSIONS Lumbar fusion with internal fixation produced better postoperative outcomes and fewer adverse effects than minimally invasive procedures in young patients with lumbar disc herniation.