Type Of Lumbar Disc Herniation Research Articles

Correlation between Disc Imaging Observations and Clinical Efficacy after Percutaneous Endoscopic Lumbar Discectomy: A 1-Year Follow-up Study.

The connection between alterations in the disc structure following percutaneous endoscopic lumbar discectomy (PELD) and symptoms in patients postsurgery has not been reported yet. The purpose of the present study was to discuss the potential correlation between the changes in the morphological characteristics of various reference surfaces of the intervertebral disc after percutaneous endoscopic lumbar discectomy (PELD) and clinical outcomes, to identify the morphological parameters that affect efficacy and provide an evidence-based foundation for assessing postoperative efficacy. From October 2019 to October 2021, after percutaneous endoscopic lumbar discectomy (PELD), 98 individuals were enrolled. MRI DICOM data of the lumbar spine were obtained before and after surgery, specifically around 3 months. The morphological parameters of the operated and adjacent segments of the discs were measured using T2-weighted images from three reference planes. Outcomes were assessed using the Oswestry disability index (ODI), visual analogue pain scores for the back and leg (VAS-back/VAS-leg), Japanese Orthopaedic Association (JOA) scores, and recovery rates. Postoperative changes in disc parameters and outcomes were compared between patients with different severity and types of LDH based on the MSU staging. Patients completed the questionnaire during outpatient follow-up appointments 3, 6, and 12 months after the surgery. The follow-up period was 14.69 ± 4.21 months, ranging from 12 to 24 months. Parameters such as area and circumference of intervertebral discs in the cross-section were not associated with the change in the efficacy index. Postoperatively, a negative correlation between the variation of the disc height, disc height index, and protrusion distance and the difference in VAS scores for low back pain at 3 and 6 months was observed among the two sagittal change parameters. Differences between changes in disc imaging parameters and postoperative efficacy were not statistically significant between various types of lumbar disc herniation. For the patients after percutaneous endoscopic lumbar discectomy, the changes in parameters such as disc area and circumference in the cross-sectional plane are not associated with efficacy, and the changes in disc height and herniation distance in the sagittal plane provide a morphologic basis for the assessment of short-term postoperative efficacy. In addition, the changes in disc morphologic parameters and postoperative efficacy do not differ between various types of lumbar disc herniation.

Correlation between spinous process deviation and lumbar disc herniation in young patients

To explore the relationship between spinous process deviation and lumbar disc herniation in young patients. From March 2015 to January 2022, 30 treated young (under the age of 30) patients with lumbar disc herniation were included as the young group. In addition 30 middle-aged patients (quinquagenarian group) with lumbar disc herniation and 30 patients with non-degenerative spinal diseases (young non-degenerative group) were selected as control groups. The angle of the spinous process deviation was measured on CT and statistically analyzed by various groups. All the data were measured twice and the average value was taken and recorded. The average angle of spinous process deviation in the degenerative lumbar vertebra of young patients were (3.89±3.77) degrees, similar to the (3.72±2.98) degrees of quinquagenarian patients(P=0.851). The average angle of s spinous process deviation young non-degenerative group were (2.20±2.28) degrees, significantly less than young group(P=0.040). The spinous process deviation angle of the superior vertebral of the degenerative lumbar in the young group was (4.10±3.44) degrees, which similar to the (3.47±2.87) degrees in the quinquagenarian group (P=0.447). A total of 19 young patients had the opposite deviation direction of the spinous process of the degenerative lumbar vertebra and upper vertebra, while only 7 quinquagenarian patients had this condition(P=0.02). The type of lumbar disc herniation in young patients had no significant relationship with the direction of spinous process deflection of the degenerative or upper lumbar vertebra (P>0.05). Spinous process deviation is a risk factor of young lumbar disc herniation patients. If the deviation directions of adjacent lumbar spinous processes are opposite, it will increase the incidence of lumbar disc herniation in young patients. There was no significant correlation between the type of disc herniation and the deviation direction of the spinous process of the degenerative or upper lumbar vertebra. People with such anatomical variation can strengthen the stability of spine and prevent lumbar disc herniation through reasonable exercise.

Autophagy in an extruded disc compared to the remaining disc after lumbar disc herniation in the same patient.

The purpose of this study was to investigate autophagy in an extruded disc and to compare this activity with the activity in the remaining disc after lumbar disc herniation in the same patient. In total, 12 patients (females 4, males 8) with the extruded type of lumbar disc herniation (LDH) were surgically treated. Their mean age was 54.3 ± 15.8years (range: 29 ~ 78years). The mean interval from the occurrence of symptoms to the operation was 9.8 ± 9.4weeks (range: 2 ~ 24weeks). The extruded discs were excised, and the remaining disc material removed, to prevent recurrence of herniation. Immediately after specimen collection, all tissues were stored at -70°C prior to analysis. Autophagy was assessed immunohistochemically and via Western blotting for Atg5, Atg7, Atg12, Atg12L1, and Beclin-1. And the relationship between autophagy and apoptosis was investigated by correlation analysis of caspase-3 with autophagy proteins. The expression levels of autophagic markers were significantly increased in the extruded discs compared to the remaining discs within the same patients. The mean expression levels of Atg5, Atg7, Atg12, and Beclin-1 in extruded discs were statistically significantly higher than those in the remaining discs (P < 0.01, P < 0.001, P < 0.01, and P < 0.001 respectively). The autophagic pathway was more active in extruded disc material than in remaining disc material within the same patient. This may explain spontaneous resorption of the extruded disc after LDH.

Factors related to the postoperative recurrence of lumbar disc herniation treated by percutaneous transforaminal endoscopy: A meta-analysis.

To explore factors related to the postoperative recurrence of lumbar disc herniation treated by percutaneous transforaminal endoscopy. PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched from the time of each library's construction to October 20, 2022. The studies that compared the influencing factors of recurrent lumbar disc herniation were included based on the PICO search structure. The Newcastle-Ottawa Scale was used to evaluate the quality of observational studies. The effects of the patient's age, gender, BMI, smoking, drinking, hypertension, diabetes, course of the disease, Pfirrmann grade, and the surgical segment on recurrent lumbar disc herniation were systematically evaluated using Revman 5.3. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Thirteen studies involving 3,393 patients (323 patients with recurrent lumbar disc herniation) treated with percutaneous transforaminal endoscopy were included in this study. The results of the systematic evaluation showed that the effects of gender, smoking, drinking, hypertension, type of lumbar disc herniation and the surgical segment on recurrent lumbar disc herniation were not statistically significant. However, age ≥60 years (OR = 2.23; 95% CI: 1.13, 4.41), BMI ≥25 (OR = 2.89; 95% CI: 1.23, 6.80), diabetes (OR = 1.73; 95% CI: 1.18, 2.55), course of disease ≥4 years (OR = 2.93; 95% CI: 1.58, 5.43), Pfirrmann grades 3-4 (OR = 3.10; 95% CI: 2.18, 4.40), incomplete removal of nucleus pulposus (OR = 3.26; 95% CI: 1.69, 6.27) and intraoperative fibre breakage (OR = 3.18; 95% CI: 1.56, 6.50) increased the risk of recurrence after treatment. The recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic treatment is related to demographic characteristics, disease history and surgical conditions. In the future, more high-quality studies are needed to explore the influencing factors of recurrent lumbar disc herniation.

Comparison of Semirigid and Rigid Lumbosacral Orthoses in Association with Routine Treatment of Pain, Fear of Movement, and Disability in Patients with Lumbar Disc Herniation

ABSTRACT Introduction Disc protrusion, as a type of lumbar disc herniation, is one of the most common causes of acute lower back pain. Lumbosacral orthoses (LSOs) can be used as a conservative treatment along with routine treatment (physiotherapy and medication). The aim of this study was to investigate the impact of routine therapy in association with two types of rigid and semirigid LSOs compared with routine treatment alone on pain, fear of movement, and disability in patients with herniated lumbar disc. Materials and Methods In this quasi-experimental study, 27 patients with lumbar disc herniation (protrusion type) were assigned into three groups including 1, semirigid LSO with routine treatment (n = 8); 2, rigid LSOs with routine treatment (n = 8); and 3, only routine treatment (n = 11). Before using any therapeutic interventions in each group, the pain, disability, and fear of movement were recorded using the visual analog scale, Oswestry questionnaire, and Tampa questionnaire, respectively. Patients in each group then used their allocated intervention for 4 weeks. After 4 weeks, variables were recorded under the same protocol. Results In between-group comparison after 4 weeks, no significant difference was observed between them in all variables (P &gt; 0.05). In intragroup comparison, in the group of routine treatment wearing semirigid LSO, a significant decrease in disability, pain, and fear of movement was observed after 4 weeks’ use of intervention compared with before (P &lt; 0.05). Routine treatment using rigid LSO caused a significant reduction in pain and disability and use of routine treatment significantly reduced only disability score (P &lt; 0.05). Conclusions Based on the findings, no significant difference was found between interventions in measured outcomes. However, the use of physiotherapy and medication along with semirigid LSO improved all outcomes compared with before using. Clinical Relevance Both routine treatment alone and routine treatment along with an LSO can be used in people with herniated lumbar disc. Use of physiotherapy and medication along with semirigid LSO could improves pain, fear of movement, and disability in these patients.

Percutaneous endoscopic interlaminar discectomy for L5-S1 calcified lumbar disc herniation: A retrospective study.

BackgroundCalcified lumbar disc herniation (CLDH) is considered to be a special type of lumbar disc herniation (LDH). Percutaneous endoscopic interlaminar discectomy (PEID), with safety and efficacy, has been proved to be a minimally invasive surgery for LDH. However, there are few studies on PEID in the treatment of CLDH at the L5-S1 level. This study aimed to analyze the clinical efficacy of PEID for L5-S1 CLDH.MethodsFrom August 2016 to April 2020, we retrospectively analyzed 28 consecutive patients (17 males and 11 females) with L5-S1 CLDH treated with PEID at our institution. All the patients were monitored for more than 1 year postoperatively. The demographic characteristics, surgical results, and clinical outcomes estimated by the visual analog scale (VAS) for leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria were collected.ResultsAll patients successfully underwent PEID. The mean operative time and intraoperative blood loss were 65.36 ± 5.26 min and 13.21 ± 4.35 ml, respectively. The VAS for leg pain and ODI scores improved remarkably from 7.54 ± 0.96 to 1.50 ± 0.51 (P < 0.05) and from 69.29 ± 9.91 to 17.43 ± 3.69 (P < 0.05) a year after operation, respectively. According to the modified MacNab criteria of the last follow-up, the excellent and good rates are 92.86%. Two of the patients had complications, one had nerve root injury and the other had postoperative dysesthesia.ConclusionsPEID achieved good clinical outcomes in the treatment of L5-S1 CLDH, and it was a safe and effective minimally invasive surgery for L5-S1 CLDH.

Prevalence of Lumbar Segmental Instability in Young Individuals with the Different Types of Lumbar Disc Herniation-Preliminary Report.

Lumbar segmental instability (LSI) can cause pain and disability, and its background can be related to lumbar disc herniation (LDH). This retrospective study was conducted to analyze the prevalence of lumbar segmental instability (LSI) in young patients with different types of lumbar disc herniation (LDH). The study evaluated 133 individuals (18–25 years old) who suffered from LDH and underwent MRI and flexion-extension X-rays. Two groups were created: protrusion (PRO) and extrusion (EXT). LSI was scored positive when translatory motion was greater than 4 mm anteriorly or 2 mm posteriorly at the level of herniation. Statistica 13 was used to perform statistics. The LSI overall prevalence was 18.33% in PRO and 21.92% in EXT (p > 0.05). Out of all LSI positives, higher LSI incidence was observed in females compared to males; in PRO: 63.64%; in EXT: 68.75% (p > 0.05). LSI correlated positively with the passive lumbar extension test (PLE) (R = 0.32; p = 0.01) in the PRO group only. In summary, the results showed that the overall incidence of LSI was higher with severer disc damage. In addition, females were more prone to this pathology. However, the different types of LDH do not significantly affect the prevalence of LSI in young individuals.

Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding: A Retrospective Study.

PurposeThis study aimed to investigate the use of the percutaneous intervertebral foramen lens technology for secondary molding of the intervertebral foramen in the treatment of calcified lumbar discs.MethodsThe study included 104 patients who were divided into two groups. Group A comprised 50 patients with calcified lumbar disc herniation and group B comprised 54 patients with non-calcified lumbar disc herniation diagnosed by computed tomography and magnetic resonance imaging. Patients underwent a percutaneous endoscopic lumbar discectomy at our hospital from January 1, 2017, to December 31, 2019. Demographic characteristics before the surgery and perioperative outcomes were retrospectively reviewed. The treatment outcome was analyzed using the numerical rating scale (NRS) score, Oswestry Disability Index (ODI) score, and modified Macnab criteria.ResultsPatients in groups A and B showed significant improvement in both the NRS and ODI scores after the surgery and maintained relatively low ODI and NRS scores during subsequent follow-ups. According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy was 94% in group A and 92.6% in group B at the 3 month follow-up. In group A, one patient developed neck pain during the surgery, which was diagnosed as spinal hypertension syndrome, and the surgery was suspended until the patient’s condition improved. No similar complications occurred in group B. In both the groups, no patient reported any dural leak, infection, or other related complications.ConclusionThe use of transforaminal remolding technology can significantly improve the symptoms and dysfunction of patients with calcified and non calcified lumbar disc herniation. There are few intraoperative and postoperative complications and have little impact on vertebral stability. It can provide a reference for the treatment of special types of lumbar disc herniation.

Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study.

ObjectiveTo introduce the concept of ‘nerve root as the core’ and to investigate the surgical procedure and curative effect of percutaneous translaminar endoscopic discectomy (PTED) surgery in the treatment of different types of lumbar disc herniation (LDH).MethodsThis retrospective study analysed the clinical data from patients with LDH that underwent single-segment PTED surgery. They were divided into three groups based on LDH location: central canal zone group, lateral recess zone group and foraminal/far lateral zone group. Different working cannula placement methods were used for the different types of LDH. All patients were followed for at least 12 months. Clinical and follow-up data were compared between the three groups.ResultsA total of 130 patients were enrolled in the study: 44 (33.8%) in the central canal zone group, 72 (55.4%) in the lateral recess zone group and 14 (10.8%) in the foraminal/far lateral zone group. All three groups of patients achieved good postoperative results. The improvements in leg pain and disability were most marked in the first postoperative month in all three groups.ConclusionPTED achieved adequate decompression for different types of LDH. The concept of ‘nerve root as the core’ facilitated the accurate placement of the working cannula.

Fully endoscopic interlaminar and transforaminal lumbar discectomy: clinical results of 857 surgically treated patients.

Minimally invasive surgical techniques are becoming increasingly common in spinal surgery in an attempt to decrease tissue trauma during surgery, which in turn decreases post-operative pain and opioid use. The aim of this study was to investigate the clinical outcomes of a large group of patients with lumbar disc disease who underwent full endoscopic surgery. 857 patients who underwent fully endoscopic lumbar discectomy were investigated retrospectively. General demographics were evaluated in terms of mean operating time, mean length of hospital stay, mean time to return to work, complications and recurrences. Clinical outcomes were evaluated using visual analogue scale (VAS) for low back and leg pain, and Oswestry Disability Index (ODI) for functional assessment. The mean follow-up time was 36 months. The operation time ranged from 20 to 65 minutes (39 min on average), and there was no measurable intraoperative blood loss. Patients were mobilised on average 3.5 hours after the surgery. The length of hospital stay after the operation was 12-24 hours (18 hours on average). During postoperative follow-up, 19 patients required revision surgery due to recurrence (2.2%). There was one case of nerve root injury in which the patient recovered well following physical therapy, and 11 cases of paresthesia that gradually improved following 2-6 weeks of rehabilitation and treatment with pregabalin. All types of lumbar disc herniations are accessible via the full-endoscopic technique. Full-endoscopic discectomy, as a minimally invasive procedure, has the technical advantages of less paraspinal muscle dissection, less tissue trauma, less risk of spinal instability, and minimal blood loss.

Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: a new guidance is coming? [abstract

PURPOSE: To investigate the sub-types of lumbar disc herniation, compare efficacies of ozone treatment in various types of lumbar disc herniation and analyze the mechanisms.&#x0D; &#x0D; MATERIAL AND METHODS: A total of 250 patients (159 males, 91 females; age range: 14 - 85 years) diagnosed of lumbar disc herniation from January 2009 to Jun 2014 in Nanfang Hospital were enrolled. Disc Lesions, classified by Magnetic Resonance examinations and images when injecting ozone under Digital Subtraction Angiography, were divided into four types: type I: Non-prominent nucleus pulposus with ruptured fibre ring; type II: Prominent nucleus pulposus with ruptured fibre ring; type III: Non-prominent nucleus pulposus with Non-ruptured fibre ring; type IV: Prominent nucleus pulposus with Non-ruptured fibre ring. All patients underwent intradiscal and paravertebral injection of oxygen-ozone. Visual Analogue Scale (VAS) weighted score was administered for the measurement of low back pain before treatment, and the evaluation of efficacy respectively at 1 week, 1 month, 6 month and 12 month follow-up period. &#x0D; &#x0D; RESULTS: Most of the patients (about 4/5) showed better response to ozone treatment. Herniated disc shrinkage was obtained among type II and IV. The type II had the most reduction of average score while the type III had the least. The proportion of patients who had once experienced pain relief at the follow up interval, namely the curative efficacy, showed significant difference: type I occupied the most, type IV occupied the least.&#x0D; &#x0D; CONCLUSION: Ozone treatment is effective and safe for all types of lumbar disc herniation, but efficacy varies according the types, of which type I has the best results and type IV has the worst ones.

Clinical Effectiveness of Percutaneous Epidural Neuroplasty According to the Type of Single-Level Lumbar Disc Herniation : A 12-Month Follow-Up Study.

ObjectiveTo determine whether the outcomes of percutaneous epidural neuroplasty (PEN) are influenced by the type of lumbar disc herniation (LDH) and evaluate the effectiveness of PEN in patients with single-level LDH. MethodsThis study included 430 consecutive patients with single-level LDH who underwent PEN. Before treatment, the LDH type was categorized as bulging, protrusion, extrusion, and sequestration, while Pfirrmann grades were assigned according to imaging findings. Visual analog scale (VAS) scores for back and leg pain and success rates (Odom’s criteria) were assessed at 1, 3, 6, and 12 months after treatment. ResultsThe mean preoperative VAS scores for back and leg pain were 6.90 and 4.23, respectively; these decreased after PEN as follows : 2.25 and 1.45, respectively, at 1 month; 2.61 and 1.68, respectively, at 3 months; 2.28 and 1.48, respectively, at 6 months; and 2.88 and 1.48, respectively, at 12 months (p<0.001). The decrease in VAS scores for leg pain was significantly greater in the extrusion and sequestration groups than in the other two groups (p<0.05); there were no other significant differences among groups. More than 70% patients exhibited good or excellent 12-month outcomes according to Odom’s criteria. Subsequent surgery was required for 59 patients (13.7%), with a significantly higher rate in the extrusion (25.0%) and sequestration (30.0%) groups than in the bulging (7.3%) and protrusion (13.8%) groups (p<0.05). Nevertheless, subsequent surgery was not required for >70% patients with extrusion or sequestration. Patients with Pfirrmann grades 1–3 (14.0–21.5%) showed a significantly higher rate of subsequent surgery than those with Pfirrmann grade 0 (4.9%; p<0.05). ConclusionOur findings suggest that PEN is an effective treatment for back and leg pain caused by single-level LDH, with the outcomes remaining unaffected by the LDH type.

Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

Lumbar disc herniation (LDH) is being treated with limited indication by percutaneous full endoscopic lumbar discectomy. However, microscopic lumbar discectomy (MLD) is still considered as a gold standard. With the advances in spinal endoscopic instruments and surgical techniques, all LDHs have now become operable with percutaneous full endoscopic lumbar discectomy procedure. We report the results of percutaneous full endoscopic lumbar discectomy (PELD) for all patients diagnosed with LDH, including severely difficult and extremely difficult LDH cases who visited our clinic with leg pain and lower back pain. Retrospective study of consecutive prospective patients. Spine center, Nanoori Suwon Hospital, Suwon, Korea. Electronic medical records of 98 consecutive patients (104 levels) who underwent surgery from October 2015 to May 2016, by PELD for different LDHs either by percutaneous endoscopic transforaminal lumbar discectomy (PETLD) or percutaneous endoscopic interlaminar lumbar discectomy (PEILD) approach were reviewed retrospectively. The L5-S1 level was accessed with PEILD approach and the other levels were accessed with PETLD approach. Outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), Mac Nab Criteria and endoscopic surgical success grade/score. There were 75 (72.1%) men and 29 (27.9%) women patients with a mean age of 48.12 ± 15.88 years. Follow-up range from a minimum of 10 to 15 months (mean 12.77 ± 1.84 months). Most of the LDHs were located at L4-5 level. There were 76% severely difficult and extremely difficult cases. PETLD was the choice of approach in most of the cases (78 cases, 75%). VAS decreased significantly. ODI improved from preoperative 54.67 ± 7.52 to 24.50 ± 6.45 at last follow-up. 96.1% good to excellent result was obtained as per Mac Nab criteria. 98.1% of patients were managed with a successful to completely successful grade according to the endoscopic surgical success grading/scoring. Two cases (1.9%) developed transient motor weakness. Retrospective analysis of consecutive prospective patients. With more than 96% success (98.1% as per endoscopic success grading/scoring) all kinds of LDHs, including severely difficult and extremely difficult LDHs, are accessible by the PELD (PETLD and PEILD) technique. PELD can now be considered an alternative to microscopic lumbar discectomy (MLD) in the treatment of all kinds of disc herniations with the added benefits of keyhole surgery even for severely difficult and extremely difficult LDH cases. Lumbar disc herniation (LDH), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic transforaminal lumbar discectomy (PETLD), percutaneous endoscopic interlaminar discectomy (PEILD), evolution of PELD, difficult LDH, highly migrated LDH, high canal compromised LDH, revision LDH, LDH with discal cyst, calcified LDH.

Combining YESS and TESSYS techniques during percutaneous transforaminal endoscopic discectomy for multilevel lumbar disc herniation.

The authors retrospectively characterized the clinical outcomes of combining the Yeung endoscopic spine system (YESS) and transforaminal endoscopic surgical system (TESSYS) techniques during percutaneous transforaminal endoscopic discectomy (PTED) to treat multilevel lumbar disc herniation.PTED using both YESS and TESSYS was performed on 52 patients with multilevel lumbar disc herniations who had shown no apparent response to previous conservative treatments. Postsurgical follow-ups were conducted at weeks 1, 26, and 48. Patients’ preoperative and postoperative performances were assessed by modified MacNab classification, Japanese Orthopedic Association (JOA) scores, Oswestry disability index (ODI), and visual analog scale (VAS), and compared with 34 and 45 patients who were treated only by YESS and TESSYS, respectively.The postsurgery surgeon-performed assessment showed satisfactory results in 98% of the YESS + TESSYS-treated cases. The average operative time was 116 ± 23 minutes, intraoperative bleeding was 19 ± 12 mL, and bed stay was 3 days. No complications occurred, including infection, nerve injury, or spinal canal hematoma. One week after surgery, the modified MacNab classifications of the patients were excellent in 45, good in 6, fair in 1, and poor in 0 (98% were excellent or good). JOA, ODI, and VAS scores for low back pain significantly improved relative to the preoperative assessment (P < .01) and had remained stable at 26 and 48 weeks.PTED that combined YESS and TESSYS techniques, depending on the predominant type of lumbar disc herniation at individual levels, is safe, minimally invasive, and effective.

The Extraforaminal Approach for the Management of Far Lateral Lumbar Disc Herniation

Background Data: Far lateral lumbar disc herniation accounts for 1-12% of all lumbar disc herniations. Every aspect of management of this unique type of lumbar disc herniation is challenging for spine surgeons, and no consensus has been reached for the best surgical approach and technique to use.Purpose: The purpose of this study is to evaluate the extraforaminal approach, which is a less invasive approach, for the treatment of far lateral lumbar disc herniation.Study Design: A prospective case series.Patients and Methods: Of 501 lumbar disc prolapse patients treated surgically in our department between September 2013 and August 2015, 15 patients presented with far lateral lumbar disc herniation. These 15 patients (11 males and 4 females, mean age 46.80 ± 8.08 years) were treated surgically using the extraforaminal approach and were prospectively followed for 1 year. The study was approved by the Institution Ethical Committee, and all patients signed an informed consent form. Clinical and functional outcomes were assessed using VAS and ODI scores and MacNab’s criteria. Follow-up MRI was performed at 1 year. Results: Far lateral lumbar disc herniation accounted for 3% of all lumbar disc herniation patients treated surgically in our department. The mean back pain VAS score improved from 6.46 preoperatively to 1.06 at the 1-year follow-up evaluation (P=0.001). The mean leg pain VAS score improved from 7.40 preoperatively to 1.06 at the 1-year follow-up evaluation (P=0.001). The mean ODI score improved from 30.20 preoperatively to 2.80 at the 1-year follow-up evaluation (P=0.001). According to MacNab’s criteria, 12 patients (80%) had excellent outcomes, 3 (20%) had good outcomes, and no patients showed fair or poor outcomes at the final follow-up evaluation at 1 year.Conclusion: The extraforaminal approach seems to be a safe, less traumatic and less destabilizing approach for managing far lateral lumbar disc herniation and can lead to a better outcome than traditional approaches. (2017ESJ129)

A Study of Lumbar Disc Herniation and Facet Joint Asymmetry

Purpose: To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine. Methods: A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type. Results: At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P &amp;gt; 0.05). Conclusion: Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.

Retrospective analysis on correlation factors of preserving the ligamentum flavum in microendoscopic discectomy

ObjectiveThe present study was conducted to investigate the correlation factors of successful preservation of the ligamentum flavum (LF) in microendoscopic discectomy. MethodsThis retrospective review was carried out on 78 consecutive patients who underwent single segment microendoscopic discectomy projecting to preserve the LF between January 2012 to January 2013. The demographic and clinical data including age, gender, duration of disease, area of interlaminar space, disc level and position type of lumbar disc herniation were recorded. Intraoperative outcomes including duration of operation and peri-operative bleeding were recorded. Clinical outcomes were assessed by Oswestry disability index (ODI) and visual analog scale (VAS), and fibrosis formation was detected using computed tomographic scans with IV iopamidol injection. The follow up lasted six months. ResultsLF was successfully preserved in 54 patients (69.2%) and 24 patients (30.8%) underwent microendoscopic discectomy without preservation of LF. In multivariate logistic analysis, factors including age (OR, 1.17; 95% CI, 1.07–1.28; P<0.001) and area of the laminar space (OR, 0.09; 95% CI, 0.01–0.67; P=0.018) significantly associated with the preservation of LF. Other factors including gender, duration of ill course, disc level and position type seemed not associated with the preservation of the LF. In addition, there was no significant difference of the duration of the operation (P=0.689) as well as the peri-operative bleeding (P=0.147) between patients with preservation of the LF and patients without. However, patients with preservation of the LF showed significantly improved clinical outcomes (ODI: P=0.006, VAS: P=0.035) and less fibrosis formation than those without LF (P=0.018). ConclusionsMicroendoscopic discectomy with preservation of the LF could achieve better clinical outcomes and less epidural fibrosis, while elder patients with smaller area of the laminar space should be deliberated on the preservation of the LF during the microendoscopic discectomy.

Efficacy of Nucleo-Annuloplasty Using Disc-Fx in Lumbar Disc Herniation

Background: Lumbar radicular pain may be caused by lumbar disc herniation, spinal stenosis, or degenerative spondylolisthesis. It is most often caused by lumbar disc herniation and presents as pain radiating from the back into the leg, usually in a dermatomal pattern corresponding to the compressed nerve root. In patients whose pain does not respond to epidural steroid injections, other treatment modalities can be considered. Minimally invasive disc decompression procedures have been developed to treat radicular pain caused by disc herniation. The Disc-FX system combines percutaneous manual discectomy using forceps, nuclear ablation, and annular modification using radiofrequency equipment. To our knowledge, no reports of a correlation between response to Disc-FX and type of lumbar disc herniation have been published. The aim of this study was to determine patients’ responses to and shortterm outcomes of Disc-FX procedures. Methods: This single-center study enrolled 43 patients and followed them for 6 months. Disc-FX procedures were performed in the operating room using local anesthesia. Outcome measures were obtained with a numeric rating scale at 1 and 6 months post-treatment. Results: Patients’ mean pain scores were significantly lower 1 and 6 months after treatment than before treatment. The percentage of patients who experienced pain relief (numeric rating scale scores less than 50% of baseline scores) was 55.8% at 1 month and 56.1% at 6 months after the procedure. There were no statistically significant correlations between pain relief and type of herniation, pain location (lower back and/or leg pain), pain duration, or presence of an annular tear. Conclusion: Our results suggest that the Disc-FX procedure is a reasonable treatment option for carefully selected patients with lower back and radicular pain of discogenic origin.

Risk factors for recurrent lumbar disc herniations.

The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future.

The expression of Interleukin-17 in disc tissue of two types of lumbar disc herniation and the relationship with Modic changes

Objective To observe the expression of Interleukin-17 (IL-17) in different types of herniated disc tissue,and to investigate Modic changes in corresponding injured segment and relationship between Modic changes and herniated types.Methods Fifty patients with single level disc herniation were enrolled in this study.According to clinical diagnosis criteria,imaging (CT and MR) examination results,and the view in surgery process the patients were divided into 2 groups:herniation group(35 patients),degeneration group(15 patients).According to MRI,patients were divided into 2 groups:Modic changes group(14 patients),non-Modic changes group (36 patients).The disc tissues were observed by HE staining and immunohistochemical staining,and the expression of IL-17 was detected by using real-time quantitative PCR.Results Pathological examination revealed that there were more granulation tissue and neovascularization in herniation group than in degeneration group.Immunohistochemical result showed that there were more IL-17-positive cells in herniation group than in degeneration group; there were more IL-17-postive cells in Modic changes group than in non-Modic changes group.The expression of IL-17 mRNA in herniation group was 6.7701 times more than that in degeneration group.The expression of IL-17mRNA in Modic changes group was 4.2836 times more than that in non-Modic changes group. Conclusion The herniated disc nucleus pulposus can cause more prominent local inflammation.Autoimmune responses maybe play an important role in pathophysiological mechanisms of Modic changes. Key words: Lumbar vertebrae; Intervertebral disk displacement; Interleukin -17