Objective To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. Methods We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (Pgt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.
ObjectiveTo summarize the research progress of resorption of lumbar disc herniation (RLDH). Methods The literature on RLDH at home and abroad in recent years was reviewed to summarize its influencing factors, pathogenesis, imaging findings, and predictive effect, as well as its influence on the treatment selection of lumbar disc herniation (LDH). ResultsThe main mechanism of RLDH is the combined effect of inflammatory response and neovascularization. Age, smoking, body mass index, and clinical manifestations are the influencing factors. Studies have shown that the annular enhancement around the nucleus pulposus on enhanced MRI images is the characteristic imaging manifestation of RLDH, which is a predictor of whether RLDH occurs. In the treatment of LDH, cyclooxygenase 2 inhibitors may have a negative impact on RLDH. ConclusionThe occurrence of RLDH suggests that strict conservative treatment is the first choice for LDH treatment, but surgery is still an important treatment method when the patient’s symptoms and imaging symptoms don’t significantly improved after conservative treatment.
Objective To comprehensively investigate the incidence of resorption of lumbar disc herniation, and provide reference data for clinical decision-making. Methods Seven electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wangfang data and Chongqing VIP database) were searched for relevant studies that might have reported morphologic changes in lumbar disc herniation when reporting the follow-up results of patients with lumbar disc herniation treated non-surgically from inception to March, 2020. Articles were screened according to inclusion and exclusion criteria, and the total number of patients, number of patients with resorption, and other important data were extracted for analysis. Random effect models were used for meta-analysis, and subgroup analysis, sensitivity analysis, meta-regression analysis, and Egger’s test were performed. Results A total of 15712 articles were identified from these databases, and 48 were eligible for analysis. A total of 2880 non-surgically treated patients with lumbar disc herniation were included in the meta-analysis, 1740 of whom presented resorption. Meta-analysis revealed that the incidence of resorption was 0.60 [95% confidence interval (CI) (0.46, 0.72)]. In subgroup analyses, studies that quantitatively measured the resorption of lumbar disc herniation yielded statistically higher pooled incidence [0.73, 95%CI (0.60, 0.85)] than those that used qualitative methods [0.51, 95%CI (0.34, 0.69)] (P=0.0252). The pooled incidence gradually increased in randomized controlled trials (RCTs) [0.50, 95%CI (0.15, 0.85)], non-RCT prospective studies [0.59, 95%CI (0.48, 0.70)] and retrospective studies [0.69, 95%CI (0.36, 0.95)], but the difference was not statistically significant (P=0.7523). The pooled incidence varied from 0.58 [95%CI (0.54, 0.71)] to 0.62 [95%CI (0.49, 0.74)] after the sequential omission of each single study. There was no significant change in the pooled incidence [0.62, 95%CI (0.43, 0.79)] when only low-risk RCTs and high-quality non-RCT studies were included, comparing with original meta-analysis results. Meta-regression showed that measurements partially caused heterogeneity (R2=15.34%, P=0.0858). Egger’s test suggested that there was no publication bias (P=0.4622). Conclusions According to current research, there is an overall incidence of resorption of 60% [95%CI (46%, 72%)] among non-surgically treated patients with lumbar disc herniation. The probability of resorption should be fully considered before making a decision on surgery.
Objective To determine the contents of matrix metalloproteinase 3 (MMP-3) and interleukin 1 (IL-1) in the tissues of the lumbar disc herniation and to investigate their roles in the pathogenesis. Methods The tissues of the herniated lumbar disc were obtained from 30 patients undergoing surgery for persistent radiculopathy from June 2003 to December 2004 and at the same time these samples were divided into the following three experimentalgroups: the bulge group (n=11), the protrusion group (n=9), and the prolapsus group (n=10)，14 males, 16 females, aged 33.64 years. As the control group, 9 lumbar disc specimens were harvested from 9 patients(4 males, 5 females, aged 21-58 years) suffering from bursting fracture of the lumbar spine. The specimens were analyzed by the ELISA method for the contents of MMP-3 and IL-1. Results The contents of MMP-3(14.25±1.32, 19.89±2.97,20.69±2.18 ng/ml in the bulge group, protrusion group and prolapsus group, separately) and IL-1(8.52±0.22， 11.88±0.52，11.90±0.73 pg/ml in the bulge group, protrusion group and prolapsus group, separately) in the experimental groups were significantly higher than those in the control group. The contents of MMP-3 and IL-1 in the protrusion group were not significantly higher than those in the prolapsus group, but they were significantly higher than those in the bulge group(P＜0.01). The contents of MMP-3 had a significant relationship with the contents of IL-1 in the three experimental groups and the control group(P＜0.01). Conclusion The result demonstrates that the tissues of the lumbar disc herniation can produce both MMP-3 and IL-1, which may have an unknown but important relationship with each other.
Lumbar disc herniation (LDH) is very prevalent in clinical practice. It manifests as low back pain and pain radiating to the leg, followed by disfunction and large family and social cost. Risk factors for LDH include biomechanical stress on the lumbar spine, specifically torsion and hyperflexion, poor posture, obesity, and occupational hazards including heavy manual labor or prolonged driving. Rehabilitation therapy mainly includes bed rest, drug therapy, physical therapy, exercise, manipulation therapy, acupuncture treatment, epidural injection treatment and so on. This review summarizes the current status of epidemiology, clinical features and rehabilitation treatment of LDH so as to improve our understanding of it and to provide a reference for clinical treatment.
Lumbar disc herniation is one of the most common causes of low back and leg pain in clinic. There are a lot of non-surgical therapeutic methods widely used in clinic for treating lumbar disc herniation. The author assessed the available systematic reviews of non-surgical methods in treating lumbar disc herniation which had been published in these years, and finally a total of 13 systematic reviews were retrieved including 1 about conservative treatments, 8 Chinese medicine treatments, and 4 percutaneous treatments, such as chemonucleolysis and epidural steroid injection. The results showed that the conservative treatments included injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture. But no evidence was found to show that any of the above treatments was clearly superior to others including no treatment for patients with lumbar disc herniation. The outcomes from some reviews showed that Chinese medicine treatments were safer and comprehensive treatment of traditional Chinese medicine was relatively effective compared with single treatment. Electro-acupuncture, compared with conventional therapy (bed rest, waist protection, pelvic traction, manual or physical therapy) and oral medications as well, was safe and effective in alleviating pain and improving overall function. Chinese medicinal fumigation combined with traction was more effective than single treatment. Percutaneous treatment of chemonucleolysis had much better short-term effectiveness. Percutaneous epidural steroid injection also had certain effects. To summarize, Chinese medicine and percutaneous treatments may be effective in treating lumbar disc herniation. However, more clinical trials are needed, since current evidence is of low quality.
Objective To investigate the effectiveness of combined Pregabalin and Celecoxib for neuropathic pain after percutaneous endoscopic lumbar discectomy. Methods Between January and June 2014, 178 patients with lumbar disc herniation underwent percutaneous endoscopic interlaminar discectomy (PEID). Ninety patients who met the inclusion criteria were recruited in this study. Every case in group A was recruited to match its counterpart in group B and group C according to gender, disease duration, herniated level, smoking history, preoperative Leeds assessment of neuropathic symptoms and signs (LANSS), and Oswestry disability index (ODI). Nine patients were excluded due to incomplete study or loss of follow-up. In each group, 27 cases were included in the final analysis. There was no significant difference in gender, age, height, body mass index, herniated level, disease duration, smoking history, preoperative LANSS, ODI, and visual analogue scale (VAS) between groups (P>0.05). All patients of 3 groups received oral administration of Celecoxib from preoperative 3rd day to postoperative 14th day. Pregabalin was taken orally from preoperative 3rd day to postoperative 14th day in group A, and from postoperative 1st to 14th day in group B. Adverse drug reactions were observed during medication. The LANSS score and VAS score in rest state and active state were conducted before operation and at 1 day, 1 month, and 3 months after operation. ODI was conducted before operation and at 1, 3 months after operation. The number of neuropathic pain cases was recorded, and the effectiveness was evaluated by modified Macnab criteria at 3 months after operation. Results During period of increasing Pregabalin dose, 1 patient of group A suffered severe dizziness, and 1 patient of group B suffered sleepiness, who were eliminated from this research. Another 2 cases (1 case of group A and 1 case of group C) suffered dry mouth, and 1 case of group B suffered muscle weakness. At 1 day after operation, the LANSS score and VAS in rest state and active state of group A were significantly lower than those of groups B and C (P<0.05). At 1 month after operation, the LANSS score, ODI, and VAS in rest state and active state of group A and group B were significantly lower than those of group C (P<0.05). At 3 months after operation, the LANSS score, ODI, and VAS in active state of group A and group B were significantly lower than those of group C (P<0.05). There was no significant difference in the above indicators at the other time points between groups (P>0.05). Neuropathic pain occurred at 3 months after operation in 1 case (3.7%) of group A and 6 cases (22.2%) of group C, showing significant differences in incidence of neuropathy pain between groups A, B and group C (P<0.05), but no significant difference was found between group A and group B (P>0.05). The excellent and good rate of modified Macnab criteria was 92.6% in group A, was 88.9% in group B, and was 85.2% in group C at 3 months after operation, showing no significant difference between groups (P>0.05). Conclusion Combined use of Pregabalin and Celecoxib during perioperative period can reduce postoperative pain and incidence of postoperative neuropathic pain. Preoperative oral Pregabalin can reduce the incidence of acute postoperative neuropathic pain.
ObjectiveTo investigate the morphology of endplate shape in teens with lumbar degenerative disc disease by means of MRI and the correlation between endplate shape and lumbar disc degeneration. MethodsA retrospective study was performed on 31 teenage patients with lumbar disc herniation who underwent MRI examination between January 2011 and April 2015. The morphology of endplate was classified into three groups:concave, flat and irregular based on the midsagittal T1-weighed MRI. The degree of disc degeneration was graded on T1-weighed MRI according to Pfirrmann's method with one to five points representing grade Ⅰ to Ⅴ. All endplates were determined by Modic grading system. The associations between morphology of endplate in lower lumbar spine and disc degenerative degree as well as Modic changes were evaluated retrospectively. ResultsAmong the 93 endplates, concave represented the maximum proportion (52/93). Irregular endplate increased from L3/4(4/21) to L5/S1(10/21) gradually. The average degenerative degree for concave, flat and irregular endplate was respectively (1.19±0.11) points, (2.25±0.43) points and (3.33±0.51) point, which showed significant differences (P<0.05). Irregular was the majority in protruding sections, and concave was the majority of non-protruding sections. There were 27 modic changes in 93 endplates, in which irregular was the most, showing significant difference (P<0.05), while the difference between concave and flat endplate was not significant (P>0.05). ConclusionWe can use endplate morphology, modic changes and disc degeneration to reflect degree of disc degeneration in teenage patients. Since the L5/S1 segments bear the greatest power in the lower lumbar spine, they are most prone to disc degeneration with more irregular endplates.
Objective To compare the effectiveness of unilateral biportal endoscopy (UBE) technique with the interlaminar uniportal endoscopy (IUE) technique for the treatment of L5, S1 lumbar disc herniation. MethodsThe clinical data of 69 patients with L5, S1 lumbar disc herniation who met the selection criteria between January 2020 and December 2020 were retrospectively analysed. The patients were divided into UBE group (30 cases) and IUE group (39 cases) according to endoscopic surgical technique. The general data, such as gender, age, body mass index, disease duration, and preoperative visual analogue scale (VAS) scores of low back/leg pain and Oswestry disability index (ODI), was not significantly different between the two groups (P>0.05). Perioperative outcomes [estimated blood loss (EBL), total operation time, extracanal operation time, intracanal decompression time, intraoperative radiation exposure dose, incision length, operative related complications, and postoperative hospitalization stay] and clinical outcomes (VAS score of low back/leg pain before operation and at 3 days, 3 months, 6 months, and 12 months after operation as well as the ODI before operation and at 3 months, 6 months, and 12 months after operation) were recorded and compared between the two groups. ResultsAll patients completed the surgery successfully. The incision length, EBL, and extracanal operation time in UBE group were significantly longer than those in IUE group (P<0.05), and the intracanal decompression time in UBE group was significantly shorter than that in IUE group (P<0.05). There was no significant difference in the total operation time, intraoperative radiation exposure dose, and postoperative hospitalization stay between the two groups (P>0.05). Patients in both groups were followed up 12-15 months (mean, 13.3 months). Dural tear ocurred in 1 patient of the UBE group, and recurrence ocurred in 1 patient of the IUE group, the others of both groups had no surgery-related complications and recovered well after operation. The VAS scores of low back/leg pain and ODI in both groups at each time point after operation significantly improved when compared with those before operation (P<0.05); there was no significant difference in VAS scores and ODI at each time point after operation between two groups (P>0.05). ConclusionThe effectiveness of UBE technique in the treatment of L5, S1 lumbar disc herniation is similar to that of IUE technique, and the efficiency of intraspinal operation is better than that of IUE technique. Although UBE technique is inferior to IUE technique in terms of surgical trauma, there is no significant difference in postoperative recovery between the two techniques.
ObjectiveTo compare the early efficacy between Quadrant channel and traditional method in treating lumbar disc herniation. MethodBetween July 2010 and December 2012, 60 patients with lumbar disc herniation were randomly divided into two groups with 30 in each. Quadrant channel and traditional method were used respectively to do the same one single segmental pedicle screw fixation with single pieces of cage bone grafting fusion and internal fixation. Then, we compared the two groups in incision length, operative time, blood loss, incision healing time and postoperative incidence of low back pain between the two groups of patients. ResultsThere were no significant differences between the two groups in terms of operation time, blood loss, and recent curative effect (P>0.05), while Quadrant channel was superior in small skin incision, reduced incidence of low back pain, and shorter postoperative incision healing time (P<0.05). ConclusionsTreatment of lumbar disc herniation using Quadrant channel is minimally invasive with less complications. Mid-and long-term efficacy remains to be further analyzed.