ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
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 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.
Objective To explore the correlation between postoperative kinesiophobia and rehabilitation outcome in patients with lumbar disc herniation (LDH). Methods This study was a cross-sectional survey. The patients who underwent lumbar discectomy due to LDH in West China Hospital of Sichuan University between June and October 2019 were included consecutively. According to the Tampa Scale for Kinesiophobia (TSK) score, patients were divided into two groups: the kinesiophobia group and the non-kinesiophobia group. The patients’ scores of the TSK, the Visual Analogue Scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopaedic Association Scores (JOA) at different time points were collected. The relationship between postoperative kinesiophobia, pain, and lumbar function in patients was analyzed. Results A total of 201 patients were included. Among them, there were 128 cases in the kinesiophobia group and 73 cases in the non-kinesiophobia group. The incidence of kinesiophobia was 63.68%. Pearson correlation test analysis showed that TSK score was positively correlated with VAS score (r=0.218, P<0.01) and ODI score (r=0.263, P<0.01) at 24 h after surgery. At one month after surgery, there was a positive correlation with VAS score (r=0.296, P<0.01) and a negative correlation with JOA score (r=?0.182, P<0.05). The results of multiple linear regression showed that postoperative age, pain, lumbar function, and postoperative kinesiophobia were interrelated (P<0.05). Conclusions Patients with LDH had a higher incidence of kinesiophobia 24 h after surgery. Postoperative kinesiophobia was correlated with the recovery outcome of patients with LDH.
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.
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.
Objective To explore the postoperative satisfaction of patients with lumbar disc herniation after enhanced recovery after surgery and its related factors. Methods A total of 102 patients with lumbar disc herniation were selected and analyzed by convenient sampling method from September 2016 to June 2017. The patients’ general information, functional status [using the Oswestry Disability Index (ODI) to investigate the preoperative, postoperative and post-discharge ODI] and patients’ satisfaction (1 month after the discharge) were collected. Results A total of 102 patients, including 62 males and 40 females, aged from 14 to 82 years with an average of (43.8±14.4) years were included in the study.The mean length of hospital stay was (6.61±2.49) days. The total score of patients’ satisfaction was 62.43±6.37, and the satisfaction degree was at the middle and high level. Postoperative and post-discharge ODIs were associated with patients’ satisfaction (rs=0.328, 0.452; P<0.05). Conclusions The postoperative satisfaction of patients with lumbar disc herniation after enhanced recovery after surgery should be further improved. The medical staff should pay attention to the recovery of postoperative function in order to improve the patients’ satisfaction.
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.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.
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.