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La Rocca G, Galieri G, Mazzucchi E, Pignotti F, Orlando V, Pappalardo S, Olivi A, Sabatino G. The Three-Step Approach for Lumbar Disk Herniation with Anatomical Insights Tailored for the Next Generation of Young Spine Surgeons. J Clin Med 2024; 13:3571. [PMID: 38930100 PMCID: PMC11204482 DOI: 10.3390/jcm13123571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Lumbar disc herniation, a complex challenge in spinal health, significantly impacts individuals across diverse age groups. This article delves into the intricacies of this condition, emphasising the pivotal role of anatomical considerations in its understanding and management. Additionally, lumbar discectomy might be considered an "easy" surgery; nevertheless, it carries significant risks. The aim of the study was to present a groundbreaking "three-step approach" with some anatomical insight derived from our comprehensive clinical experiences, designed to systematise the surgical approach and optimise the outcomes, especially for young spine surgeons. We highlighted the purpose of the study and introduced our research question(s) and the context surrounding them. Methods: This retrospective study involved patients treated for lumbar disc herniation at a single institution. The patient demographics, surgical details, and postoperative assessments were meticulously recorded. All surgeries were performed by a consistent surgical team. Results: A total of 847 patients of the 998 patients initially included completed the follow-up period. A three-step approach was performed for every patient. The recurrence rate was 1.89%. Furthermore, the incidence of lumbar instability and the need for reoperation were carefully examined, presenting a holistic view of the outcomes. Conclusions: The three-step approach emerged as a robust and effective strategy for addressing lumbar disc herniation. This structured approach ensures a safe and educational experience for young spinal surgeons.
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Affiliation(s)
- Giuseppe La Rocca
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
| | - Gianluca Galieri
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
| | - Edoardo Mazzucchi
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
- Department of Neurosurgery, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Fabrizio Pignotti
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Vittorio Orlando
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
| | - Simona Pappalardo
- Department of Anatomical Pathology, Giovanni Paolo II Hospital, 97100 Olbia, Italy;
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (G.L.R.); (V.O.); (A.O.); (G.S.)
- Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, 07026 Olbia, Italy; (E.M.); (F.P.)
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Albano S, Brown NJ, Pennington Z, Nguyen A, Hsu TI, Pham MH, Oh MY. Risks Associated with Surgical Management of Lumbosacral Transitional Vertebrae: Systematic Review of Surgical Considerations and Illustrative Case. World Neurosurg 2024; 186:e54-e64. [PMID: 38350597 DOI: 10.1016/j.wneu.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Lumbosacral transitional vertebrae (LSTV) are congenital anomalies of the L5-S1 segments characterized by either sacralization of the most caudal lumbar vertebra or lumbarization of the most cephalad sacral vertebra. This variation in anatomy exposes patients to additional surgical risks. METHODS In order to shed light on surgical considerations reported for lumbar spine cases involving LSTV as described in the extant literature, we performed a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We also present a case example in which wrong level surgery was avoided due to anatomical understanding of LSTV. RESULTS A 48-year-old female presented with severe back pain after sustaining a fall from ten feet. The patient exhibited full motor function in all extremities but had begun to experience urinary retention. On initial imaging read, the patient was suspected to have an L1 burst fracture. A review of the imaging demonstrated a transitional vertebra. Therefore, based on the last rib corresponding to T12, the fractured level was L2. This case illustrates the risk LSTV carries for wrong site surgery; appropriate levels were then decompressed and instrumented. On systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a three database literature search identified 39 studies describing 885 patients with LSTV and relevant surgical considerations. The primary indications for surgery were for disc herniation (37%), Bertolotti's syndrome (35%), and spinal stenosis (25%). This cohort displayed a mean follow-up time of 23 months. Reherniation occurred in 12 patients (5.5%). Medical management through steroid injection was 24, 72% (n = 80) for the sample. Wrong level surgery occurred in 1.4% (n = 12) of patients. CONCLUSIONS LSTV represents a constellation of changes in anatomy beyond just a sacralized or lumbarized vertebra. These anatomical differences expose the patient to additional surgical risks. This case and review of the literature highlight avoidable complications and in particular wrong level surgery.
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Affiliation(s)
- Stephen Albano
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA.
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew Nguyen
- University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Timothy I Hsu
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego, La Jolla, California, USA
| | - Michael Y Oh
- Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
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Shang Q, Xiang W, Wu Y, Lu Y, Li Z, Zheng J, Wang X, Wang X, Song X. Identification and analysis of immunogenicity and immunotherapy efficacy by fatty acid genes: a novel prognostic features of lumbar disc herniation and Mendelian randomization analysis. Int J Neurosci 2024:1-15. [PMID: 38738478 DOI: 10.1080/00207454.2024.2353367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/05/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Sciatica is a phrase used to describe radiating leg discomfort. The most common cause is lumbar disc herniation (LDH), which is considered to start in the nucleus pulposus. Advancements in lipidomics and metabolomics have unveiled the complex role of fatty acid metabolism (FAM) in both healthy and pathological states. However, the specific roles of fatty acid metabolism-related genes (FAMGs) in shaping therapeutic approaches, especially in LDH, remain largely unexplored and are a subject of ongoing research. METHODS The junction of the weighted correlation network analysis (WGCNA) test with 6 FAMGs enabled the finding of FAMGs. Gene set variation analysis (GSVA) was used to identify the possible biological activities and pathways of FAMGs. LASSO was used to determine diagnostic effectiveness of the four FAMGs in diagnosing LDH. GSE124272, GSE147383, GSE150408, and GSE153761 were utilized to confirm the levels of expression of four FAMGs. RESULTS Four FAMGs were discovered [Acyl-CoA Thioesterase 4 (ACOT4), Cytochrome P450 Family 4 Subfamily A Member 11 (CYP4A11), Acyl-CoA Dehydrogenase Long Chain (ACADL), Enoyl-CoA Hydratase and 3-Hydroxyacyl CoA Dehydrogenase (EHHADH)] For biological function analysis, mhc class ib receptor activity, response to thyroxine, response to l phenylalanine derivative were emphasized. CONCLUSIONS FAMGs can help with prognosis and immunology, and provide evidence for fatty acid metabolism-related targeted therapeutics. In LDH, FAMGs and their interactions with immune cells might be therapeutic targets.
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Affiliation(s)
- Qisong Shang
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
- Department of Spine Surgery, The Third Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Wei Xiang
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yuanyuan Wu
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yun Lu
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhe Li
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Junru Zheng
- Department of Spine Surgery, The Third Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Xing Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Xiaonan Wang
- Department of Spine Surgery, The Third Affiliated Hospital of Shihezi University, Shihezi, Xinjiang, China
| | - Xinghua Song
- Department of Spine Surgery, The Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Shen Z, Wang W, Ni L, Zhao H, Yang L, Yang H, Zhang L. Lumbar lordosis and sacral slope do not differ in two types of postoperative lumbar disc re-herniation: a cross-sectional observational study. BMC Musculoskelet Disord 2024; 25:267. [PMID: 38582848 PMCID: PMC10998392 DOI: 10.1186/s12891-024-07376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/21/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND To identify the differences of lumbar lordosis (LL) and sacral slope (SS) angles between two types of postoperative lumbar disc re-herniation, including the recurrence of same level and adjacent segment herniation (ASH). METHODS We searched the medical records of lumbar disc herniation (LDH) patients with re-herniation with complete imaging data (n = 58) from January 1, 2013 to December 30, 2020 in our hospital. After matching for age and sex, 58 patients with LDH without re-herniation from the same period operated by the same treatment group in our hospital were served as a control group. Re-herniation patients were divided into two groups, same-level recurrent lumbar disc herniation group (rLDHG) and adjacent segment herniation group with or without recurrence (ASHG). The preoperative, postoperative and one month after operation LL and SS were measured on standing radiographs and compared with the control group by using t-test, ANOVA, and rank-sum test. Next, we calculated the odds ratios (ORs) by unconditional logistic regression, progressively adjusted for other confounding factors. RESULTS Compared with the control group, the postoperative LL and SS were significantly lower in LDH patients with re-herniation. However, there were no differences in LL and SS between ASHG and rLDHG at any stage. After progressive adjustment for confounding factors, no matter what stage is, LL and SS remained unassociated with the two types of re-herniation. CONCLUSIONS Low postoperative LL and SS angles are associated with degeneration of the remaining disc. Low LL and SS may be independent risk factors for re-herniation but cannot determine type of recurrence (same or adjacent disc level).
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Affiliation(s)
- Zhijia Shen
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Wenhao Wang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Li Ni
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
| | - Hongcheng Zhao
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Lianda Yang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China
- Suzhou Medical College of Soochow University, 199 Ren'ai Road, Suzhou, Jiangsu, 215123, China
| | - Huilin Yang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
| | - Linlin Zhang
- Department of Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China.
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Zileli M, Oertel J, Sharif S, Zygourakis C. Lumbar disc herniation: Prevention and treatment of recurrence: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100275. [PMID: 38385057 PMCID: PMC10878111 DOI: 10.1016/j.wnsx.2024.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This review aims to formulate the most current evidence-based recommendations on the epidemiology, prevention, and treatment of recurrent lumbar disc herniation (LDH). Methods We performed a systematic literature search in PubMed, Medline, and Google Scholar databases from 2012 to 2022 using the keywords "lumbar disc recurrence." Screening criteria resulted in 57 papers, which were summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The 57 papers covered the following topics: (1) Definition and incidence of recurrence after lumbar disc surgery; (2) Prediction of recurrence before primary surgery; (3) Prevention of recurrence by surgical measures; (4) Prevention of recurrence by postoperative measures; (5) Treatment options for recurrent disc herniation; (6) The outcomes of recurrent disc herniation surgery. We utilized the Delphi method and voted on eight final consensus statements. Results and conclusion Recurrence after disc herniation surgery may be considered a surgical complication, its incidence is approximately 5% and is different from overall re-operation incidence. There are multiple risk factors predicting LDH recurrence, including smoking, younger age, male gender, obesity, diabetes, disc degeneration, and presence of lumbosacral transitional vertebrae. The level of lumbar discectomy surgery and the amount of disc material removed do not correlate with recurrence rate. Minimally invasive discectomies may have higher recurrence rates, especially during the surgeon's learning period. However, the experience of the surgeon is not related to recurrence. High-quality studies are needed to determine if activity restriction, weight loss, smoking cessation, and muscle-strengthening exercises after primary surgery can help prevent recurrence of LDH.The best treatment option for recurrent disc herniation is still being discussed. While complications of minimally invasive techniques may be lower than open discectomy, outcomes are similar. Fusion should only be considered when spinal instability and/or spinal deformity are present. Clinical outcomes and patient satisfaction after recurrent disc herniation surgery are inferior to those after initial discectomy.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Sanko University Faculty of Medicine, Gaziantep, Turkey
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany
| | - Salman Sharif
- Department of Neurosurgery, Liaqat Medical School, Karachi, Pakistan
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Liu L, Wang W, Huang L, Xian Y, Ma W, Fan J, Li Y, Liu H, Zheng Z, Wu D. Injectable pathological microenvironment-responsive anti-inflammatory hydrogels for ameliorating intervertebral disc degeneration. Biomaterials 2024; 306:122509. [PMID: 38377847 DOI: 10.1016/j.biomaterials.2024.122509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024]
Abstract
Chronic local inflammation and resulting cellular dysfunction of nucleus pulposus (NP) cells are important pathogenic factors of intervertebral disc degeneration (IDD). Injectable pathological microenvironment-responsive hydrogels hold significant potential for treating IDD by adapting to dynamic microenvironment of IDD. Herein, we proposed an injectable gelatin-based hydrogel drug delivery system that could respond to the pathological microenvironment of IDD for controlled release of anti-inflammatory drug to promote degenerative NP repair. The hydrogel system was prepared by conjugating phenylboronic acid-modified gelatin methacryloyl (GP) with the naturally extracted anti-inflammatory drug epigallocatechin-3-gallate (EGCG) through dynamic boronic esters. The hydrogel exhibited excellent degradability, injectability, antioxidant properties, anti-inflammatory effects, and biocompatibility. It also displayed responsive-release of EGCG under high reactive oxygen species (ROS) levels and acidic conditions. The hydrogel demonstrated remarkable cytoprotective effects on NP cells in both hyperactive ROS environments and inflammatory cytokine-overexpressed environments in vitro. In vivo studies revealed that the hydrogel injected in situ could effectively ameliorate the intervertebral disc degeneration by maintaining the disc height and NP tissue structure in a rat IDD model. The hydrogel system exhibited excellent biocompatibility and responsive-release of diol-containing drugs in pathological microenvironments, indicating its potential application as a drug delivery platform.
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Affiliation(s)
- Lei Liu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Wantao Wang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China; Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China; Pain Research Center, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Lin Huang
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Yiwen Xian
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Wenzheng Ma
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China; Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China; Pain Research Center, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Jinghao Fan
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Yixi Li
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Hongmei Liu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China; Pain Research Center, Sun Yat-Sen University, Guangzhou, 510080, China.
| | - Decheng Wu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China.
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Kweon M, Bak KH, Yi HJ, Choi KS, Han MH, Na MK, Chun HJ. Changes in Disc Height as a Prognostic Factor in Patients Undergoing Microscopic Discectomy. J Korean Neurosurg Soc 2024; 67:209-216. [PMID: 37799026 PMCID: PMC10924907 DOI: 10.3340/jkns.2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Some patients with disc herniation who underwent discectomy complain of back pain after surgery and are unsatisfied with the surgical results. This study aimed to evaluate the relationship between preoperative disc height (DH), postoperative DH, and pain score 12 months after surgery in patients who underwent microdiscectomy for herniated lumbar disc. METHODS This study enrolled patients who underwent microdiscectomy at a medical center between January 2012 and December 2020. Patients with X-ray or computed tomography and pain score assessment (visual analog scale score) prior to surgery, immediately post-op, and at 1, 6, and 12 months after surgery were included. The DH index was defined as DH/overlying vertebral width. The DH ratio was defined as the postoperative DH/preoperative DH. Simple linear regression and multivariate linear regression analyses were applied to assess the correlation between DHs and leg pain scores 12 months after surgery. RESULTS A total of 118 patients who underwent microdiscectomy were included. DH decreased up to 12 months after surgery. The DH ratio at 1, 6, and 12 months after discectomy showed a significant positive correlation with the pain scores at 12 months after discectomy (1 month : p=0.045, B=0.52; 6 months : p=0.008, B=0.78; 12 months : p=0.005, B=0.69). Multivariate linear regression analysis revealed that the level of surgery, sex, age, and body mass index had no significant relationship with back pain scores after 12 months. CONCLUSION In patients who underwent microdiscectomy, the DH ratios at 1, 6, and 12 months after surgery were prognostic factors for back pain scores at 12 months after surgery. Aggressive discectomy is recommended for lower postoperative DH ratios and Visual analog scale scores, leading to improved patient satisfaction.
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Affiliation(s)
- Myeonggeon Kweon
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Korea
| | - Min-Kyun Na
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Korea
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Bäcker HC, Johnson MA, Hanlon J, Chan P, Turner P, Cunningham J. Return to sports following discectomy: does a consensus exist? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:111-117. [PMID: 37280437 DOI: 10.1007/s00586-023-07776-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION In the USA, lumbar discectomy is one of the most commonly performed spinal procedures. As certain sports are considered to be major risk factors for disc herniation, the question remains as to when highly active patients should return to their previous level of activity. This study aimed to analyze spine surgeons' opinions on when patients may return to activities following discectomy as well as their underlying rationale for their decision. METHODS A questionnaire was designed by five different fellowship-trained spine surgeons for the 168 members of the Spine Society of Australia. Questions on the surgeons experience, decision making, preferred surgical technique, the postoperative rehabilitation and the response to patient expectations were included. RESULTS In total, 83.9% of surgeons discuss the postoperative level of activity with their patients. Sport is considered as an important contributor for good functional outcome by 71.0% of surgeons. Surgeons recommend avoiding, often permanently, weightlifting (35.7%) of the time, rugby (21.4%), horseback riding (17.9%) as well as martial arts (14.3%) postoperatively even with previous training. The return to high levels of activity is considered as a major risk factor for disc herniation recurrence by 25.8% of surgeons. Return to high level of activity is typically recommended after 3 months by 48.4% of surgeons. CONCLUSION So far no consensus on the rehabilitation protocol and return to level of activity exists. Recommendations depend on personal experience as well as the individuals' training, and typically, a period of avoidance of sport for up to 3 months is recommended. LEVEL OF EVIDENCE Level III, therapeutic and prognostic study.
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Affiliation(s)
- Henrik C Bäcker
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville VIC 3050, Melbourne, Australia.
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia.
- Department of Orthopaedic Surgery, Auckland City Hospital, Grafton, New Zealand.
| | - Michael A Johnson
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
| | - Jack Hanlon
- Department of Orthopaedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - Patrick Chan
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
- Department of Neurosurgery, Alfred Health, 315, Victoria, 3181, Prahran, Australia
| | - Peter Turner
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville VIC 3050, Melbourne, Australia
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
| | - John Cunningham
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville VIC 3050, Melbourne, Australia
- Neurosciences Clinical Institute, Epworth Richmond, Richmond, Melbourne, Australia
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Chen D, Lv Z, Wu Y, Hao P, Liu L, Pan B, Shi H, Che Y, Shen B, Du P, Si X, Hu Z, Luan G, Xue M. Estimating surgical probability: Development and validation of a prognostic model for patients with lumbar disc herniation treated with acupuncture. Medicine (Baltimore) 2023; 102:e36425. [PMID: 38050285 PMCID: PMC10695558 DOI: 10.1097/md.0000000000036425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Lumbar disc herniation (LDH) is a common cause of pain in the lumbar spine and legs. While acupuncture has become the primary conservative treatment for LDH, some patients experience treatment failure and require surgery, causing substantial concern for clinicians. We developed an effective personalized clinical prediction model to identify the independent risk factors associated with acupuncture failure in patients with LDH. Our model aimed to predict the probability of surgery within 6 months of acupuncture failure in patients with LDH. A total of 738 patients with LDH who underwent acupuncture at 4 Chinese hospitals between January 2019 and October 2021 were selected. The patients were divided into training (n = 496) and validation (n = 242) cohorts. Seven predictive variables, including smoking, Oswestry Disability Index (ODI) score, lower-limb herniation, disc herniation type, lumbar spinal stenosis, lumbar lateral recess stenosis, and acupuncture frequency, were selected as risk factors using least absolute shrinkage and selection operato (LASSO) regression. A prediction model was developed using multivariate logistic regression analysis and a nomogram was constructed. The model exhibited good discrimination, with an area under the ROC curve (AUC) of 0.903 for the development cohort and 0.899 for the validation cohort. The Hosmer-Lemeshow goodness-of-fit test was a good fit for both cohorts (P = .956 for the development cohort; P = .513 for the validation cohort). Decision curve analysis (DCA) demonstrated that the threshold probabilities for the 2 cohorts ranged from > 4% and 5-95%, respectively. Therefore, the prediction model had a good net benefit. The nomogram established in this study, incorporating 7 risk factors, demonstrated a good predictive ability. It could predict acupuncture failure in LDH patients and the risk of surgery within 6 months, enabling physicians to conduct individualized treatment measures.
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Affiliation(s)
- Di Chen
- Nanjing University of Chinese Medicine, Nanjing, China
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Zimeng Lv
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Yicheng Wu
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Panfu Hao
- Acupuncture Rehabilitation Department, the Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Liu Liu
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Bin Pan
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Haiping Shi
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Youlu Che
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Bo Shen
- Department of Rehabilitation Medicine, Anhui NO.2 Provincial People’s Hospital, Hefei, China
| | - Peng Du
- Department of Tui Na, Anhui Provincial Hospital of Integrated Chinese and Western Medicine, Hefei, China
| | - Xiaohua Si
- Department of Tui Na, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Zhongling Hu
- Acupuncture Rehabilitation Department, Traditional Chinese Hospital of Luan, Luan, China
| | - Guorui Luan
- Department of Tui Na, Anhui Provincial Hospital of Integrated Chinese and Western Medicine, Hefei, China
| | - Mingxin Xue
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, China
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Zhu F, Chen Y, Jia D, Zhang Y, Peng Y, Ning Y, Leng X, Feng C, Zhou Y, Li C, Huang B. Risk Factors of Low Back Pain Aggravation After Tubular Microdiscectomy of Lumbar Disc Herniation. World Neurosurg 2023; 178:e673-e681. [PMID: 37543197 DOI: 10.1016/j.wneu.2023.07.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Although lumbar disc herniation (LDH) patients' sciatic symptoms such as leg pain can be improved by decompressive surgery, some patients report postoperative aggravated low back pain (LBP). However, the exact reason for this phenomenon remained unknown. METHODS We retrospectively analyzed the prospectively collected LDH data of patients who underwent tubular microdiscectomy between December 2015 and December 2020. The patients were divided into aggravated and non-aggravated group according to whether the postoperative LBP visual analogue scale (VAS) score was higher than the preoperative score. We analyzed the relationship of the clinical and radiologic parameters with aggravated LBP. RESULTS Postoperative aggravated LBP cases accounted for 14.1% (57 of 404) of this series. Of the 57 patients, 88% (50 of 57) had mild postoperative LBP aggravation (1-2), and 12% (7 of 57) had severe LBP aggravation (>2). The preoperative LBP VAS score of the aggravated group was significantly lower than that of the non-aggravated group (P < 0.001), while the LBP VAS score and Oswestry Disability Index at final follow-up was significantly higher in the aggravated group (P < 0.05). Additionally, the proportion of preoperative moderate-to-severe multifidus fatty atrophy (MFA) and lumbar facet joint degeneration (LFJD) was significantly higher in the aggravated group. A multiple stepwise logistic regression analysis indicated that the preoperative LBP VAS score (P < 0.001, odds ratio 0.266, 95% CI 0.161-0.439) and MFA (P < 0.001, odds ratio 4.491, 95% CI 2.092-9.640) were the risk factors for postoperative aggravated LBP. CONCLUSIONS A preoperative lower LBP VAS score and moderate-to-severe MFA were associated with postoperative aggravated LBP. This will provide important guidance for patient's preoperative assessment and education.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu Chen
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Peng
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
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11
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Ohnishi T, Homan K, Fukushima A, Ukeba D, Iwasaki N, Sudo H. A Review: Methodologies to Promote the Differentiation of Mesenchymal Stem Cells for the Regeneration of Intervertebral Disc Cells Following Intervertebral Disc Degeneration. Cells 2023; 12:2161. [PMID: 37681893 PMCID: PMC10486900 DOI: 10.3390/cells12172161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
Intervertebral disc (IVD) degeneration (IDD), a highly prevalent pathological condition worldwide, is widely associated with back pain. Treatments available compensate for the impaired function of the degenerated IVD but typically have incomplete resolutions because of their adverse complications. Therefore, fundamental regenerative treatments need exploration. Mesenchymal stem cell (MSC) therapy has been recognized as a mainstream research objective by the World Health Organization and was consequently studied by various research groups. Implanted MSCs exert anti-inflammatory, anti-apoptotic, and anti-pyroptotic effects and promote extracellular component production, as well as differentiation into IVD cells themselves. Hence, the ultimate goal of MSC therapy is to recover IVD cells and consequently regenerate the extracellular matrix of degenerated IVDs. Notably, in addition to MSC implantation, healthy nucleus pulposus (NP) cells (NPCs) have been implanted to regenerate NP, which is currently undergoing clinical trials. NPC-derived exosomes have been investigated for their ability to differentiate MSCs from NPC-like phenotypes. A stable and economical source of IVD cells may include allogeneic MSCs from the cell bank for differentiation into IVD cells. Therefore, multiple alternative therapeutic options should be considered if a refined protocol for the differentiation of MSCs into IVD cells is established. In this study, we comprehensively reviewed the molecules, scaffolds, and environmental factors that facilitate the differentiation of MSCs into IVD cells for regenerative therapies for IDD.
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Affiliation(s)
- Takashi Ohnishi
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.O.); (K.H.); (A.F.); (N.I.)
| | - Kentaro Homan
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.O.); (K.H.); (A.F.); (N.I.)
| | - Akira Fukushima
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.O.); (K.H.); (A.F.); (N.I.)
| | - Daisuke Ukeba
- Department of Orthopedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan; (T.O.); (K.H.); (A.F.); (N.I.)
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
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12
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Baranowska-Kijewska J, Baranowski P, Baranowska A, Jarzyński T, Rybarczyk M. Reoperation rate after fusion and non-fusion surgery for degenerative lumbar spine disease. Arch Med Sci 2023; 19:1154-1161. [PMID: 37560744 PMCID: PMC10408031 DOI: 10.5114/aoms/165859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION The number of reoperations increases with the growing number of operations performed. METHODS The clinical material included a group of 2194 patients treated surgically due to degenerative disease of the lumbar spine; we selected a total of 332 patients who were reoperated, and the indications for reoperation were analysed. RESULTS The percentage of patients operated due to adjacent segment disease in the group of patients with stabilization was on average 8.9%. CONCLUSIONS Indications for stabilizing or preservation of the mobility of the operated segment should provide for the nature of the lesions, and anatomical and surgical conditions.
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Affiliation(s)
| | - Paweł Baranowski
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Alicja Baranowska
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Faculty of Medicine, Lazarski University, Warsaw, Poland
| | - Tobiasz Jarzyński
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
- Department of Descriptive and Clinical Anatomy, the Medical University of Warsaw, Warsaw, Poland
| | - Marek Rybarczyk
- Department of Neuro-orthopaedics, Mazovian Rehabilitation Centre STOCER, Konstancin-Jeziorna, Poland
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Zhu F, Jia D, Zhang Y, Ning Y, Leng X, Feng C, Li C, Zhou Y, Huang B. Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation. Neurospine 2023; 20:637-650. [PMID: 37401083 PMCID: PMC10323347 DOI: 10.14245/ns.2346054.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy. METHODS We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH. RESULTS This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy. CONCLUSION Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
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Shan ZM, Ren XS, Shi H, Zheng SJ, Zhang C, Zhuang SY, Wu XT, Xie XH. Machine Learning Prediction Model and Risk Factor Analysis of Reoperation in Recurrent Lumbar Disc Herniation Patients After Percutaneous Endoscopic Lumbar Discectomy. Global Spine J 2023:21925682231173353. [PMID: 37161730 DOI: 10.1177/21925682231173353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To investigate the risk factors of reoperation after percutaneous endoscopic lumbar discectomy (PELD) due to recurrent lumbar disc herniation (rLDH) and to establish a set of individualized prediction models. METHODS Patients who underwent PELD successfully from January 2016 to February 2022 in a single institution were enrolled in this study. Six methods of machine learning (ML) were used to establish an individualized prediction model for reoperation in rLDH patients after PELD, and these models were compared with logistics regression model to select optimal model. RESULTS A total of 2603 patients were enrolled in this study. 57 patients had repeated operation due to rLDH and 114 patients were selected from the remaining 2546 nonrecurrent patients as matched controls. Multivariate logistic regression analysis showed that disc herniation type (P < .001), Modic changes (type II) (P = .003), sagittal range of motion (sROM) (P = .022), facet orientation (FO) (P = .028) and fat infiltration (FI) (P = .001) were independent risk factors for reoperation in rLDH patients after PELD. The XGBoost AUC was of 90.71%, accuracy was approximately 88.87%, sensitivity was 70.81%, specificity was 97.19%. The traditional logistic regression AUC was 77.4%, accuracy was about 77.73%, sensitivity was 47.15%, specificity was 92.12%. CONCLUSION This study showed that disc herniation type (extrusion, sequestration), Modic changes (type II), a large sROM, a large FO and high FI were independent risk factors for reoperation in LDH patients after PELD. The prediction efficiency of XGBoost model was higher than traditional Logistic regression analysis model.
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Affiliation(s)
- Zheng-Ming Shan
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xue-Song Ren
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hang Shi
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Shi-Jie Zheng
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Cong Zhang
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Su-Yang Zhuang
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xin-Hui Xie
- Department of Spine Surgery, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
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15
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Yang J, Liu R, Miao Y, Nian L, Meng X. Risk Factors for Recurrence After Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis. World Neurosurg 2023; 172:88-93. [PMID: 36764451 DOI: 10.1016/j.wneu.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Postoperative recurrence of percutaneous endoscopic lumbar disc increases the physical damage and financial burden on patients and negatively affects physicians' treatment decisions. We conducted this meta-analysis to explore the risk factors for postoperative recurrence of percutaneous endoscopic lumbar disc for lumbar disc herniation. METHODS We conducted article search in the PubMed, EMBASE and Cochrane Library databases. PRISMA guidelines were followed in this review. The data are statistically analyzed by the Roundup Manager (version 3.6.1). The results of the meta-analysis are presented in the form of forest-like plots. RESULTS We included 13 articles and identified 7524 cases. Patients with older age (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.18-1.40), higher body mass index (OR = 1.16, 95% CI: 1.05-1.28), smoker (OR = 1.73, 95% CI: 0.95-3.15), degenerative grades ≥3 (OR = 6.07, 95% CI: 2.81-13.11), and postoperative sagittal motion ≥10° (OR = 2.42, 95% CI: 1.63-3.58) have a higher recurrence rate. CONCLUSIONS A thorough preoperative evaluation is essential to prevent postoperative recurrence of percutaneous endoscopic lumbar discectomy. The study addresses several factors of preoperative evaluation, which is hopeful to provide a reference for neurosurgeons.
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Affiliation(s)
- Jiameng Yang
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Rui Liu
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
| | - Yu Miao
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
| | - Liwei Nian
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaotao Meng
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
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Lastra-Power J, Nieves-Ríos C, Baralt-Nazario F, Costello-Serrano AG, Maldonado-Pérez AM, Olivella G, Pérez-Rosado J, Ramírez N. Predictors of reoperation in hispanic-americans with recurrent lumbosacral disc herniation following primary hemilaminectomy and discectomy surgery. World Neurosurg X 2023; 18:100172. [PMID: 36923606 PMCID: PMC10009277 DOI: 10.1016/j.wnsx.2023.100172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Background Multiple risk factors for recurrent lumbosacral disc herniation (rLDH) have been evaluated. However, it has been difficult to establish a consensus due to conflicting results. Therefore, the aim of our study was to evaluate the predictors of reoperation in Hispanic-Americans with rLDH following primary hemilaminectomy and discectomy surgery. Methods A retrospective case-control study of 451 Hispanic-Americans with lumbosacral disc herniation (LDH) was conducted. The sample was divided into two groups: reoperated (cases) and non-reoperated (controls). Preoperative, operative, and postoperative variables of initial surgery were compared between the two groups. Results The reoperation rate was 11.5%, with a mean interval between primary surgery and reoperation of 3.32 years ± 2.07. Analysis of preoperative variables identified a higher rate of reoperation in patients who were unemployed (cases: 48.1%, controls: 17.1%, p=0.001). A significant difference was also seen regarding the presence of gastrointestinal disease (cases: 11.5%, controls: 4.3%, p=0.038). However, there were no differences in the sociodemographic factors, preoperative physical exam, preoperative management, radiological parameters, or operative data. Those patients with persistent postoperative lower extremity pain, radiculopathy, low back pain, and buttock pain demonstrated a higher correlation with rLDH. Multivariable logistic regression analysis identified a significant difference only in work status (employed; OR and 95% CI [0.60 (0.55, 0.67)], p=0.002) and presence of postoperative low back pain (OR and 95% CI [2.17 (1.13, 4.29)], p=0.014). Conclusions Patients who required reoperation due to rLDH were more frequently unemployed and/or suffered postoperative low back pain after primary hemilaminectomy and discectomy surgery.
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Affiliation(s)
- Jorge Lastra-Power
- Department of Neuroscience, Manati Medical Center, Manati, Puerto Rico, 00674, USA
| | - Christian Nieves-Ríos
- Department of Surgery, Ponce Health Sciences University, P.O. Box 7004, Ponce, Puerto Rico, 00732, USA
| | - Francisco Baralt-Nazario
- Department of Surgery, Ponce Health Sciences University, P.O. Box 7004, Ponce, Puerto Rico, 00732, USA
| | | | - Ashlie M Maldonado-Pérez
- Department of Surgery, Ponce Health Sciences University, P.O. Box 7004, Ponce, Puerto Rico, 00732, USA
| | - Gerardo Olivella
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936, USA
| | - Juan Pérez-Rosado
- Department of Internal Medicine, Manati Medical Center, Manati, Puerto Rico, 00674, USA
| | - Norman Ramírez
- Department of Pediatric Orthopaedic Surgery, Mayaguez Medical Center, Mayaguez, Puerto Rico, 00681, USA
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Sayin Gülensoy E, Gülensoy B. A 9-year retrospective cohort of patients with lumbar disc herniation: Comparison of patient characteristics and recurrence frequency by smoking status. Medicine (Baltimore) 2022; 101:e32462. [PMID: 36595869 PMCID: PMC9794230 DOI: 10.1097/md.0000000000032462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To evaluate the association between smoking status and patient characteristics and to identify risk factors associated with recurrence in patients who underwent surgery for lumbar disc herniation (LDH). This retrospective study was carried out at Lokman Hekim University, Ankara, Turkey between January 1, 2021 and January 1, 2022. The medical data of patients who underwent microsurgical discectomy for LDH were retrospectively recorded. Patients with any reemergence of LDH within a 6-month period after surgery were defined as having recurrent LDH. A total of 1109 patients were included in the study and mean age was 50.7 ± 14.3 years. The frequency of hernia at L2-L3 and L3-L4 levels was higher in the nonsmoker group (P < .001). The frequency of cases with Pfirrmann Grade 4 degeneration was higher in the nonsmoker group than in smokers and ex-smokers (P < .001). Protrusion-type hernias were more common in nonsmokers (P = .014), whereas paracentral hernias were more common in smokers (P < .001). The overall frequency of recurrence was 20.4%, and was higher in smokers than in non-smokers and ex-smokers (P < .001). Multivariable logistic regression revealed that current smoking (OR: 2.778, 95% CI [confidence interval]: 1.939-3.980, P < .001), presence of Pfirrmann Grade 4&5 disc degeneration (OR: 4.217, 95% CI: 2.966-5.996, P < .001), and paracentral herniation (OR: 5.040, 95% CI: 2.266-11,207, P < .001) were associated with higher risk of recurrence, whereas presence of sequestrated disc was associated with lower risk of recurrence (OR: 2.262, 95% CI:0.272-0.717, P = .001). Taken together, our data show that smoking, increased degree of degeneration and paracentral hernia increase the risk of LDH recurrence, while sequestrated disc appears to decrease risk. Taking steps to combat smoking in individuals followed for LDH may reduce the risk of recurrence in LDH patients.
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Affiliation(s)
- Esen Sayin Gülensoy
- Ufuk University, Faculty of Medicine, Department of Chest Diseases, Ankara, Turkey
- * Correspondence: Esen Sayin Gülensoy, Ufuk University, Faculty of Medicine, Department of Chest Diseases, Mevlana Bulvari 86/88 Balgat, Ankara 06520, Turkey (e-mail: )
| | - Bülent Gülensoy
- Lokman HekimUniversity, Faculty of Medicine, Department of Neurosurgery, Ankara, Turkey
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Chen J, Luo Z, Liu M, Wang F, Zhou R, Wang Y, Jia Y, Wang X, Leng X. Thunder-fire moxibustion for lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32270. [PMID: 36626497 PMCID: PMC9750694 DOI: 10.1097/md.0000000000032270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is a common degenerative disease that severely impacts the quality of life of patients. Thunder-fire moxibustion is an ancient Chinese medicine-based external therapeutic procedure that has been employed for pain relief until this day. The focus of our study was to demonstrate the effectiveness and safety of thunder-fire moxibustion in the treatment of LDH. METHODS The literature databases searched included the Cochrane Library, Web of Science, Springer, PubMed, Wanfang digital periodicals database, China national knowledge infrastructure, VIP, and Chinese biomedical literature database, and the search period was from database creation to March 2022. These include randomized controlled trials of Thunder-Fire moxibustion alone or in combination with other therapies for LDH. Two evaluators independently extracted data. We accessed the quality of inclusive studies through a Cochrane risk of bias tool. Meta-analyses were performed using Review Manager (Version 5.5). Data was analyzed using fixed-effects or random-effects models, depending on the heterogeneity test results. RESULTS The meta-analysis included 17 studies involving 1344 patients with LDH. The analysis results were as follows: compared with other therapies, the efficacy of thunder-fire moxibustion was statistically significant; the total effective rate (RR = 1.20; 95%CI [1.15, 1.26]; P < .00001), the Japanese orthopaedic association score (MD = 4.42; 95%CI [4.10, 4.73]; P < .00001), the pain score (SMD = -2.66; 95% CI [-3.39, -1.94]; P < .00001). Only 2 reported no adverse events in the included literature, and the remaining had no relevant records. The quality of the evidence in the 17 papers we examined was low or very low. CONCLUSION Thunder-Fire moxibustion is effective in relieving discomfort in patients with LDH. It has significant clinical efficacy, but there is still a need for prospective, multicentre, large-sample randomized controlled trials to enhance the clinical evidence due to the quality of included studies and methodological limitations.
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Affiliation(s)
- Jianye Chen
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Zongxiu Luo
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Mingda Liu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Fusheng Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Rui Zhou
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Ying Wang
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Yuyan Jia
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xukai Wang
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
- * Correspondence: Xukai Wang and Xiangyang Leng, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130117, China (e-mail: )
| | - Xiangyang Leng
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
- * Correspondence: Xukai Wang and Xiangyang Leng, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun 130117, China (e-mail: )
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Bahar ME, Hwang JS, Ahmed M, Lai TH, Pham TM, Elashkar O, Akter KM, Kim DH, Yang J, Kim DR. Targeting Autophagy for Developing New Therapeutic Strategy in Intervertebral Disc Degeneration. Antioxidants (Basel) 2022; 11:antiox11081571. [PMID: 36009290 PMCID: PMC9405341 DOI: 10.3390/antiox11081571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 12/25/2022] Open
Abstract
Intervertebral disc degeneration (IVDD) is a prevalent cause of low back pain. IVDD is characterized by abnormal expression of extracellular matrix components such as collagen and aggrecan. In addition, it results in dysfunctional growth, senescence, and death of intervertebral cells. The biological pathways involved in the development and progression of IVDD are not fully understood. Therefore, a better understanding of the molecular mechanisms underlying IVDD could aid in the development of strategies for prevention and treatment. Autophagy is a cellular process that removes damaged proteins and dysfunctional organelles, and its dysfunction is linked to a variety of diseases, including IVDD and osteoarthritis. In this review, we describe recent research findings on the role of autophagy in IVDD pathogenesis and highlight autophagy-targeting molecules which can be exploited to treat IVDD. Many studies exhibit that autophagy protects against and postpones disc degeneration. Further research is needed to determine whether autophagy is required for cell integrity in intervertebral discs and to establish autophagy as a viable therapeutic target for IVDD.
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Affiliation(s)
- Md Entaz Bahar
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Jin Seok Hwang
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Mahmoud Ahmed
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Trang Huyen Lai
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Trang Minh Pham
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Omar Elashkar
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Kazi-Marjahan Akter
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Gyeongsang National University, Jinju 52828, GyeongNam, Korea
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery, Institute of Health Sciences, Gyeongsang National University Hospital and Gyeongsang National University College of Medicine, Jinju 52727, GyeongNam, Korea
| | - Jinsung Yang
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
| | - Deok Ryong Kim
- Department of Biochemistry and Convergence Medical Science, Institute of Health Sciences, College of Medicine, Gyeongsang National University, Jinju 52727, GyeongNam, Korea
- Correspondence: ; Tel.: +82-55-772-8054
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20
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Du Y, Li J, Tang X, Liu Y, Bian G, Shi J, Zhang Y, Zhao B, Zhao H, Sui K, Xi Y. The Thermosensitive Injectable Celecoxib-Loaded Chitosan Hydrogel for Repairing Postoperative Intervertebral Disc Defect. Front Bioeng Biotechnol 2022; 10:876157. [PMID: 35837544 PMCID: PMC9274121 DOI: 10.3389/fbioe.2022.876157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Percutaneous endoscopic lumbar discectomy has been widely used in clinical practice for lumbar spine diseases. But the postoperative disc re-herniation and inflammation are the main reason for pain recurrence after surgery. The postoperative local defect of the intervertebral disc will lead to the instability of the spine, further aggravating the process of intervertebral disc degeneration. In this work, we successfully synthesized the thermosensitive injectable celecoxib-loaded chitosan hydrogel and investigated its material properties, repair effect, biocompatibility, and histocompatibility in in vitro and in vivo study. In vitro and in vivo, the hydrogel has low toxicity, biodegradability, and good biocompatibility. In an animal experiment, this composite hydrogel can effectively fill local tissue defects to maintain the stability of the spine and delay the process of intervertebral disc degeneration after surgery. These results indicated that this composite hydrogel will be a promising way to treat postoperative intervertebral disc disease in future clinical applications.
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Affiliation(s)
- Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojie Tang
- Department of Spinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Yingying Liu
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Guoshuai Bian
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Jianzhuang Shi
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Yixin Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Health Care Ward III, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baomeng Zhao
- Department of Surgery teaching and research, Binzhou Medical University, Yantai, China
| | - Hongri Zhao
- Department of Spinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Kunyan Sui
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
- *Correspondence: Kunyan Sui, ; Yongming Xi,
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Kunyan Sui, ; Yongming Xi,
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21
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Wang H, Yuan W, Yu Z, Wang X, Zhao X, Deng Z, Yang G, Chen W, Shen Z, Zhan H. Study on the efficacy and safety of the combination of Shi's manual therapy and percutaneous endoscopic lumbar diskectomy for lumbar disc herniation with radiculopathy: study protocol for a multicenter randomized controlled trial. Trials 2022; 23:338. [PMID: 35461259 PMCID: PMC9034638 DOI: 10.1186/s13063-022-06195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Background Lumbar disc herniation (LDH) is a common chronic musculoskeletal disorder that seriously affects quality of life. The percutaneous endoscopic lumbar diskectomy (PELD) technique was developed to address spinal nerve root compression through direct visualization of pathological findings while minimizing tissue destruction upon exposure. It is an effective and safe treatment for LDH. However, recurrent LDH is a major concern after lumbar discectomy for primary LDH. A considerable number of clinical studies have reported that patients with LDH with radiculopathy could benefit from manual therapy. Shi’s manual therapy (SMT) was established based on traditional Chinese medicine (TCM) theory and has been shown to have a superior effect in alleviating muscle tension and loosening joints to improve lumbar and leg pain, radiculopathy, stiffness, activity discomfort, and related disorders. However, there is a lack of high-quality clinical evidence to support this conclusion. The purpose of this study is to evaluate the efficacy and safety of the combination of Shi’s manual therapy (SMT) and PELD for LDH with radiculopathy. Methods/design A multicenter randomized controlled trial (RCT) with a 1-year follow-up period will be performed. A total of 510 participants with LDH with radiculopathy will be recruited from four clinical centers. The sample size was estimated, and statistical analysis will be performed and supervised by biostatisticians from an independent third-party research institution. Two hundred fifty-five subjects will be randomly allocated to each group. The subjects in the control group will undergo PELD. Participants in the intervention group will be treated with a combination of SMT and PELD. Recurrence rate is the primary endpoint and the survival analysis of recurrence rate is the secondary endpoint, and the primary analysis of recurrence rate is the chi-square test and the secondary analysis of recurrence rate is survival analysis. The primary outcome measure is the recurrence rate of LDH with radiculopathy at the 1-year follow-up after treatment. The secondary outcome measures will be the ODI score, the VAS score for pain for the lumbar spine and lower limbs, the straight leg raise angle, the stability of the operated lumbar segment, and the SF-36 scores. Assessments will occur at baseline, postoperation, and 1 week, 4 weeks, 13 weeks, 26 weeks, and 1 year postoperation. In addition, adverse events related to clinical symptoms and signs and the results of laboratory tests will be documented during the clinical trials. Discussion This study will provide reliable evidence of the effectiveness and safety of the combination of SMT and PELD for LDH with radiculopathy. If the results are favorable, it is expected that patients with LDH with radiculopathy will benefit from this study, and many patients could gain a good alternative treatment for LDH with radiculopathy. Trial registration China Registered Clinical Trial Registration Center ChiCTR2000036515. Registered on 13 November 2020.
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Affiliation(s)
- Huihao Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Weian Yuan
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhongxiang Yu
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xiang Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xinxin Zhao
- Tongji University School of Medicine, Shanghai, 200065, China
| | - Zhen Deng
- Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 201999, China
| | - Guangyue Yang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Weinan Chen
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhibi Shen
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hongsheng Zhan
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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22
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Gonçalves RM, Saggese T, Yong Z, Ferreira JR, Ignatius A, Wilke HJ, Neidlinger-Wilke C, Teixeira GQ. Interleukin-1β More Than Mechanical Loading Induces a Degenerative Phenotype in Human Annulus Fibrosus Cells, Partially Impaired by Anti-Proteolytic Activity of Mesenchymal Stem Cell Secretome. Front Bioeng Biotechnol 2022; 9:802789. [PMID: 35155408 PMCID: PMC8831733 DOI: 10.3389/fbioe.2021.802789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/27/2021] [Indexed: 12/04/2022] Open
Abstract
Mesenchymal stem/stromal cell (MSC)–based therapies for low back pain and intervertebral disc (IVD) degeneration have been emerging, despite the poor knowledge of their full mechanism of action. As failure of the annulus fibrosus (AF) is often associated with IVD herniation and inflammation, the objective of the present study was to investigate the impact of the MSC secretome on human AF cells exposed to mechanical loading and a pro-inflammatory environment. Human AF cells isolated from IVD biopsies from patients with adolescent idiopathic scoliosis (AIS) or disc degeneration (DD) were exposed to physiological cyclic tensile strain (CTS) for 72 h in a custom-made device, with or without interleukin (IL)-1β medium supplementation. AF cells stimulated with CTS + IL-1β were then treated with secretome from IL-1β–preconditioned MSCs for 48 h. AF cell metabolic activity, gene expression, protein secretion, matrix metalloproteinase (MMP) activity, and tissue inhibitor of MMPs (TIMP) concentration were evaluated. Expanded AF cells from AIS and DD patients revealed similar metabolic activity and gene expression profiles. CTS stimulation upregulated collagen type I (COL1A1) expression, while IL-1β significantly stimulated IL-6, IL-8, MMP-1, and MMP-3 gene expression and prostaglandin E2 production by AF cells but downregulated COL1A1. The combination of CTS + IL-1β had a similar outcome as IL-1β alone, accompanied by a significant upregulation of elastin. The MSC secretome did not show any immunomodulatory effect on CTS + IL-1β–stimulated AF cells but significantly decreased MMP-1, MMP-2, MMP-3, and MMP-9, while increasing the production of TIMP-1. The obtained results demonstrate a stronger impact of the inflammatory milieu on human AF cells than upper physiologic mechanical stress. In addition, a new MSC mechanism of action in degenerated IVD consisting of the modulation of AF MMP activity was also evidenced, contributing to the advancement of knowledge in AF tissue metabolism.
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Affiliation(s)
- Raquel M. Gonçalves
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
- Instituto de Investigação e Inovação Em Saúde (i3S), Universidade Do Porto, Porto, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Taryn Saggese
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
| | - Zhiyao Yong
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
| | - Joana R. Ferreira
- Instituto de Investigação e Inovação Em Saúde (i3S), Universidade Do Porto, Porto, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
| | - Cornelia Neidlinger-Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
| | - Graciosa Q. Teixeira
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, Ulm University, Ulm, Germany
- *Correspondence: Graciosa Q. Teixeira,
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23
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Ohnishi T, Iwasaki N, Sudo H. Causes of and Molecular Targets for the Treatment of Intervertebral Disc Degeneration: A Review. Cells 2022; 11:cells11030394. [PMID: 35159202 PMCID: PMC8834258 DOI: 10.3390/cells11030394] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Intervertebral disc degeneration (IVDD) is a pathological condition that can lead to intractable back pain or secondary neurological deficits. There is no fundamental cure for this condition, and current treatments focus on alleviating symptoms indirectly. Numerous studies have been performed to date, and the major strategy for all treatments of IVDD is to prevent cell loss due to programmed or regulated cell death. Accumulating evidence suggests that several types of cell death other than apoptosis, including necroptosis, pyroptosis, and ferroptosis, are also involved in IVDD. In this study, we discuss the molecular pathway of each type of cell death and review the literature that has identified their role in IVDD. We also summarize the recent advances in targeted therapy at the RNA level, including RNA modulations through RNA interference and regulation of non-coding RNAs, for preventing cell death and subsequent IVDD. Therefore, we review the causes and possible therapeutic targets for RNA intervention and discuss the future direction of this research field.
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Affiliation(s)
- Takashi Ohnishi
- Department of Orthopedic Surgery, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan;
| | - Hideki Sudo
- Department of Advanced Medicine for Spine and Spinal Cord Disorders, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
- Correspondence:
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Posterior Dynamic Stabilization with Limited Rediscectomy for Recurrent Lumbar Disc Herniation. Pain Res Manag 2022; 2021:1288246. [PMID: 34976251 PMCID: PMC8718289 DOI: 10.1155/2021/1288246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
Objective Recurrent lumbar disc herniation (RLDH) is the most common cause of sciatica after primary discectomy. The purpose of this study was to evaluate the efficacy of transpedicular dynamic stabilization (TDS) combined with limited rediscectomy in the treatment of single-level RLDH. Methods We retrospectively evaluated a consecutive series of 24 middle-aged patients who underwent TDS (Dynesys system) combined with limited rediscectomy (i.e., removing only extruded or loose disc fragments) for single-level Carragee type II and type IV RLDH between April 2012 and September 2017. Clinical results were evaluated with visual analog scale (VAS) for leg and low back pain, Oswestry Disability Index (ODI) scores, and complications. Imaging data include lumbar segment motion and intervertebral height. Results The mean follow-up period was 38 months. The VAS and ODI scores were significantly improved at the last follow-up. The average range of motion (ROM) at the stabilized segment was 6.4° before surgery and 4.2° at the last follow-up, with a 78.6% mean preservation (P < 0.05). Intervertebral height at the stabilized segment decreased slightly after surgery (P < 0.05). However, there was no further decline at the last follow-up. There were no cases of reherniation, screw loosening, or segmental instability. Conclusions TDS combined with limited rediscectomy resulted in an effective procedure in middle-aged patients with Carragee type II and type IV RLDH. It was able to stabilize the operated segment with partial motion preservation. Moreover, it could maintain disc height and decrease the risk of recurrence in patients with a large posterior annular defect.
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25
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Christiani T, Mys K, Dyer K, Kadlowec J, Iftode C, Vernengo AJ. Using embedded alginate microparticles to tune the properties of in situ forming poly( N-isopropylacrylamide)-graft-chondroitin sulfate bioadhesive hydrogels for replacement and repair of the nucleus pulposus of the intervertebral disc. JOR Spine 2021; 4:e1161. [PMID: 34611588 PMCID: PMC8479524 DOI: 10.1002/jsp2.1161] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/16/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Low back pain is a major public health issue associated with degeneration of the intervertebral disc (IVD). The early stages of degeneration are characterized by the dehydration of the central, gelatinous portion of the IVD, the nucleus pulposus (NP). One possible treatment approach is to replace the NP in the early stages of IVD degeneration with a hydrogel that restores healthy biomechanics while supporting tissue regeneration. The present study evaluates a novel thermosensitive hydrogel based on poly(N-isopropylacrylamide-graft-chondroitin sulfate) (PNIPAAM-g-CS) for NP replacement. The hypothesis was tested that the addition of freeze-dried, calcium crosslinked alginate microparticles (MPs) to aqueous solutions of PNIPAAm-g-CS would enable tuning of the rheological properties of the injectable solution, as well as the bioadhesive and mechanical properties of the thermally precipitated composite gel. Further, we hypothesized that the composite would support encapsulated cell viability and differentiation. Structure-material property relationships were evaluated by varying MP concentration and diameter. The addition of high concentrations (50 mg/mL) of small MPs (20 ± 6 μm) resulted in the greatest improvement in injectability, compressive mechanical properties, and bioadhesive strength of PNIPAAm-g-CS. This combination of PNIPAAM-g-CS and alginate MPs supported the survival, proliferation, and differentiation of adipose derived mesenchymal stem cells toward an NP-like phenotype in the presence of soluble GDF-6. When implanted ex vivo into the intradiscal cavity of degenerated porcine IVDs, the formulation restored the compressive and neutral zone stiffnesses to intact values and resisted expulsion under lateral bending. Overall, results indicate the potential of the hydrogel composite to serve as a scaffold for supporting NP regeneration. This work uniquely demonstrates that encapsulation of re-hydrating polysaccharide-based MPs may be an effective method for improving key functional properties of in situ forming hydrogels for orthopedic tissue engineering applications.
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Affiliation(s)
- Thomas Christiani
- Department of Biomedical Engineering, Rowan UniversityGlassboroNew JerseyUSA
| | - Karen Mys
- AO Research Institute DavosDavosSwitzerland
| | - Karl Dyer
- Department of Mechanical Engineering, Rowan UniversityGlassboroNew JerseyUSA
| | - Jennifer Kadlowec
- Department of Computer Science and Engineering, Baldwin Wallace UniversityBereaOhioUSA
| | - Cristina Iftode
- Department of Molecular and Cellular Biosciences, Rowan UniversityGlassboroNew JerseyUSA
| | - Andrea Jennifer Vernengo
- Department of Biomedical Engineering, Rowan UniversityGlassboroNew JerseyUSA
- AO Research Institute DavosDavosSwitzerland
- Department of Chemical Engineering, Rowan UniversityGlassboroNew JerseyUSA
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26
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Lumbosacral Transitional Vertebrae in Adolescents: Effects on the Short-Term Outcomes of Percutaneous Endoscopic Lumbar Discectomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9911579. [PMID: 34337062 PMCID: PMC8292041 DOI: 10.1155/2021/9911579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/03/2021] [Indexed: 12/02/2022]
Abstract
Objective To investigate whether lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in adolescent patients with lumbar disc herniation (LDH). Methods This was a retrospective study with two groups. Group A was made up of 22 adolescent LDH patients with LSTV (18 males and 4 females). Group B was made up of 44 adolescent LDH patients without LSTV (36 males and 4 females), who were matched to group A for age, sex, and body mass index. All patients underwent PELD at the L4/5 or L5/S1 single level and were followed up at 18 months after surgery. We identified LSTV on radiographs and computed tomography and assessed the imaging characteristics of all patients. Outcomes were evaluated through a numerical rating scale (NRS), the Oswestry Disability Index (ODI), the modified MacNab grading system, and the incidence of additional lumbar surgery. Results At 18 months after PELD, both groups had significant improvements in the mean NRS scores of low back pain (LBP) or leg pain and the ODI scores. In terms of the MacNab criteria, 90.9% in group A and 93.2% in group B showed excellent or good outcomes. The mean NRS scores of LBP or leg pain, ODI score, and MacNab grade after surgery were not significantly different between the 2 groups. Two patients (one patient had a recurrence; one patient had a new lumbar disc herniation) in group A and 3 patients (one patient had a recurrence; two patients had new lumbar disc herniations) in group B underwent additional lumbar surgery. Conclusions Our study suggests that in terms of pain relief, life function improvement, and the incidence of additional lumbar surgery, LSTV has no effect on the short-term clinical outcomes of PELD in adolescents. A new lumbar disc herniation is an important reason for additional surgery in adolescents, regardless of the LSTV status.
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27
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Hosseini S, Niakan A, Dehghankhalili M, Dehdab R, Shahjouei S, Rekabdar Y, Shaghaghian E, Shaghaghian A, Ghaffarpasand F. Effects of adhesion barrier gel on functional outcomes of patients with lumbar disc herniation surgery; A systematic review and meta-analysis of clinical trials. Heliyon 2021; 7:e07286. [PMID: 34189319 PMCID: PMC8220332 DOI: 10.1016/j.heliyon.2021.e07286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/21/2021] [Accepted: 06/07/2021] [Indexed: 11/09/2022] Open
Abstract
Failed Back Surgery Syndrome (FBSS) is persistent pain and disability following lumbar laminectomy which is associated with decreased quality of life and disability and has been reported in up to 40% of the patients undergoing lumbar laminectomy. Several approaches have been introduced to reduce the rate of the FBSS. Among these, applying anti-adhesive barrier gels have been studied with interest with controversial results. The aim of the current study was to determine the effects of anti-adhesive barrier gels on functional outcome and recurrence of patients undergoing lumbar disc surgery. We searched databases including EMBASE, PUBMED, Web of Science, Scopus, Cochrane Library, and scholar databases until November 2019. To assess the heterogeneity across included studies was used Cochran's Q and I-square (I2) statistics. Standardized mean difference (SMD) and 95% CI between were used to estimate pooled effect sizes. Out of 4507, 10 clinical trials found to be appropriate for current meta-analysis. The pooled results of included clinical trials indicated that adhesion barrier gel significantly decreased leg pain (LP) (SMD = −0.31; 95% CI, −0.60, −0.03; P = 0.032; I2: 59.2%) among patients with lumbar disc herniation surgery. Back pain (BP) (SMD = −0.03; 95% CI, −0.23, 0.16; P = 0.734; I2: 40.2%), and Oswestry disability index (ODI) (SMD = −0.11; 95% CI, −0.27, 0.05; P = 0.178; I2: 0.0%), were not significantly affected following adhesion barrier gel application. Application of adhesion barrier gel in single level lumbar disc surgery is associated with deceased leg pain. However, its application does not affect the low back pain, disability and gate. Further, larger randomized clinical trials are required.
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Affiliation(s)
- Seyedmorteza Hosseini
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Niakan
- Trauma Research Center, Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Dehdab
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shima Shahjouei
- Neuroscience Institute, Geisinger Health System, Pennsylvania, USA
| | - Yasamin Rekabdar
- Young Researchers and Elite Club, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Elaheh Shaghaghian
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fariborz Ghaffarpasand
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
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28
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Brooks M, Dower A, Abdul Jalil MF, Kohan S. Radiological predictors of recurrent lumbar disc herniation: a systematic review and meta-analysis. J Neurosurg Spine 2020:1-11. [PMID: 33254135 DOI: 10.3171/2020.6.spine20598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Lumbar discectomy for the management of lumbar radiculopathy is a commonly performed procedure with generally excellent patient outcomes. However, recurrent lumbar disc herniation (rLDH) remains one of the most common complications of the procedure, often necessitating repeat surgery. rLDH is known to be influenced by a variety of factors, and in this systematic review the authors aimed to explore the radiological predictors of recurrence. METHODS A systematic review and meta-analysis was conducted to identify studies analyzing radiological predictors of recurrent herniation, both ipsilateral and contralateral. A search was conducted on Medline and EMBASE. Both retrospective and prospective comparative studies were included, measuring radiological parameters of lumbar discectomy patients. All factors were considered irrespective of imaging modality, and a meta-analysis of the data was performed in which 5 or more studies were identified analyzing the same parameter. RESULTS In total, 1626 reported studies were screened, with 23 being included in this review, of which 13 were appropriate for meta-analysis. Three factors, namely disc height index, Modic changes, and sagittal range of motion, were determined to be significantly correlated with an increased rate of rLDH. Some variables were considered in only 1 or 2 different studies, and the authors have included a narrative review of these novel findings. CONCLUSIONS The findings of associations between the radiological parameters and rLDH implicates the role of instability in the development of recurrence. Understanding the physiological factors associated with instability is important, because although early degenerative disc changes may predispose patients to herniation recurrence, more advanced degeneration likely reduces segmental motion and concurrently risk of recurrence.
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Affiliation(s)
- Michael Brooks
- 1Department of Neurosurgery, St. George Hospital, Kogarah.,2South Western Sydney Clinical School, School of Medicine, University of New South Wales (UNSW), Randwick; and
| | - Ashraf Dower
- 1Department of Neurosurgery, St. George Hospital, Kogarah.,3Faculty of Medicine, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | | | - Saeed Kohan
- 1Department of Neurosurgery, St. George Hospital, Kogarah
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Caspase-3 knockout inhibits intervertebral disc degeneration related to injury but accelerates degeneration related to aging. Sci Rep 2019; 9:19324. [PMID: 31852919 PMCID: PMC6920379 DOI: 10.1038/s41598-019-55709-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022] Open
Abstract
Approximately 40% of people under 30 and over 90% of people 55 or older suffer from moderate-to-severe levels of degenerative intervertebral disc (IVD) disease in their lumbar spines. Surgical treatments are sometimes effective; however, the treatment of back pain related to IVD degeneration is still a challenge; therefore, new treatments are necessary. Apoptosis may be important in IVD degeneration because suppressing cell apoptosis inside the IVD inhibits degeneration. Caspase-3, the primary effector of apoptosis, may be a key treatment target. We analyzed caspase-3’s role in two different types of IVD degeneration using caspase-3 knockout (Casp-3 KO) mice. Casp-3 KO delayed IVD degeneration in the injury-induced model but accelerated it in the age-induced model. Our results suggest that this is due to different pathological mechanisms of these two types of IVD degeneration. Apoptosis was suppressed in the IVD cells of Casp-3 KO mice, but cellular senescence was enhanced. This would explain why the Casp-3 KO was effective against injury-induced, but not age-related, IVD degeneration. Our results suggest that short-term caspase-3 inhibition could be used to treat injury-induced IVD degeneration.
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Lee JJ, Nguyen ET, Harrison JR, Gribbin CK, Hurwitz NR, Cheng J, Boachie-Adjei K, Bogner EA, Moley PJ, Wyss JF, Lutz GE. Fluoroscopically guided caudal epidural steroid injections for axial low back pain associated with central disc protrusions: a prospective outcome study. INTERNATIONAL ORTHOPAEDICS 2019; 43:1883-1889. [PMID: 31168645 DOI: 10.1007/s00264-019-04350-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine if axial low back pain (LBP) associated with central disc protrusions can be improved by caudal epidural steroid injections (ESIs). METHODS Adults with chronic (> 3 months) moderate-to-severe axial LBP with L4-5 and/or L5-S1 central disc protrusions were enrolled in this prospective study. Participants underwent caudal ESIs under standard-of-care practice. The numerical rating scale (NRS) pain score, modified North American Spine Society satisfaction, and Roland Morris Disability Questionnaire (RMDQ) were collected at one week, one month, three months, six months, and one year post-injection. Pre-injection magnetic resonance images were assessed by a musculoskeletal radiologist. RESULTS Sixty-eight participants (42 males, 26 females) were analyzed. There were statistically significant improvements in all outcome measures at all follow-up time points, with the exception of NRS best pain at six months. Clinically significant improvements in outcomes were observed at various time points: at three months and one year for current pain; at one week, one month, three months, six months, and one year for worst pain; and at one month and one year for RMDQ. The proportion of satisfied participants ranged from 57 to 69% throughout the study. No adverse events were observed. CONCLUSIONS This study demonstrated significant improvements in pain and function following caudal ESIs in a cohort of axial LBP with associated central disc protrusions. Further studies, including the use of randomized controlled trials, are needed to determine the ideal subset of candidates for this treatment and to explore additional applications that caudal ESIs may have for chronic LBP.
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Affiliation(s)
- James J Lee
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth T Nguyen
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Julian R Harrison
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Caitlin K Gribbin
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Nicole R Hurwitz
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | | | - Eric A Bogner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Peter J Moley
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - James F Wyss
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA
| | - Gregory E Lutz
- Department of Physiatry, Hospital for Special Surgery, New York, NY, USA.
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Benzakour T, Benzakour A. Disc herniation and disc disease: the present and the future of management. INTERNATIONAL ORTHOPAEDICS 2019; 43:755-760. [PMID: 30891636 DOI: 10.1007/s00264-019-04324-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Thami Benzakour
- Zerktouni Orthopaedic Clinic - Casablanca, 158, Boulevard Anfa, 20050, Casablanca, Morocco
| | - Ahmed Benzakour
- Clinique de l'Archette, 83 rue Jacques Monod, 45160, Olivet, France.
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Lumbar disc herniation: long-term outcomes after mini-open discectomy. INTERNATIONAL ORTHOPAEDICS 2019; 43:869-874. [PMID: 30848331 DOI: 10.1007/s00264-019-04312-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The outcomes of mini open discectomy in lumbar disc herniation are usually satisfying. Our study aims at finding if its results are still good at long-term follow-up. METHODS We reviewed 552 patients operated between 1993 and 2013 by mini open discectomy procedure. Our main evaluation criterion is a modified Stauffer and Coventry classification applied during follow-up visits at three months, one year, five years, and every five years. The secondary criterion was the Oswestry Disability Index. RESULTS The outcomes are considered good to very good in 87.3% of the cases at one year follow-up. These results deteriorate after an average follow-up of 14.7 years but remain satisfactory with 63.7%. The global decrease is 23.6%. The Oswestry Score decreases by 35 points at the same follow-up. In addition, 6.52% of patients required fusion at first revision and 1.08% at second revision. We also noticed 51 (9.2%) post-operative recurrences at the same level. In 23 (4.16%) of them, we proceeded to a new discectomy in an average interval of 41.4 months. At an adjacent level, 29 patients (5.2%) presented a new symptomatic disc herniation; among them, eight cases (1.44%) needed discectomy. The re-operative rate (including recurrent disc herniation and fusion for degenerative indications) is 10.68% at the last follow-up. CONCLUSIONS Nearly 2/3 of our patient series keep satisfactory outcomes after about 15-year follow-up. The mini open discectomy remains a reliable surgical technique provided we respect the indications and surgical requirements. This procedure also avoids excessive instrumentation and its possible iatrogenic complications. Powerful randomized and controlled trials are needed to strengthen these deductions.
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Carlson BB, Albert TJ. Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us? INTERNATIONAL ORTHOPAEDICS 2019; 43:853-859. [DOI: 10.1007/s00264-019-04309-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/05/2019] [Indexed: 01/12/2023]
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The evidence-based approach for surgical complications in the treatment of lumbar disc herniation. INTERNATIONAL ORTHOPAEDICS 2018; 43:975-980. [PMID: 30543041 DOI: 10.1007/s00264-018-4255-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/25/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this article is to review the evidence-based approach for surgical complications following disc herniation. METHODS A search of the primary English literature was conducted for research examining the outcomes and complications of surgical discectomy. Special regard was given to high-quality prospective randomized studies. RESULTS The most commonly reported complications of surgical treatment of disc herniation are included in this review. Medical complications, and surgical complications including infection, durotomy, neurological injury, symptomatic re-herniation, and revision surgery are defined and systematically reviewed in detail for incidence, evaluation, and management. CONCLUSION This article provides the clinician and surgeon with a review of the evidence-based evaluation and management of surgical complications following disc herniation, offering best practice guidelines for informed discussions with patients in shared decision-making.
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