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Penchev P, Ilyov IG, Todorov T, Petrov PP, Traykov P. Comprehensive Analysis of Treatment Approaches for Lumbar Disc Herniation: A Systematic Review. Cureus 2024; 16:e67899. [PMID: 39328604 PMCID: PMC11425427 DOI: 10.7759/cureus.67899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
Lumbar disc herniation is a common disorder that has an important impact on the quality of life and daily activities of those affected. It is defined as the displacement of the nucleus pulposus beyond the intervertebral space. This systematic review aims to evaluate and compare the efficacy of several treatment modalities, including conservative, pharmaceutical, and surgical interventions. The data sources utilized were PubMed, Google Scholar, Embase, and Cochrane. We conducted a systematic review of English-language articles published between 2019 and 2024, using the PRISMA guidelines. A total of 720 studies were identified during the search. Following the evaluation of the title, abstract, and full text, and the application of exclusion criteria, a total of 15 studies met the requirements for inclusion in the analysis. The results indicate that although conservative treatment is frequently successful in providing immediate relief of symptoms, surgical interventions may be required for patients experiencing neurological deficits or those who do not respond to conservative treatments. One limitation of this systematic review is the inclusion of a limited number of studies, which may affect the generalizability of the findings. Additionally, the review was restricted to English-language publications from 2019 to 2024, potentially excluding relevant research published in other languages or outside this timeframe.
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Affiliation(s)
| | - Ilko G Ilyov
- Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | - Todor Todorov
- Medicine, Medical Univesity of Plovdiv, Plovdiv, BGR
| | | | - Petar Traykov
- Thoracic Surgery, Evangelisches Krankenhaus Duisburg-Nord, Duisburg, DEU
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Zeng Z, Qin J, Guo L, Hirai T, Gui Z, Liu T, Su C, Yu D, Yan M. Prediction and Mechanisms of Spontaneous Resorption in Lumbar Disc Herniation: Narrative Review. Spine Surg Relat Res 2024; 8:235-242. [PMID: 38868799 PMCID: PMC11165499 DOI: 10.22603/ssrr.2023-0152] [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: 07/11/2023] [Accepted: 09/18/2023] [Indexed: 06/14/2024] Open
Abstract
The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from great distress in their daily life accompanied by severe economic hardship and difficulty in self-care, with an increasing tendency in the aging population. PubMed and the Cochrane Central Register of Controlled Trials were searched for relevant studies of spontaneous resorption or regression in LDH after conservative treatment and for other potential studies, which included those from inception to June 30, 2023. The objective of this narrative review is to summarize previous literatures about spontaneous resorption in LDH and to discuss the mechanisms and influencing factors in order to assess the probability of spontaneous resorption by conservative treatment. Spontaneous resorption without surgical treatment is influenced by the types and sizes of the LDH, inflammatory responses, and therapeutic factors. If the lumbar disc herniated tissue comprises a higher percentage of cartilage or modic changes have been shown on magnetic resonance imaging (MRI), resorption in LDH is prevented. The bull's eye sign on enhanced MRI, which is a ring enhancement around a protruding disc, is a vital indicator for easy reabsorption. In addition, the type of extrusion and sequestration in LDH could forecast the higher feasibility of natural reabsorption. Moreover, the higher the proportion of protrusion on the intervertebral disc tissue within the spinal canal, the greater the likelihood of reabsorption. Therefore, which illustrates the feasibility of conservative treatments for LDH. Nonsurgical management of LDH with clinical symptoms is recommended by the authors.
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Affiliation(s)
- Zili Zeng
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Qin
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Guo
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Takashi Hirai
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Zhiheng Gui
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tao Liu
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Chen Su
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daiyang Yu
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mengmeng Yan
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Yaman O, Guchkha A, Vaishya S, Zileli M, Zygourakis C, Oertel J. The role of conservative treatment in lumbar disc herniations: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100277. [PMID: 38389961 PMCID: PMC10882128 DOI: 10.1016/j.wnsx.2024.100277] [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: 07/28/2023] [Revised: 11/18/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Objective To formulate the most current, evidence-based recommendations for the conservative management of lumbar disc herniations (LDH). Methods A systematic literatüre search was performed 2012-2022 in PubMed/Medline and Cochrane using the keywords ''lumbar disc herniation'' and ''conservative treatment,'' yielding 342 total manuscripts. Screening criteria resulted in 12 final manuscripts which were summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The Delphi method was utilized to arrive at three final consensus statements. Results and conclusion s: In the absence of cauda equina syndrome, motor, or other serious neurologic deficits, conservative treatment should be the first line of treatment for LDH. NSAIDs may significantly improve acute low back and sciatic pain caused by LDH. A combination of activity modification, pharmacotherapy, and physical therapy provides good outcomes in most LDH patients.
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Affiliation(s)
- Onur Yaman
- Department of Neurosurgery, Memorial Bahçelievler Hospital, Istanbul, Turkiye
| | - Artem Guchkha
- Department of Neurosurgery, Research Center of Neurology, Moscow, Russia
| | - Sandeep Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Guragaon and Fortis Hospital Vasant Kunj, New Delhi, India
| | - Mehmet Zileli
- Department of Neurosurgery, Sanko University Faculty of Medicine, Gaziantep, Turkiye
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany
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Azharuddin A, Aryandono T, Magetsari R, Dwiprahasto I. Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia. Asian J Surg 2021; 45:277-283. [PMID: 34384675 DOI: 10.1016/j.asjsur.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). METHODS A prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. RESULTS We recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7-10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1-4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15-96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15-96.93). CONCLUSION Type of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.
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Affiliation(s)
- Azharuddin Azharuddin
- Department of Orthopaedic and Traumatology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Department of Orthopaedic and Traumatology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia.
| | - Teguh Aryandono
- Department of Surgery, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Rahadyan Magetsari
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
| | - Iwan Dwiprahasto
- Department of Clinical Pharamacology, Faculty of Medicine, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia.
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Ji Y, Li X, Wang Z, Xiao W, He Z, Xiong Z, Zhao L. Extraction optimization of accelerated solvent extraction for eight active compounds from Yaobitong capsule using response surface methodology: Comparison with ultrasonic and reflux extraction. J Chromatogr A 2020; 1620:460984. [PMID: 32102737 DOI: 10.1016/j.chroma.2020.460984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/23/2020] [Accepted: 02/17/2020] [Indexed: 12/27/2022]
Abstract
This work described the development of a novel method for simultaneous extraction of eight active compounds (including catechin, albiflorin, paeoniflorin, ferulic acid, ginsenoside Rg1, tetrahydropalmatine, ginsenoside Rb1 and osthole) from Yaobitong capsule by accelerated solvent extraction (ASE). Response surface methodology (RSM) with desirability functions was employed to optimize the extraction conditions yielding the optimal conditions of ASE (extraction time 8 min, extraction temperature 80 °C, extraction solvent 70% methanol and flushing volume 100%). A high-performance liquid chromatography coupled with a diode array detector (HPLC-DAD) method was developed and validated for simultaneous quantification of the eight compounds in Yaobitong capsule. The values of correlation coefficient (R) were satisfactory between 0.9992 and 0.9999 over the linear concentration range of 0.5-1000 μg mL-1. It was found that the limits of detection (LODs) and the limits of quantification (LOQs) for the eight active compounds were 0.10-2.90 μg•mL-1 and 0.30-9.40 μg•mL-1, respectively. The recoveries of the eight main active compounds in Yaobitong capsule were in the range of 93.31%-106.22%. And the contents of the analytes extracted by ASE under the optimal conditions were compared to traditional solvent extraction methods, such as ultrasonic and reflux extraction. The results indicated that the ASE method proved to be more suitable for the extract of active compounds in Yaobitong capsule, which could obtain higher extraction efficiency. At last, the proposed method was applied to analyze ten batches of actual samples, which provided high extraction efficiency and had wide potential application in the analysis of traditional Chinese medicines.
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Affiliation(s)
- Yinghe Ji
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road Shenhe District, Shenyang 110016, China
| | - Xianhui Li
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road Shenhe District, Shenyang 110016, China
| | - Zhenzhong Wang
- Jiangsu Kanion Pharmaceutical Co. Ltd., Lianyungang 222002, China
| | - Wei Xiao
- Jiangsu Kanion Pharmaceutical Co. Ltd., Lianyungang 222002, China
| | - Zhonggui He
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road Shenhe District, Shenyang 110016, China
| | - Zhili Xiong
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road Shenhe District, Shenyang 110016, China
| | - Longshan Zhao
- School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road Shenhe District, Shenyang 110016, China.
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Kaliya-Perumal AK, Oh JYL. Spontaneous Total Resolution of Severe Lumbar Disc Herniation. Chonnam Med J 2020; 56:77-78. [PMID: 32021847 PMCID: PMC6976777 DOI: 10.4068/cmj.2020.56.1.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Fattahi A, Taheri M, Tabibkhooei A. Spontaneous regression of a large extruded disc herniation. Chirurgia (Bucur) 2019; 32. [DOI: 10.23736/s0394-9508.18.04811-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Ivanova MA, Parfenov VA, Isaikin AI. [Disc hernia regression as a natural course of discogenic lumbosacral radiculopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:58-62. [PMID: 30499498 DOI: 10.17116/jnevro201811810158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disc herniation with radiculopathy is a common cause of severe back pain leading to significant disability and a decrease in patients' quality of life. The authors report a case of 38-year-old female patient with radiculopathy of the first sacral root due to a large (11 mm) sequestered disc herniation between the fifth lumbar and the first sacral vertebrae. Conservative treatment with fluoroscopically-guided epidural steroid injection provided a significant clinical improvement, the patient was able to return to normal daily and professional activity in a short time. MRI in 9 months showed the regression of disc herniation. Possible predictors and timing of disc herniation regression are discussed, as well as the proposed mechanisms, the main one of which is considered to be immune-mediated lysis.
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Affiliation(s)
- M A Ivanova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Parfenov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A I Isaikin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Clinical Outcome of Minimally Invasive Decompression Without Discectomy in Contained Foraminal Disc Herniation: A Single-Center Study. World Neurosurg 2018; 118:e367-e374. [PMID: 29969734 DOI: 10.1016/j.wneu.2018.06.192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Foraminal disc herniation is rare. When conservative treatment fails, it is often treated with discectomy via a paraspinal or Wiltse approach. In contained foraminal disc herniation, more symptoms arise from the foraminal compression of the exiting nerve root, including the dorsal root ganglion, than from the herniation itself. We aimed to evaluate the benefits of stand-alone decompression without discectomy for patients with contained foraminal disc herniation. METHODS This study included 17 patients with unilateral single-level foraminal disc herniation (14 women and 3 men; mean age, 62.8 ± 14.6 years, range, 37-86 years). Disc herniation was confirmed as contained by preoperative magnetic resonance imaging and/or computed tomography and by intraoperative exploration. All patients underwent thorough decompression without discectomy, via a paraspinal approach. Pain was evaluated preoperatively and at 3 and 12 months postoperatively using a visual analog scale (VAS). The Oswestry Disability Index (ODI) and Macnab criteria were used to evaluate final outcomes. RESULTS The most commonly affected level was L5-S1. All 17 patients showed significant improvements in VAS and ODI scores at 3 and 12 months postoperatively. According to the Macnab criteria, outcome results were excellent in 13 patients and good in 4. The mean duration of follow-up was 18.4 ± 2.4 months, with no recurrences or lumbar instability at the final follow-up. CONCLUSIONS Stand-alone decompression without discectomy is an effective method for relieving symptoms and preserving the disc in contained foraminal disc herniation. A minimally invasive approach with thorough decompression techniques yields good results.
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Zhang B, Xu H, Wang J, Liu B, Sun G. A narrative review of non-operative treatment, especially traditional Chinese medicine therapy, for lumbar intervertebral disc herniation. Biosci Trends 2017; 11:406-417. [DOI: 10.5582/bst.2017.01199] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bo Zhang
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Haidong Xu
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Juntao Wang
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Bin Liu
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Guodong Sun
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
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