Exploring the body surface temperature of the lumbosacral region and relevant back-shu points in patients with lumbar disc herniation induced low back pain based on infrared thermography

OBJECTIVES

To observe the body surface temperature of the lumbosacral region and relevant back-shu points in patients with lumbar disc herniation (LDH) induced low back pain utilizing infrared thermography, and to explore the functional attribute changes of acupoints under pathological conditions.

METHODS

A total of 50 patients with LDH induced low back pain were included as the observation group, and 45 healthy subjects were included as the control group. Using infrared thermography, the body surface temperature of the lumbosacral region and bilateral Sanjiaoshu (BL 22), Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25), Guanyuanshu (BL 26), Xiaochangshu (BL 27), and Pangguangshu (BL 28) was measured in both groups. The temperature difference values between the bilateral lumbosacral regions and back-shu points of the two groups were calculated. Additionally, the body surface temperature of the affected and healthy sides of the lumbosacral region and relevant back-shu points was compared in the observation group.

RESULTS

Compared with the control group, the body surface temperature of the lumbosacral region and the bilateral temperature difference values of the lumbosacral regions were increased in the observation group (P<0.001). The body surface temperature difference values of bilateral Shenshu (BL 23), Qihaishu (BL 24), Dachangshu (BL 25), Guanyuanshu (BL 26) and Xiaochangshu (BL 27) in the observation group were higher than those in the control group (P<0.05, P<0.01, P<0.001). In the observation group, the body surface temperature of the affected side of the lumbosacral region as well as Shenshu (BL 23) and Dachangshu (BL 25) was elevated compared with that of healthy side (P<0.001).

CONCLUSIONS

The patients with LDH induced low back pain have imbalanced and asymmetrical distribution of body surface temperature in the lumbosacral region and related back-shu points, Shenshu (BL 23) and Dachangshu (BL 25) have the relative specificity.

Clinical Outcome for Lumbar Disc Herniation Treatment with Intradiscal Oxygen-ozone Therapy

BACKGROUND

Low back pain due to disc herniation is a common problem causing frequent hospital visits and loss of working days with major socio-economic impact. Conservative treatments like analgesics, physiotherapy do not work in all patients. Surgical treatment has been the mainstay of treatment when indicated but is associated with anesthetic and surgical complications. Intradiscal oxygen-ozone chemonucleolysis is a minimally invasive procedure done under local anesthesia and has promising role in shrinking the bulged disc and reducing nerve root compression and related symptoms. This retrospective study was done to see how intradiscal oxygen-ozone chemonucleolysis reduces pain severity in patients with discogenic low back pain.

METHODS

Retrospective data were retrieved of those patients who underwent fluoroscopy guided intradiscal oxygen-ozone chemonucleolysis with 5-6 ml of an O2-O3 mixture (concentration of 30 microgram/ml) during a period of two years in Nepal pain care and research center. Numerical pain scale (NRS) at various follow ups were compared to preprocedural NRS.

RESULTS

Preprocedural NRS was 8± 13. NRS at three hours, one week, one month, three months and six months were 2± 13 (73 percent reduction), 2± 53 (68 percent reduction), 2± 27 (72 percent reduction), 1± 08 (77 percent reduction) and 1± 67 (79 percent reduction) respectively.

CONCLUSIONS

Intradiscal oxygen-ozone chemonucleolysis can be a useful modality of treatment for discogenic low back pain in patients who fail to respond to conservative management and in whom surgery is not indicated.

Efficacy evaluation of Mongolian medical warm acupuncture for sciatica caused by lumbar disc herniation: a randomized, controlled, single-blind clinical trial

OBJECTIVE

This study aimed to evaluate the short-term and long-term efficacy of Mongolian medical warm acupuncture for sciatica caused by lumbar disc herniation (LDH).

PATIENTS AND METHODS

The patients diagnosed with sciatica caused by LDH were randomly divided into the warm acupuncture of the Mongolian medicine group (n = 42, warm acupuncture treatment), the sham acupuncture group (n = 38, sham acupuncture using blunt-tipped needles) and the conventional drug group (n = 40, ibuprofen sustained release capsule). All patients were treated for 4 weeks and followed up for 8 weeks. The visual analog scale for leg pain (VAS-LP), Mongolian medicine indicators (efficacy indicators), VAS for waist pain (VAS-WP) and the Mos 36-item short form health survey (SF-36) score were analyzed at baseline, after two-week treatment, after four-week treatment, at four-week follow-up and at eight-week follow-up.

RESULTS

Warm acupuncture treatment significantly decreased the VAS-LP and VAS-WP scores of patients at treatment and follow-up (p < 0.05), and pain was improved compared to the conventional drug group and sham acupuncture group. The total effective rate was markedly higher in the warm acupuncture of the Mongolian medicine group compared with the conventional drug group at 8-week follow-up (p < 0.05), but sham acupuncture treatment resulted in no evident improvement in the Mongolian medicine indicators. Additionally, at treatment and follow-up, warm acupuncture of the Mongolian medicine group showed a significant increase in the physical function, physical role, body pain, and emotional and mental health role scores of the SF-36 survey compared with the sham acupuncture groups.

CONCLUSIONS

Mongolian medical warm acupuncture effectively relieves leg and waist pain and improves the total therapeutic effect and the quality of daily life for patients with sciatica caused by LDH, with significant long-term efficacy. Our study provides a basis for warm acupuncture in the treatment of sciatica caused by LDH. Chinese Clinical Trial Registry ID: ChiCTR- INR-15007413.

Warm Acupuncture Reduces Pain and Inflammation in Rats with Lumbar Disc Herniation Induced by Autologous Nucleus Pulposus Transplantation via Regulating p38MAPK/NF-κB Pathway

Background

: Warm acupuncture (WA) has analgesic and anti-inflammatory effects. However, the underlying mechanism of these effects remain unclear.

Objectives

: To explore the analgesic and anti-inflammatory effects of WA and the potential underlying mechanism in male Sprague-Dawley rats with non-compressive lumbar disk herniation (LDH) caused by autologous nucleus pulposus (NP) transplantation.

Methods

: We used low-frequency (2 Hz) electrical stimulation and WA (40℃) to treat GB30 and BL54 acupoints in rats for 30 mins per day. We monitored the paw withdrawal threshold of rats during the experiment and measured serum cytokine levels using commercial kits. Dorsal root ganglion (DRG) tissue pathology was analyzed via H&E staining. We used qRT-PCR to measure the mRNA expression levels of IL-1β, IL-6, and TNF-α genes in DRG. Western blot was used to analyze the expression levels of IL-1β, IL-6, TNFα, P-p38MAPK, p38MAPK, P-IκBα, IκB α, and NF-κB p65 proteins.

Results

: WA treatment significantly increased the pain threshold of rats, reduced serum IL-6, PEG2, NO, SP, NP-Y, and MMP-3 levels, and effected histopathological improvements in the DRG in rats. Moreover, WA treatment significantly downregulated the expression levels of inflammation-associated genes (Il-1β, Il-6, and Tnf-α) and proteins (IL-1β, IL-6, TNF-α, P-p38MAPK, P-IκBα, and NF-κB p65) in the DRG of non-compressive LDH rats.

Conclusion

: WA can alleviate pain and inhibit inflammatory response in rats with non-compressive LDH caused by autologous NP transplantation, and these effects are likely associated with the inhibition of the p38MAPK/NF-κB pathway.

[Injection treatment for cervical and lumbar syndromes : Special infiltration techniques]

Minimally invasive injection treatment is indicated particularly in cases of treatment-resistant, painful degenerative alterations of the cervical and lumbar spine, intervertebral disc displacement and radicular syndrome. Through the injections and the supplementation with further conservative, e.g., physical therapy and activating measures, the vicious circle of neural irritation and muscle tension and sympathetic nerve reactions can be interrupted.

Massage ameliorates lumbar disc herniation-related radicular pain in rats by suppressing TLR4/NLRP3 inflammasome signaling transduction

BACKGROUND

Lumbar disc herniation (LDH) is a common spinal disease that can cause severe radicular pain. Massage, also known as Tuina in Chinese, has been indicated to exert an analgesic effect in patients with LDH. Nonetheless, the mechanism underlying this effect of massage on LDH remains unclarified.

METHODS

Forty Sprague-Dawley rats were randomly divided into four groups. A rat LDH model was established by autologous nucleus pulpous (NP) implantation, followed by treatment with or without massage. A toll-like receptor 4 (TLR4) antagonist TAK-242 was administrated to rats for blocking TLR4. Behavioral tests were conducted to examine rat mechanical and thermal sensitivities. Western blotting was employed for determining TLR4 and NLRP3 inflammasome-associated protein levels in the spinal dorsal horn (SDH). Immunofluorescence staining was implemented for estimating the microglial marker Iba-1 expression in rat SDH tissue.

RESULTS

NP implantation induced mechanical allodynia and thermal hyperalgesia in rat ipsilateral hindpaws and activated TLR4/NLRP3 inflammasome signaling transduction in the ipsilateral SDH. Massage therapy or TAK-242 administration relieved NP implantation-triggered pain behaviors in rats. Massage or TAK-242 hindered microglia activation and blocked TLR4/NLRP3 inflammasome activation in ipsilateral SDH of LDH rats.

CONCLUSION

Massage ameliorates LDH-related radicular pain in rats by suppressing microglia activation and TLR4/NLRP3 inflammasome signaling transduction.

Huoxue Tongluo decoction combined with acupuncture in the treatment of lumbar disc herniation and its effect on JOA and VAS scores

BACKGROUND

Lumbar disc herniation (LDH) is a common clinical disease of the skeletal system, and its prevalence has been on a rise.

OBJECTIVE

To evaluate the efficacy of Huoxue Tongluo decoction plus acupuncture in the treatment of lumbar disc herniation and its effectiveness in improving the functional recovery of the patients' affected joints and mitigating their pain.

METHODS

In this prospective study, 110 patients with lumbar disc herniation enrolled in our Hospital from June 2019 to June 2021 were collected and randomized to receive either conventional treatment (control group) or Huoxue Tongluo Decoction plus acupuncture (study group).

RESULTS

Huoxue Tongluo Decoction plus acupuncture resulted in more rapid mitigation of lower extremity symptoms and lumbar symptoms versus conventional treatment (P< 0.05). Patients receiving traditional Chinese medicine (TCM) showed milder inflammatory responses than those with conventional medication, as evidenced by the lower serum concentrations of tumor necrosis factor-α (TNF-α), interleukin (IL)-6, and high-sensitivity C-reactive protein (hs-CRP) (P< 0.05). After treatment, the study group had higher Japanese Orthopedic Association (JOA) scores and lower visual analogue scale (VAS) scores than the control group (P< 0.05), suggesting that the combination of the herbal decoction and acupuncture provided better functional recovery of the affected joints and pain mitigation for the patients. Furthermore, the lower Pittsburgh sleep quality index (PSQI) scores in patients in the study group indicated better sleep quality of patients after TCM intervention than after conventional treatment (P< 0.05). Huoxue Tongluo Decoction plus acupuncture was associated with a significantly higher efficacy (94.55%) versus conventional treatment (80%) (P< 0.05).

CONCLUSIONS

Huoxue Tongluo Decoction combined with acupuncture significantly offers a viable treatment alternative for lumbar disc herniation with promising treatment outcomes, mitigates patients' limb pain, and improves their lumbar function and sleep quality. Further trials are, however, required prior to general application in clinical practice.

Acupuncture treatment for lumbar disc herniation with scoliosis: A case report

INTRODUCTION

Lumbar disc herniation (LDH) with scoliosis usually refers to lumbar disc herniation caused by scoliosis, which is a postural compensatory deformity to reduce low back and leg pain, mostly with nonstructural changes. Scoliosis may disappear after the treatment of LDH.

PATIENT CONCERNS

At present, this kind of scoliosis is mainly treated with medicine and surgery, but all these methods may have some adverse effects.

DIAGNOSIS

A 24-year-old female patient was admitted to the acupuncture department of our hospital due to unbearable pain caused by LDH.

INTERVENTIONS

According to the patient condition, the acupuncture treatment plan was adopted by Professor Wang Zhanglian, a famous Chinese medicine practitioner.

OUTCOMES

After 12 weeks of acupuncture treatment, the patient low back pain was significantly relieved.

CONCLUSION

This case suggests that acupuncture may be an effective alternative treatment for LDH.

Effect of DiscoGel treatment of the intervertebral disc at MRI

AIM

To determine the impact of ethanol gel chemonucleolysis (EGCh) on the radiological picture of the treated intervertebral disc, the relationship between the initial radiological status and the clinical status of the patient after EGCh treatment, and the optimal radiographic criteria for qualifying a patient for EGCh treatment.

MATERIALS AND METHODS

The study involved a group of 45 patients (25 men and 20 women) aged 23-68 years (46 ± 11) who underwent an EGCh procedure after qualification, radiography, and clinical questionnaire evaluation.

RESULTS

The results showed a decrease in the size of the protrusion and Gadolinium-Enhanced (GI) zone in the treated intervertebral disc. The presence of a high-intensity zone (HIZ) on baseline magnetic resonance imaging was found to be a good predictor of the timing and outcome of treatment, and an increase in disc height was observed in adjacent segments.

CONCLUSION

These findings suggest that EGCh is a promising treatment for spine diseases, and the HIZ on baseline magnetic resonance imaging can be used as a qualification criterion for this procedure.

Effects of spinal manipulation or mobilization as an adjunct to neurodynamic mobilization for lumbar disc herniation with radiculopathy: a randomized clinical trial

OBJECTIVES

To determine the long-term clinical effects of spinal manipulative therapy (SMT) or mobilization (MOB) as an adjunct to neurodynamic mobilization (NM) in the management of individuals with Lumbar Disc Herniation with Radiculopathy (DHR).

DESIGN

Parallel group, single-blind randomized clinical trial.

SETTING

The study was conducted in a governmental tertiary hospital.

PARTICIPANTS

Forty (40) participants diagnosed as having a chronic DHR (≥3 months) were randomly allocated into two groups with 20 participants each in the SMT and MOB groups.

INTERVENTIONS

Participants in the SMT group received high-velocity, low-amplitude manipulation, while those in the MOB group received Mulligans' spinal mobilization with leg movement. Each treatment group also received NM as a co-intervention, administered immediately after the SMT and MOB treatment sessions. Each group received treatment twice a week for 12 weeks.

OUTCOME MEASURES

The following outcomes were measured at baseline, 6, 12, 26, and 52 weeks post-randomization; back pain, leg pain, activity limitation, sciatica bothersomeness, sciatica frequency, functional mobility, quality of life, and global effect. The primary outcomes were pain and activity limitation at 12 weeks post-randomization.

RESULTS

The results indicate that the MOB group improved significantly better than the SMT group in all outcomes (p < 0.05), and at all timelines (6, 12, 26, and 52 weeks post-randomization), except for sensory deficit at 52 weeks, and reflex and motor deficits at 12 and 52 weeks. These improvements were also clinically meaningful for neurodynamic testing and sensory deficits at 12 weeks, back pain intensity at 6 weeks, and for activity limitation, functional mobility, and quality of life outcomes at 6, 12, 26, and 52 weeks of follow-ups. The risk of being improved at 12 weeks post-randomization was 40% lower (RR = 0.6, CI = 0.4 to 0.9, p = 0.007) in the SMT group compared to the MOB group.

CONCLUSION

This study found that individuals with DHR demonstrated better improvements when treated with MOB plus NM than when treated with SMT plus NM. These improvements were also clinically meaningful for activity limitation, functional mobility, and quality of life outcomes at long-term follow-up.

TRIAL REGISTRATION

Pan-African Clinical Trial Registry: PACTR201812840142310.

Estimating surgical probability: Development and validation of a prognostic model for patients with lumbar disc herniation treated with acupuncture

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.

Regenerative effects of platelet-rich plasma releasate injection in rabbit discs degenerated by intradiscal injection of condoliase

BACKGROUND

Intradiscal condoliase injection is an alternative therapeutic option for lumbar disc herniation (LDH). However, it is often associated with disc degeneration. Several in vivo studies have demonstrated the regenerative potential of platelet-rich plasma (PRP) in disc degeneration. Thus, we hypothesized that the intradiscal injection of PRP releasate (PRPr), a soluble releasate isolated from PRP, has the potential to regenerate degenerated intervertebral discs (IVDs) induced by condoliase. This study examined the regenerative effects of PRPr on rabbit IVDs degenerated following condoliase injection.

METHODS

Eleven New Zealand white rabbits were used in this study. Condoliase (12.5 mU/10 μl) was injected into two non-contiguous discs (L2-L3 and L4-L5), and L3-L4 disc was left intact as a non-injection control. Saline (20 μl) or PRPr (20 μl) was randomly injected into L2-L3 and L4-L5 discs 4 weeks after the condoliase injection. Disc height (DH) was radiographically monitored biweekly from the day of condoliase injection to 16 weeks post-injection. Changes in DH were expressed as percentage DH (%DH) normalized to the baseline DH. Sixteen weeks after condoliase injection, all rabbits were euthanized, and subjected to MRI and histological analyses.

RESULTS

Intradiscal injection of condoliase induced a significant decrease in %DH (L2-L3 and L4-L5) to 52.0% at week 4. However, the %DH began to return to normal after saline injection and reached 76.3% at week 16. In the PRPr group, %DH began to recover to normal after the PRPr injection and was restored to 95.5% at week 16. The MRI-modified Pfirrmann grade of the PRPr group was significantly lower than that of the saline group (P < 0.01). Histological analyses showed progressive degenerative changes, including reduction of the NP area and condensation of the matrix in the saline and PRPr groups. The histological score of the PRPr group was significantly lower than that of the saline group (P < 0.01).

CONCLUSIONS

PRPr has great potential to enhance the regeneration of degenerated rabbit IVDs induced by condoliase. The results of this preclinical study suggest that PRPr injection therapy may be indicated for patients with LDH who have poor recovery from disc degeneration after chemonucleolysis treatment with condoliase.

Clinical Efficacy of Acupuncture with Canggui Tanxue Technique on Huantiao Point for Treating Sciatica Caused by Lumbar Disc Herniation

Objective

The present study aimed to assess the clinical efficacy of acupuncture with the Canggui Tanxue Technique on the Huantiao point for treating sciatica caused by lumbar disc herniation.

Methods

This randomized controlled trial evaluated outpatient and inpatient data of patients from the Department of Acupuncture and Encephalopathy at Yancheng City Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, between March 2020 and October 2022. A total of 100 eligible cases were recruited. Patients were randomly assigned using a random number table method at a ratio of 1:1 to receive either routine acupuncture technique on the Huantiao point (control group) or Canggui Tanxue Technique on the Huantiao point (Canggui Tanxue group), with 50 cases in each group. Outcome measures included post-treatment pain and clinical efficacy.

Results

Canggui Tanxue Technique demonstrated significant pain reduction and improved functional restoration compared to the routine technique, as evidenced by significantly lower scores on the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, and Roland-Morris Disability Questionnaire (RDQ) scores (P < .05). Patients receiving acupuncture with Canggui Tanxue Technique exhibited significantly higher clinical efficacy compared to those receiving the routine technique (P < .05).

Conclusion

Acupuncture with Canggui Tanxue Technique on the Huantiao point provides superior pain reduction and functional restoration for patients with sciatica caused by lumbar disc herniation compared to routine techniques. This approach offers high safety, potent efficiency, and better operability.

Effect of Radiofrequency on Dorsal Root Ganglion Versus Transforaminal Steroids Injection on Tumor Necrosis Factor-Alpha Level in Lumbar Radicular Pain

BACKGROUND

The mechanism of pain control with pulsed radiofrequency (PRF) is unclear.

OBJECTIVES

We aimed to compare the efficacy of combined PRF on dorsal root ganglion (DRG) with transforaminal epidural steroid injection (TFESI) vs TFESI-alone on pain improvement and serum tumor necrosis factor-alpha (TNF-a) level in lumbar disc-related radicular pain.

STUDY DESIGN

Prospective, randomized, controlled trial.

SETTING

Neurology and Pain Management clinics.

METHODS

A total of 80 patients with lumbar disc prolapse were divided into 2 groups: combined PRF on DRG with TFESI group and TFESI-alone group. The Numeric Rating Scale (NRS-11), Oswestry Disability Index (ODI), and Functional Rating Index (FRI) before intervention and at 2 weeks, 1 month, and 3 months after the intervention were observed. Serum TNF-a level was assessed pre- and post-intervention at 3 months.

RESULTS

The scores of NRS-11, ODI, and FRI showed a significant improvement at 2 weeks, 1 month, and 3 months following intervention in both combined PRF & TFESI group and TFESI-alone group (P < 0.001 in all comparisons), with no significant difference between the 2 groups. Serum TNF-a levels showed a statistically significant reduction, 3 months following intervention in the combined PRF & TFESI group (P < 0.001), but not in the TFESI-alone group (P = 0.297) (P between groups < 0.001).

LIMITATIONS

The main limitation of this study is that TNF-a level was not assessed earlier to see how long the steroids might reduce TNF-a. On the other hand, further study with extended follow-up periods is needed to confirm the long-term lowering effect of TNF-a provided by PRF.

CONCLUSIONS

Combined PRF on DRG with TFESI showed similar outcomes to TFESI-alone in relieving pain in patients with lumbar disc prolapse. However, PRF on DRG caused a significant decrease in TNF-a serum levels at 3 months.

[Bibliographic review of the efficacy of platelet-rich plasma treatment in lumbar disc herniation]

Platelet-rich plasma (PRP) is an autologous blood product containing growth factors and proteins, widely employed in the clinical setting for tissue repair. Robust evidence in basic science literature has facilitated clinical research involving PRP for patients with disc disease and lumbar pain. Degenerative disc disease (DDD) has been identified as a significant contributor to lower back pain, with approximately 40% of patients under 30 and 90% of those over 50 experiencing lumbar pain showing MRI findings consistent with degenerative changes in intervertebral discs. Regenerative medicine within the disc has primarily been studied in patients with chronic, untreatable lumbar pain. Objective: to understand the available evidence regarding the efficacy of PRP in lumbar disc herniation. By understanding the scientific evidence supporting PRP as a lumbar disc herniation treatment, a research project can be developed, providing the theoretical foundation for implementing this therapy in the Mexican population. A search was conducted using PUBMED, ClinicalKey (Elsevier), Medscape, Science Direct, and Google Scholar databases. Conclusions: despite promising results in several studies on intradiscal PRP injection, small sample sizes and non-standardized graft preparation procedures have hindered these research efforts.

Lever positioning manipulation alters real-time brain activity in patients with lumbar disc herniation: An amplitude of low-frequency fluctuation and regional homogeneity study

INTRODUCTION

Lumbar disk herniation (LDH) is the preeminent disease of lever positioning manipulation (LPM), a complex disorder involving alterations in brain function. Resting-state functional magnetic resonance imaging (rs-fMRI) has the advantages of non-trauma, zero radiation, and high spatial resolution, which has become an effective means to study brain science in contemporary physical therapy. Furthermore, it can better elucidate the response characteristics of the brain region of LPM intervention in LDH. We utilized two data analysis methods, the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) of rs-fMRI, to assess the effects of LPM on real-time brain activity in patients with LDH.

METHODS

Patients with LDH (Group 1, n = 21) and age-, gender- and education-matched healthy controls without LDH (Group 2, n = 21) were prospectively enrolled. Brain fMRI was performed for Group 1 at two-time points (TPs): before LPM (TP1) and after one LPM session (TP2). The healthy controls (Group 2) did not receive LPM and underwent only one fMRI scan. Participants in Group 1 completed clinical questionnaires assessing pain and functional disorders using a Visual Analog Scale and the Japanese Orthopaedic Association (JOA), respectively. Furthermore, we employed MNL90 (Montreal Neurological Institute) as a brain-specific template.

RESULTS

Compared to the healthy controls (Group 2), the patients with LDH (Group 1) had significant variation in ALFF and ReHo values in brain activity. After the LPM session (TP2), Group 1 at TP1 also showed significant variation in ALFF and ReHo values in brain activity. In addition, the latter (TP2 vs TP1) showed more significant changes in brain regions than the former (Group 1 vs Group 2). The ALFF values were increased in the Frontal_Mid_R and decreased in the Precentral_L in Group 1 at TP2 compared with TP1. The Reho values were increased in the Frontal_Mid_R and decreased in the Precentral_L in Group 1 at TP2 compared with TP1. The ALFF values were increased in the Precuneus_R and decreased in the Frontal_Mid_Orb_L in Group 1 compared with Group 2. Only three brain areas with significant activity in Group 1 compared with Group 2: Frontal_Mid_Orb_L, Frontal_Sup_Orb_L, and Frontal_Mid_R. ALFF value in the Frontal_Mid_R at TP2 correlated positively with the change rates of JOA scores between TP1 and TP2 (P = 0.04, r = 0.319, R2 = 0.102).

DISCUSSION

Patients with LDH showed abnormal brain ALFF and ReHo values, which were altered after LPM. The default mode network, prefrontal cortex, and primary somatosensory cortex regions could predict real-time brain activity for sensory and emotional pain management in patients with LDH after LPM.

Randomized single-blinded prospective comparison between ozone therapy and electroacupuncture for canine thoracolumbar disk disease

Ozone therapy has been used to control pain in animals. Moreover, electroacupuncture (EA) has been effective in neurological recovery and pain control in dogs with thoracolumbar discopathy. EA was compared with Ozone applied at acupuncture points in dogs with signs of thoracolumbar disk disease. Chondrodystrophic mongrel dogs, with lesion scores between 1 and 4, were randomly divided into groups: EA (n = 13) - electroacupuncture at BL20, BL23, ST36, KID3 and BL60 and dry needle in lumbar Bai Hui, and OZO (n = 15) - paravertebral application of 3 mL ozone (20 μg / mL) at BL20, BL23, lumbar Bai Hui, ST36, and KID3/BL60, both groups with weekly applications. No significant differences were observed between groups in weekly blind pain assessments using a dynamic interactive visual analog scale, and neurological assessments using a numerical-functional scale. Both groups showed a progressive improvement in pain control and neurological condition, which was observed when comparing the group's EA and OZO in dogs with all lesion scores. The time of return to locomotion (days) of dogs scored 3 and 4, between groups EA (10.6 ± 5.4) and OZO (14.5 ± 15.7), had no significant differences. Ozone therapy was effective to control pain and motor rehabilitation and sensory functions of dogs with thoracolumbar discopathy signs, just as electroacupuncture. Ozone application was a quick and easy-to-handle treatment. Paravertebral and subcutaneous routes did not require anesthesia or other advanced imaging technology, besides being safe and effective.

[Effect of acupotomy intervention on the expressions of proteoglycans in lumbar intervertebral disc of rabbits with lumbar intervertebral disc degeneration]

OBJECTIVE

To observe the effect of acupotomy intervention on the expressions of biglycan(BGN), decorin(DCN) and Caspase-3 in lumbar intervertebral disc of rabbits with lumbar intervertebral disc degeneration (LIDD), so as to explore its possible mechanism in relieving LIDD.

METHODS

Thirty male Japanese white rabbits were randomly divided into normal, model and acupotomy groups, with 10 rabbits in each group. The LIDD model was established by axial compression method, and magnetic resonance imaging (MRI) was used to judge whether the model was successful or not. After modeling, the acupotomy was applied to lumbar (L)4-L5 spinous process space and bilateral transverse processes for loosening, twice a week for 4 weeks. The structural changes of L4-L5 intervertebral disc were observed by MRI. The morphological changes of lumbar spine were observed by HE staining. The expression of Caspase-3 in nucleus pulposus was observed by immunohistochemistry, and the protein expressions of DCN and BGN in intervertebral disc were detected by Western blot, separatively.

RESULTS

After mode-ling, the rabbits showed slow movement, stiff back muscles with cords or nodules, the fibrous ring structure of lumbar intervertebral disc was disordered, the number of nucleus pulposus cells was reduced, and the signal intensity of L4-L5 intervertebral disc was decreased in the model group relevant to the normal group. At the same time, the expression of Caspase-3 in nucleus pulposus was increased significantly (P<0.05), and the expression levels of DCN and BGN in intervertebral disc were decreased significantly (P<0.05). After acupotomy treatment, the modeling induced slow movement, stiff back muscles and disordered structure of lumbar intervertebral disc were significantly improved. The number of nucleus pulposus cells was increased, the signal intensity of L4-L5 intervertebral disc was enhanced, the expression of Caspase-3 in nucleus pulposus was decreased significantly (P<0.05), and the expression levels of DCN and BGN in intervertebral disc were increased significantly (P<0.05) compared with the model group.

CONCLUSION

Acupotomy intervention can inhibit cell apoptosis, reduce the degradation of extracellular matrix in nucleus pulposus of intervertebral disc, and restore the normal force balance and dynamic balance of lumbar spine, which may be one of its mechanisms underlying improving LIDD.

CT-guided Pulsed Radiofrequency Combined with Steroid Injection for Sciatica from Herniated Disk: A Randomized Trial

Background Evidence regarding effective nonsurgical management of sciatica remains limited. Purpose To determine a difference in effectiveness between combined pulsed radiofrequency (PRF) and transforaminal epidural steroid injection (TFESI) treatment versus TFESI alone for sciatic pain due to lumbar disk herniation. Materials and Methods This prospective multicenter double-blind randomized clinical trial was conducted between February 2017 and September 2019 in participants with sciatica due to lumbar disk herniation lasting 12 weeks or longer that was not responsive to conservative treatment. Study participants were randomly assigned to undergo one CT-guided treatment with combined PRF and TFESI (n = 174) or TFESI alone (n = 177). The primary outcome was leg pain severity, as assessed with the numeric rating scale (NRS) (range, 0-10) at weeks 1 and 52 after treatment. Secondary outcomes included Roland-Morris Disability Questionnaire (RMDQ) score (range, 0-24) and Oswestry Disability Index (ODI) score (range, 0-100). Outcomes were analyzed according to the intention-to-treat principle via linear regression. Results Mean age of the 351 participants (223 men) was 55 years ± 16 (SD). At baseline, NRS was 8.1 ± 1.1 in the PRF and TFESI group and 7.9 ± 1.1 in the TFESI group. NRS was 3.2 ± 0.2 in the PRF and TFESI group and 5.4 ± 0.2 in the TFESI group (average treatment effect, 2.3; 95% CI: 1.9, 2.8; P < .001) at week 1 and 1.0 ± 0.2 and 3.9 ± 0.2 (average treatment effect, 3.0; 95% CI: 2.4, 3.5; P < .001), respectively, at week 52. At week 52, the average treatment effect was 11.0 (95% CI: 6.4, 15.6; P < .001) for ODI and 2.9 (95% CI: 1.6, 4.3; P < .001) for RMDQ, favoring the combined PRF and TFSEI group. Adverse events were reported in 6% (10 of 167) of participants in the PRF and TFESI group and in 3% (six of 176) of participants in the TFESI group (eight participants did not complete follow-up questionnaires). No severe adverse events occurred. Conclusion In the treatment of sciatica caused by lumbar disk herniation, pulsed radiofrequency combined with transforaminal epidural steroid injection is more effective for pain relief and disability improvement than steroid injection alone. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Jennings in this issue.

Multiple traditional Chinese medicinal approaches in collaboration with conservative conventional medicine for lumbar herniated intervertebral discs: A systematic review and meta-analysis

BACKGROUND

This review aimed to verify the clinical effects of traditional Chinese medicine in collaboration with conservative conventional medicine for lumbar herniated intervertebral discs (LHIVD).

METHODS

The CENTRAL, EMBASE, MEDLINE/PubMed, JMAS, CNKI, and seven Korean databases were searched using pre-planned strategies. The risk of bias was assessed using the Cochrane Collaboration tool and a meta-analysis was conducted accordingly.

RESULTS

Twenty-eight randomized controlled trials (RCTs) were included in this systematic review and meta-analysis. All RCTs included 2746 participants. The experimental group showed more significant improvements in VAS (Mean differences (MD) -1.61, 95% Confidence Intervals (CI) [-2.44, -0.79]; I2 = 98%), Oswestry Disability Index (ODI) (MD -8.52, 95% CI [-11.71, -5.34]; I2 = 96%), and Japanese Orthopaedic Association (JOA) scores (MD 4.83, 95% CI [3.49, 6.17]; I2 = 85%) than the control group. However, the difference in the incidence of adverse events between the experimental and control groups was not significant (Relative Risk (RR) 0.05, 95% CI [0.23, 1.10]; I2 = 46%).

CONCLUSION

Traditional Chinese medicine in collaboration with conservative conventional medicine can be used to relieve pain and facilitate better function of the lumbar spine in lumbar herniated intervertebral disc cases. However, this conclusion should be applied with caution in clinical practice owing to the low quality of the included studies.

Non-surgical treatment of giant tumor-like lumbar disc herniation based on enhanced MRI: A case series

RATIONALE

In recent clinical follow-up, it has been vertified that resorption in lumbar disc herniation (LDH) could be of great curative effect in non-surgical treatment for LDH. However, reports of resorption in giant tumor-like LDH are rarely mentioned due to its risk of irreversible neurological damage which could be caused by long-term non-surgical treatment. In our clinical observations, we have found that enhanced MRI helps to distinguish LDH from intradural tumours and to predict the probability of resorption in LDH. We analyzed 8 patients with giant tumor-like LDH who underwent non-surgical treatment, and these patients had resorption during follow-up. All patients were examined with enhanced MRI before treatment, and the type of "bull's eye" sign classification was determined by images. The MRI protrusion volume(VP), resorption rate(HR%) and JOA score of patients at the first visit and the last follow-up were recorded.

PATIENT CONCERNS

8 patients of Han ethnicity were admitted to the department of orthopedic complaining of low back pain for 1week to 12months. They were diagnosed with giant tumor-like LDH by enhanced MRI.

DIAGNOSES

These patients were diagnosed with giant tumor-like LDH.

INTERVENTIONS

We adopted a non-surgical treatment plan for the patients, including taking oral non-steroidal anti-inflammatory agents and performing rehabilitation exercise. In consideration of the risk of irreversible neurological damage, patients were closely observed during treatment and follow-up. Once the following conditions occur, surgical treatment is required immediately: The symptoms are not signifcantly relieved after 3 to 6 months of non-surgical treatment; The symptoms are aggravated by non-surgica treatment; The clinical manifestations of cauda equina syndrome.

OUTCOMES

After treated with oral non-steroidal anti-inflammatory agents and rehabilitation exercise, the resorption was accompanied by clinical symptom relief. No neurological damage occurred in all patients, and the clinical symptoms did not recur in the subsequent follow-up.

LESSONS

Clinicians should fully consider the possibility of resorption prior to surgical treatment in patients with giant LDH. We can predict the probability of resorption in patients with giant LDH based on enhanced MRI. For patients with a high probability of resorption, we can choose non-surgical treatment in the absence of progressive neurological impairment and cauda equina syndrome.

The effect of ultrasound-guided acupotomy and Juanbi decoction on lumbar disc herniation: A randomized controlled trial

BACKGROUND

Acupotomy as well as Juanbi decoction has been used in the treatment of lumbar disc herniation. However, there is no study on ultrasound-guided acupotomy combined with Juanbi decoction in the treatment of lumbar disc herniation.

METHOD

This study was supported by the Sichuan Provincial Administration of Traditional Chinese Medicine [grant number: 2020LC0163] and the Science and Technology Department of Sichuan Province [grant number: 2022YFS0418]. This study was 3 center, open, randomized, controlled trial, and was carried out from December 2020 to December 2022. A total of 60 eligible patients with LDH were split into group A and group B at random. The group B received Juanbi Decoction 3 times daily for 2 weeks along with an acupotomy assisted by ultrasound. The acupotomy was administered once a week. The same protocol was used with the group A, but the Juanbi Decoction was replaced with normal saline.

OBSERVATION INDEX

Visual analogue scale (VAS) score on 1 day and 1 week after treatment, VAS score, Japanese orthopedic association low back pain score(JOA) rate, Oswestry Disability Index (ODI), and low back outcome scale (LBOS) at 1, 3, 6, and 12 months after treatment in 2 groups.

RESULTS

There were no significant differences in general information, VAS score before treatment, JOA, ODI, and LBOS between the 2 groups (P > .05). Intra-group comparison: VAS score, JOA rate, ODI, and LBOS were compared before and after treatment in both groups, and the differences were statistically significant (P < .05). There were significant differences in VAS and LBOS between the 2 groups at 3 and 6 months after treatment, and there were statistically significant differences in ODI and JOA rates at 3, 6, and 12 months after treatment between the 2 groups.

CONCLUSION

Acupotomy aided by ultrasound combined with Juanbi Decoction significantly relieves lumbar pain and can improve lumbar function in patients with LDH, and the clinical efficacy lasts for about 6 months.

The effects of Pilates on pain, functionality, quality of life, flexibility and endurance in lumbar disc herniation

Aim: To assess the effects of clinical Pilates exercises (CPE) on the level of pain, functional status, flexibility, static and dynamic endurance of the trunk muscles and quality of life (QoL) in patients with lumbar disc herniation. Materials & methods: Individuals were divided into two groups: the CPE (6 weeks, three-times a week) group (n = 27) and the control group (n = 27). The clinical outcome measures were the visual analog scale for the evaluation of the pain intensity, Oswestry disability index for functional disability, short form-36 for health related QoL, sit and reach and hand finger floor distance test for the flexibility, side-bridge and sit-ups test for the static and dynamic endurance. Results: At the end of the 6 weeks the amount of decrease in the level of pain and Oswestry disability index, amount of increase in sit-reach test and hand-finger-to-floor distance, duration of the lateral bridge and sits-ups test and most of the short form-36 sub parameters was significantly higher (p < 0.05) in the CPE group. Conclusion: CPE was an effective and safe method for symptomatic patients with lumbar disc herniation in reducing the pain level and functional disability and improving flexibility, static and dynamic endurance and partially their QoL. Clinical Trial Registration: NCT03198273 (ClinicalTrials.gov).

Thunder-fire moxibustion for lumbar disc herniation: A systematic review and meta-analysis

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.

Use self-gravitation traction to treat lumbar disc herniation: Study protocol for a double-center, single-blind randomized controlled trial

BACKGROUND

Self-gravitation traction is 1 of the most popular treatments for lumbar disc herniation (LDH). This study aims to evaluate the effectiveness and safety of the self-gravitation traction device in the treatment of LDH and to confirm its positive treatment effect.

METHODOLOGY

This trial is designed as a pragmatic double-center, single-blind, and 3-arm (1:1:1 ratio) randomized controlled trial. The recruited patients with LDH will be randomly allocated to the intervention (traction weight is 40% or 60% of its body weight) or control (traction weight is 20% of its body weight) group. Traction will be completed within 6 consecutive weeks (3 times a week), with 10 minutes of traction for the first 3 weeks, 20 minutes of traction for the next 3 weeks. After the experiment is completed, we will establish an experiment-related database. The software of SPSS, version 21 (SPSS Inc. Chicago, IL) will be used for statistical analysis, and measurement data will be expressed via mean and standard deviation (mean ± SD).

DISCUSSION

Once the trial is completed, we will publish the study in journals in both Chinese and English to promote the dissemination and use of the results. In addition, we also plan to promote the research results at various academic conferences both domestically and internationally.

[Study on diagnosis and treatment of lumbar disc herniation and related factors based on dynamic electromyography]

OBJECTIVE

To analyze dynamic electromyography characteristics and related factors of lumbar back muscle activity in patients with lumbar disc herniation, and to clarify the clinical significance of dynamic electromyography in the diagnosis and treatment of patients with lumbar disc herniation(LDH).

METHODS

From September 2014 to March 2021, 40 patients with lumbar disc herniation(LDH group) were detected by surface electromyography telemeter. There were 14 males and 26 females, aged from 20 to 61 years old, with an average of(40.68±10.56) years old, the course of illness was from 1 to 120 months, with an average of (17.75±27.56) months. In addition, 12 normal people were recruited as the control group. There were 2 males and 10 females. The age ranged from 24 to 53 years old, with an average of(36.50±10.30) years old. All subjects were subjected to dynamic electromyographic tests of the subthoracic erector spinae, lumbar erector spinae, and multifidus muscles during static standing and trunk flexion and extension. Compare the EMG activity data (average EMG amplitude, median frequency, original EMG graph) of the tested muscles between patients with lumbar disc herniation and normal people, and analyze the correlation between the general data of patients with lumbar disc herniation and the tested muscle EMG data.

RESULTS

When standing still, the average electromyographic amplitude of the erector spinal muscle of the right and left thoracic segments of the subjects in the LDH group increased compared with the control group, and the difference was significant(P<0.05). In the trunk flexion and extension, the average electromyographic amplitude of the right and left proximal thoracic erector spinae, the right left lumbar erector spinae, and the right left multifidus muscle of the subjects in the LDH group are all larger than the control group, and the difference was significant(P<0.05). In the trunk flexion and extension, the median frequencies of the right left proximal thoracic erector spinae、the right left lumbar erector spinae, and the right left multifidus muscle of the subjects in the LDH group were all larger than the normal control group, and the difference was significant (P<0.05). During trunk flexion and extension, the original electromyographic patterns of subjects in the LDH group were significantly different from those in the control group. During the maintenance of the maximum trunk flexion of the subjects in the LDH group, there was a high level of electromyographic activity of the lower back muscles, and the electromyographic static signals that should appear regularly in the original signal could not be distinguished. When the trunk was flexed and extended, had gender, age, weight and height of subjects in the LDH group were not significantly correlated with the average EMG amplitude and median frequency of bilateral proximal thoracic, lumbar erector spinae and bilateral multifidus muscles respectively(P>0.05).

CONCLUSION

Patients with lumbar disc herniation have characteristic surface EMG changes in the back muscles that are different from those of normal people. These features can more objectively reflect the patient's muscle condition and can be an effective indicator for the diagnosis and treatment effect evaluation of patients with lumbar disc herniation. It can be seen that surface electromyography is not only a detection method, it can be considered in the routine diagnosis and treatment plan of LDH to guide clinical work.

[Effect of administration of acupuncture stimulation combined with Gushen Zhuyu Decoction on lumbar function in patients with disc herniation]

OBJECTIVE

To investigate the therapeutic effect of acupuncture stimulation combined with administration of"Gushen Zhuyu Tang"(decoction for consolidating kidney to eliminate blood stasis, DCKEBS) in the treatment of lumbar disc herniation (LDH) patients.

METHODS

A total of 147 patients with LDH were randomly divided into DCKEBS, acupuncture and DCKEBS+acupuncture groups (n= 49 cases in each group). The patients of the acupuncture group received a) acupuncture stimulation of Dazhui (GV14), Ganshu (BL18), Shenshu (BL23), Tianshu (ST25), Yanglingquan (GB34), etc., b) fire needle pricking of the topical tendons, cord-like points, tender-points, c) row-needles stimulation of the attachment sites of muscles of the sacroiliac joint or crista iliaca, and d) acupotomy-debonding of the topical high-tension muscles, twice a week for 4 weeks. Those patients of the DCKEBS group were ordered to take DCKEBS [containing fried Yiyiren (Semen Coicis), Shanzhuyu (Fructus Corni), fried Baizhu (Rhizoma Astractylodis), Sangjisheng (Ramulus Loranthi), Duzhong (Cortex Eucommiae), Buguzhi (Fructus Psoraieae), etc.] 150 mL, twice daily, continuously for 4 weeks, and those of the DCKEBS+acupuncture group received the combined treatment mentioned above in the acupuncture and DCKEBS groups. The pain severity was assessed by using visual ana-logue scale (VAS, 0-10 points) and the modified Japan Orthopaedic Association questionnaire (M-JOA) score (0-30 points), separately, and the lumbar range of motion (ROM) and lumbar muscle strength were tested to evaluate the lumbar motor function. The levels of serum tumor necrosis factor α(TNF-α), matrix metalloproteinase-2 (MMP-2), and apoptosis related factors Caspase-3 and Caspase-9 were assayed using ELISA. The total effective rates of the three groups were compared.

RESULTS

After the treatment, the VAS and M-JOA scores, contents of serum TNF-α, MMP-2, Caspase-3 and Caspase-9 were significantly decreased (P<0.01), and the myodynamia of lumbar muscular flexor and extensor was considerably increased (P<0.01) in the three groups, and the ROM angles of lumbar extending and buckling were increased (P<0.01) in the DCKEBS+acupuncture group compared with pretreatment. Comparison among the 3 groups showed that the VAS and M-JOA scores, and serum TNF-α, MMP-2, Caspase-3 and Caspase-9 contents of the DCKEBS+acupuncture group were significantly lower than those of both DCKEBS and acupuncture groups (P<0.01), while the ROM angles of lumbar extending and buckling, and the myodynamia of lumbar muscular flexor and extensor were obviously higher in the DCKEBS+acupuncture group than those of the DCKEBS and acupuncture groups (P<0.01). The total effective rate was 93.88%(46/49) in the DCKEBS+acupuncture group, higher than 75.51%(37/49) in the DCKEBS group and 71.43%(35/49) in the acupuncture group (P<0.05).

CONCLUSION

Acupuncture combined with DCKEBS can relieve pain, improve lumbar muscle strength and lumbar movement function, and reduce serum TNF-α, MMP-2, Caspase-3 and Caspase-9 levels in LDH patients.

Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain

PURPOSE

This study aimed to assess clinical outcomes following intradiscal injections of higher-concentration (> 10 ×) platelet-rich plasma (PRP) in patients with chronic lumbar discogenic pain and to compare outcomes with a historical cohort.

METHODS

This retrospective study included 37 patients who received intradiscal injections of higher-concentration (> 10 ×) PRP and had post-procedure outcomes data (visual numerical scale pain score, Functional Rating Index [FRI], and NASS Patient Satisfaction Index). Outcomes were compared to a historical cohort of 29 patients who received intradiscal injections of < 5X PRP.

RESULTS

Pain and FRI scores significantly improved by 3.4 ± 2.5 and 46.4 ± 27.6, respectively, at 18.3 ± 13.3 months following intradiscal injections of > 10 × PRP (p < 0.001). These improvements were greater than those reported by the historical cohort (1.7 ± 1.6 and 33.7 ± 12.3; p = 0.004 and 0.016, respectively). Additionally, the satisfaction rate was higher in patients receiving > 10 × PRP compared to those receiving < 5 × PRP (81% vs. 55%; p = 0.032).

CONCLUSIONS

Findings from this study suggest that clinical outcomes can be optimized by using PRP preparations that contain a higher concentration of platelets. Further research is needed to continue to optimize the composition of PRP used to treat patients with lumbar disc disease.

COVID-19 and low back pain: previous infections lengthen recovery time after intradiscal ozone therapy in patients with herniated lumbar disc

Purpose

To assess and compare the clinical effectiveness of percutaneous intradiscal ozone therapy in patients affected by lumbar disc herniation, with and without history of COVID-19 infection.

Materials and Methods

After the rising of COVID-19 pandemics in Italy, 47 consecutive percutaneous intradiscal ozone therapies were performed on patients with low back pain and/or sciatic pain due to lumbar disc herniation. Among these, 19 had suffered from COVID-19 and successively recovered with no residual symptoms, while the remaining 28 had not previously been affected by COVID-19 and were not convalescent. Oswestry Disability Index (ODI) was administered before the treatment and at 1-month and 3-month follow-up in order to assess the clinical outcome.

Results

The two groups were similar in terms of patient age (p-value 0.54), treated levels (p-value 0.26) and pre-procedure ODI (p-value 0.33). Technical success was achieved in all cases. In patients previously affected by COVID-19, mean ODI decrease was 11.58 ± 9.51 (35.72%) at 1-month follow-up and 20.63 ± 9.87 (63.63%) at 3-month follow-up. In patients never affected by COVID-19, mean ODI decrease was 20.93 ± 10.53 (58.73%) at 1-month follow-up and 22.07 ± 11.36 (61.92%) at 3-month follow-up. Eventually, clinical success was registered in 84.21% (16/19) of patients with history of COVID-19 infection and in 85.71% (24/28) of patients with no history of COVID-19 infection. No major complication was registered.

Conclusions

In case of lumbar disc herniation treated with percutaneous intradiscal ozone therapy, patients previously affected by COVID-19 showed a significantly longer recovery time.

[Guideline for diagnosis, treatment and rehabilitation of lumbar disc herniation]

Recent years,the incidence of lumbar disc herniation is increasing annually,trending to younger age.There is a lack of clinical guideline for the management of lumbar disc herniation.Considering various problems in the management of lumbar disc herniation under different occasions,based on a systematic literature review,Basic Research and Transformation Society,Professional Committee of Spine and Spinal Cord organized experts to make this consensus jointly.This guideline aims to provide a standardized management of lumbar disc herniation with scientific principle and practical feasibility.Evidence-based medicine,and scientific suggestions are put forward specially for the management of lumbar disc herniation to standardize the diagnosis and treatment,promote the prognosis as well as improve the quality of life of patients.

Effects of Acupuncture and Moxibustion Combined with Needle-Knife on Pain and Lumbar Function in Patients with Lumbar Disc Herniation

This study aimed for the analysis of the effect of acupuncture and moxibustion combined with needle-knife on pain and lumbar function in patients with lumbar disc herniation. From June 2019 to February 2021, the medical records of 126 patients with lumbar disc herniation admitted to the department of orthopedics of our hospital were selected and divided into the control group (n = 63) treated with acupuncture and moxibustion and the observation group (n = 63) treated with acupuncture and moxibustion combined with needle-knife according to different treatment regimens. After 4 weeks of treatment, the clinical efficacy, pain status, and lumbar function were compared between the two groups. The concentrations of relevant inflammatory factors (IL-6, IL-10, TNF-α, and MMP-2) in peripheral blood of the two patients before and after treatment were measured by enzyme-linked immunosorbent assay (ELISA). After treatment, the overall response rate was 93.65% in the observation group, which was higher than 80.95% in the control group (P < 0.05); the visual blurred score (VAS) scores of lower limbs and waist in the observation group were lower than those in the control group, while the expression of pain mediators serotonin (5-HT) and prostaglandin E2 (PEG2) was also lower than that in the control group (P < 0.05); the Oswestry disability index (ODI) in the observation group was lower than that in the control group, while the Japanese Orthopedic Association assessment treatment score (JOA) was higher than that in the control group (P < 0.05). After treatment, the concentration levels in peripheral blood (IL-6, IL-10, TNF-α, and MMP-2) were significantly lower in the observation group than in the control group (P < 0.05). Acupuncture and moxibustion combined with needle-knife is effective in the treatment of lumbar disc herniation, which helps to improve the clinical efficacy, relieve pain symptoms, promote the improvement of lumbar function, and contribute to the reduction of inflammatory factors.

Microdiscectomy Is More Cost-effective Than a 6-Month Nonsurgical Care Regimen for Chronic Radiculopathy

BACKGROUND

A recent randomized controlled trial (RCT), performed by the authors, comparing early surgical microdiscectomy with 6 months of nonoperative care for chronic lumbar radiculopathy showed that early surgery resulted in improved outcomes. However, estimates of the incremental cost-utility ratio (ICUR), which is often expressed as the cost of gaining one quality-adjusted life year (QALY), of microdiscectomy versus nonsurgical management have varied. Radiculopathy lasting more than 4 months is less likely to improve without surgical intervention and may have a more favorable ICUR than previously reported for acute radiculopathy.

QUESTION/PURPOSE

In the setting of chronic radiculopathy caused by lumbar disc herniation, defined as symptoms and/or signs of 4 to 12 months duration, is surgical management more cost-effective than 6 months of nonoperative care from the third-party payer perspective based on a willingness to pay of less than CAD 50,000/QALY?

METHODS

A decision analysis model served as the vehicle for the cost-utility analysis. A decision tree was parameterized using data from our single-center RCT that was augmented with institutional microcost data from the Ontario Case Costing Initiative. Bottom-up case costing methodology generates more accurate cost estimates, although institutional costs are known to vary. There were no major surgical cost drivers such as implants or bone graft substitutes, and therefore, the jurisdictional variance would be minimal for tertiary care centers. QALYs derived from the EuroQoL-5D were the health outcome and were derived exclusively from the RCT data, given the paucity of studies evaluating the surgical treatment of lumbar radiculopathy lasting 4 to 12 months. Cost-effectiveness was assessed using the ICUR and a threshold of willingness to pay CAD 50,000 (USD 41,220) per QALY in the base case. Sensitivity analyses were performed to account for the uncertainties within the estimate of cost utility, using both a probabilistic sensitivity analysis and two one-way sensitivity analyses with varying crossover rates after the 6-month nonsurgical treatment had concluded.

RESULTS

Early surgical treatment of patients with chronic lumbar radiculopathy (defined as symptoms of 4 to 12 months duration) was cost-effective, in that the cost of one QALY was lower than the CAD 50,000 threshold (note: the purchasing power parity conversion factor between the Canadian dollar (CAD) and the US dollar (USD) for 2019 was 1 USD = 1.213 CAD; therefore, our threshold was USD 41,220). Patients in the early surgical treatment group had higher expected costs (CAD 4118 [95% CI 3429 to 4867]) than those with nonsurgical treatment (CAD 2377 [95% CI 1622 to 3518]), but they had better expected health outcomes (1.48 QALYs [95% CI 1.39 to 1.57] versus 1.30 [95% CI 1.22 to 1.37]). The ICUR was CAD 5822 per QALY gained (95% CI 3029 to 30,461). The 2-year probabilistic sensitivity analysis demonstrated that the likelihood that early surgical treatment was cost-effective was 0.99 at the willingness-to-pay threshold, as did the one-way sensitivity analyses.

CONCLUSION

Early surgery is cost-effective compared with nonoperative care in patients who have had chronic sciatica for 4 to 12 months. Decision-makers should ensure adequate funding to allow timely access to surgical care given that it is highly likely that early surgical intervention is potentially cost-effective in single-payer systems. Future work should focus on both the clinical effectiveness of the treatment of chronic radiculopathy and the costs of these treatments from a societal perspective to account for occupational absences and lost patient productivity. Parallel cost-utility analyses are critical so that appropriate decisions about resource allocation can be made.

LEVEL OF EVIDENCE

Level III, economic and decision analysis.

Therapeutic effect of intradiscal pulsed radiofrequency on internal disc disruption: A case report

RATIONALE

Discogenic low back pain often persists despite medication and medical intervention. In this study, intradiscal pulsed radiofrequency (PRF) was performed in a patient with discogenic low back pain who did not respond to oral medication, posterior medial branch block, epidural steroid injection, and percutaneous epidural adhesiolysis.

PATIENT CONCERNS

A 28-year-old woman visited a pain clinic complaining of low back pain that was scored 8 out of 10 on a numerical rating scale. Her pain was present in any position throughout the day and worsened in the sitting position.

DIAGNOSES

Magnetic resonance imaging showed L5-S1 internal discal disruption. Based on the medical history, physical examination, and magnetic resonance imaging, we determined that her pain originated from the L5-S1 disc.

INTERVENTIONS

We performed an intradiscal PRF on the affected disc under C-arm fluoroscopy guidance. PRF was performed at 5 Hz, 20-ms pulse width, and 70 V for 15 minutes while ensuring that the electrode tip temperature was maintained below 42°C.

OUTCOMES

Immediately after the procedure, the patient's pain subsided. At the 1-month follow-up visit, the patient reported complete relief of her low back pain. The Oswestry disability index, which indicates the degree of disability, improved significantly. She also reported that she could sit for long periods because the pain was reduced. No adverse effects from the procedure were found.

LESSONS

Applying intradiscal PRF seems an effective and safe technique for treating discogenic low back pain.

Efficacy and safety of Daoyin and massage for lumbar disc herniation: A protocol for overview of systematic reviews

BACKGROUND

Lumbar disc herniation (LDH) is a common disease, which can cause low back pain, sciatica, and even disability. The treatment of LDH is a global challenge. Conservative therapy with non-drugs is considered to be the first choice for patients with LDH. In recent years, an increasing number of systematic reviews and meta analyses on Daoyin and massage interventions in lumbar disc herniation have been implemented. However, the evidence quality and methodological quality of these systematic reviews/meta analyses are unknown and need to be systematically evaluated. This overview aims to systematically summarize and critically appraise the current evidence on Daoyin and massage for LDH.

METHODS

Eight electronic data will be retrieved, including China National Knowledge Infrastructure (CNKI), Wanfang database (WF), China Biomedical database (CBM), Chinese Scientific Journals Database (VIP), PubMed, Cochrane Library, Web of Science (WOS), and EMBASE from their inception to March 1, 2022. The reporting quality, methodological quality, risk of bias, quality of evidence will be assessed by using The Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 (PRISMA 2020), the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Review (ROBIS), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Two independent researchers conducted literature screening, data extraction, and quality evaluation process. In addition, we will establish an overlap matrix and calculate the corrected covered area to evaluate the impact of overlapping areas on conclusions.

RESULTS

The results will be published in a peer-reviewed journal.

CONCLUSION

This overview will provide comprehensive evidence of Daoyin and massage for treating lumbar disc herniation.

SYSTEMATIC REVIEW REGISTRATION

INPLASY202210019.

INTERVENTIONAL COMBINED RADIOFREQUENCY METHOD IN THE TREATMENT OF CHRONIC LUMBOSACRAL RADICULAR PAIN ASSOCIATED WITH MODERATE DISC HERNIATION

Intervertebral disc degeneration often is a cause of low back pain (LBP) and radicular pain even without severe compression of the nerve root by hernial material. Thermodiscoplasty, or intradiscal electrothermal therapy (IDET) is used for minimally invasive treatment of discogenic pain. Pulsed radiofrequency (PRF) of the dorsal root ganglion (DRG) is used as an interventional method for radicular pain elimination. For the first time we have proposed the simultaneous combined use of these techniques. Our research's aim - to study the dynamics of pain syndrome and disability in patients undergone simultaneous combined treatment with the IDET and PRF DRG for pain associated with moderate disc herniation without spinal root severe compression, which confirmed motor and sensitive deficit absence. A retrospective analysis of 22 patients treated at the Neurospine clinic (Kyiv) from 2019 to 2020 was carried out. All patients had degenerative-dystrophic disease of the intervertebral discs L4-L5 and L5-S1 with therapeutically resistant radicular pain. The standard examination included two-plane spondylography and magnetic resonance imaging, as well as an assessment of neurological status. The discogenic origin of pain is confirmed by provocative contrasting discography. The interest of the corresponding spinal root was confirmed by performing selective radicular blockade.The treatment results were assessed using the Numerical rating scale (NRS) and the Oswestry disability index (ODI); statistical processing was carried out using Microsoft Excel and Statistica-10 program tools. There were no complications detected. All patients noted a significant reduction in pain and decrease of disability: VAS (Me) before treatment = 7.77±1.02, ODI (Ме) before treatment = 70.45±7.85; VAS (Me) immediately after surgery = 2.18±1.13. This trend persisted for six months: VAS (Me) 6 months after surgery = 2.0±0.75, ODI (Me) 6 months after surgery = 30.45±9.98. The simultaneous combined use of IDET and PRF DRG is an effective and safe treatment for therapeutically resistant chronic lumbosacral radicular pain associated with moderate disc herniation.

Nonsurgical spinal decompression system traction combined with electroacupuncture in the treatment of multi-segmental cervical disc herniation: A case report

RATIONALE

With the spread of computers and mobile phones, cervical spondylosis has become a common occupational disease in clinics, which seriously affects the quality of life of patients. We used a nonsurgical spinal decompression system (SDS) combined with physical therapy electroacupuncture (EA) to treat a case of mixed cervical spondylosis caused by multi-level cervical disc herniation, and we achieved satisfactory results.

PATIENT CONCERNS

A 44-year-old Caucasian Asian woman presented with neck pain and numbness on the left side of the limb. MRI showed the patient's C3-C7 segment cervical disc herniation, and the flexion arch of the cervical spine was reversed.

DIAGNOSIS

The patient was diagnosed with a mixed cervical spondylosis.

INTERVENTIONS

The patient received a month of physical therapy (SDS traction combined with EA).

OUTCOMES

Before and after treatment: VAS score of neck pain decreased from 8 to 0; Cervical spine mobility returned to normal; The grip strength of left hand increased from 7.5 kg to 19.2 kg; Cervical curvature index changed from -16.04% to -3.50%; the physiological curvature of the cervical spine was significantly restored. There was no dizziness or neck discomfort at 6 month and 1 year follow-up.

LESSONS SUBSETIONS

SDS traction combined with EA is effective for the treatment of cervical disc herniation and can help restore and rebuild the biomechanical balance of the cervical spine.

[Different entry points of needle knife for lumbar disc herniation: a randomized controlled trial]

OBJECTIVE

To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH).

METHODS

A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed.

RESULTS

Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group.

CONCLUSION

The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.

Team Approach: Management of an Acute L4-L5 Disc Herniation

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Lumbar disc herniation is one of the most common spinal pathologies, often occurring at the L4-L5 and L5-S1 levels. The highest incidence has been reported in patients between the fourth and sixth decades of life.

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The severity of symptoms is influenced by the patient's risk factors, the location, and the extent and type of disc herniation.

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Lumbar disc herniation can be effectively treated with multiple treatment protocols. In most cases, first-line treatment includes oral analgesic medication, activity modification, and physical therapy. When nonoperative treatments do not provide adequate relief, patients may elect to undergo a fluoroscopically guided contrast-enhanced epidural steroid injection. A subgroup of patients whose condition is refractory to any type of nonoperative modalities will proceed to surgery, most commonly an open or minimally invasive discectomy.

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The treatment algorithm for symptomatic lumbar disc herniation often is a stepwise approach: failure of initial nonoperative measures leads to more aggressive treatment when symptoms mandate and, as such, necessitates the use of a multidisciplinary team approach. The core team should consist of an interventional physiatrist, an orthopaedic surgeon, a physician assistant, and a physical therapist. Additional team members may include nurses, radiologists, neurologists, anesthesiologists, spine fellows, psychologists, and case managers.

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This review article describes a case scenario that uses a multidisciplinary team approach for the treatment of an acute L4-L5 disc herniation in a 31-year-old patient without any major comorbidities.

Integrative traditional Chinese medicine for lumbar disc herniation after surgery: A protocol for systematic review and meta-analysis

BACKGROUND

Patients with lumbar disc herniation, who undergo spine surgery, occasionally complain of pain and functional disability. Fortunately, the concept of enhanced recovery after surgery has emerged recently. As a result, patients seek traditional Chinese medicine after spine surgery. This systematic review will thoroughly analyze and synthesize evidence on integrative traditional Chinese medicine therapy for lumbar disc herniation after surgery.

METHODS

The following databases will be utilized to search for pertinent studies: the Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, EMBASE, Chinese National Knowledge Infrastructure, Japan Medical Abstracts Society, and 7 Korean databases (the Korean Studies Information Service System, Korean Association of Medical Journal Editors, National Digital Science Library, Database Periodical Information Academic Korean Traditional Knowledge Portal, Oriental Medicine Advanced Searching Integrated System, and Korean National Assembly Digital Library). The risk of bias of the selected studies will be assessed according to the Cochrane assessment tool for risk of bias. For articles that used the same measurements, a meta-analysis will be conducted to synthesize the results of each trial. Pain severity will be the primary outcome, while the results of functional questionnaires and range of motion, etc, will be the secondary outcomes.

RESULTS AND CONCLUSION

Since this protocol does not include any data from patients, ethics approval is not required. The results of this review will be disseminated through a peer-reviewed journal.

REGISTRATION NUMBER

DOI 10.17605/OSF.IO/KP47A (https://osf.io/kp47a).

Establishing a critical pathway for Korean medical management of lumbar disc herniation: A modified Delphi consensus process

A modified Delphi method was used to establish a consensus. Stakeholders and experts were invited to participate in the expert panel. Best practice statements and decision-making questionnaires were distributed to the panel. Panel members were asked to mark "Strongly disagree" to "Strongly agree" after a series of statements over several rounds until either a consensus was reached or the decision-making method was deemed unsuitable for reaching a consensus.The most common cause of lumbar pain is intervertebral degeneration, which leads to degenerative disc disease and lumbar disc herniation. There is a lack of unanimity regarding appropriate patient protocols and rehabilitation expectations for Korean medical care. The long-term viability of Korean medical treatment, further adoption in the institutional setting, and specific patient outcomes are contingent on the existence of appropriate Korean medical programs.A Korean medical expert panel of 17 practitioners employed a modified Delphi method to achieve consensus on Korean medical care for lumbar disc herniation. The panel first reviewed the literature and guidelines relevant to Korean medical treatment for lumbar disc herniation. The panel members considered questionnaires intended to determine "standardized" Korean medical care recommendations for patients with a wide range of symptoms of lumbar disc herniation. Each panel member participated in a round of voting, which was followed by an opinion-collecting session online. Consensus was defined as a ≥75% agreement among the respondents.In the first round, 144 questionnaires across 5 domains were administered to the expert panels. After reviewing the responses and open-ended comments collected in the first round, the authors modified the questionnaires to 53 items and proceeded. In round 2, consensus was achieved in all 53 survey questions. The final treatment pathway comprised a standardized and comprehensive care approach for lumbar disc herniations in 4 types of medical institutions.This study identified a core set of evidence- and consensus-based principles that are essential to a comprehensive model of care, incorporating identification, referral, and management of patients with lumbar disc herniation.

Conservative Treatment for Giant Lumbar Disc Herniation: Clinical Study in 409 Cases

BACKGROUND

There have been several recent reports of lumbar disc herniation (LDH) resorption; however, large sample studies are lacking, and the mechanism(s) underlying this phenomenon is unclear.

OBJECTIVES

To explore the feasibility and clinical outcomes of conservative treatment for giant LDH and to analyze the factors affecting the resorption of giant LDH.

STUDY DESIGN

Observational study and original research.

SETTING

This work was performed at a University Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine.

METHODS

From January 2008 to December 2019, 409 patients with giant LDH who initially underwent nonsurgical treatment in our hospital were followed for 1-12 years to analyze the rate of surgical intervention, calculate the rate of resorption of protrusions, and the rate of excellent clinical outcomes.

RESULTS

Eighty-nine of the 409 patients (21.76%) underwent surgery, while the remaining 320 patients (78.24%) constituted the non-surgical treatment group. The Japanese Orthopaedic Association (JOA) score in the 320 patients changed from 10.22 ± 3.84 points to 24.88 ± 5.69 points after treatment, and the rate of excellent outcomes was 84.06%. Among the 320 patients in the non-surgical treatment group, the protrusion percentage decreased from 70.08±30.95% to 31.67 ± 24.42%. One-hundred and eighty-nine patients (59.06%) had > 30% resorption of protrusions, and 81 patients (25.31%) had a significant resorption of protrusions of > 50%. Among 189 patients with resorption, the shortest resorption interval was 1 month, and the longest was 8 years, with 77 patients (40.74%) showing resorption within 6 months, 51 (26.98%) within 6-12 months, and 61 patients (32.28%) after 12 months.

LIMITATION

The main limitations are that all patients were from the same site, and there was a lack of multicenter randomized controlled trials with which to compare data.

CONCLUSIONS

Patients with giant LDH are less likely to develop progressive nerve injury and cauda equina syndrome if their clinical symptoms improve after treatment. As long as there is no progressive nerve injury or cauda equina syndrome, conservative treatment is preferred for giant disc herniation. Resorption is more likely with greater disc protrusions in the spinal canal. A ring enhancement bull's eye sign) around a protruding disc on enhanced magnetic resonance imaging is an important indicator of straightforward resorption.

Axial Low Back Pain in Elite Athletes

Back pain in sport is a common complaint and seen by athletes, trainers, and treating physicians. Although there are a multitude of pain generators, mechanical sources are most common. Certain sports can lead to increased mechanical and axial loading, such as competitive weightlifting and football. Common mechanical causes of pain include disk herniation and spondylolysis. Patients typically respond to early identification and conservative treatment. In others, surgical intervention is required to provide stability and prevent long-term sequelae.