Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of lumbar disc herniation, third edition - secondary publication

Author(s):  
Hirotaka Haro ◽  
Shigeto Ebata ◽  
Gen Inoue ◽  
Takashi Kaito ◽  
Hiromichi Komori ◽  
...  
2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Wenjin Jiang ◽  
Bolin Sun ◽  
Qirui Sheng ◽  
Xuepeng Song ◽  
Yanbo Zheng ◽  
...  

Objective. This study was aimed at evaluating the effectiveness and safety of percutaneous lateral lumbar discectomy (PLLD) in treating patients with lumber disc herniation.Methods. A total of 183 patients with lumbar disc herniation were recruited to receive PLLD surgery from April 2006 to October 2011. All the adverse effects were recorded during the follow-up at 1, 3, 6, and 12 months after PLLD. The clinical outcomes were determined by visual analog scale and Japanese Orthopaedic Association score.Results. The surgery was performed successfully in all patients (102 males and 81 females aged from 21 to 66 years) with a mean 16.6-month follow-up (range from 26 to 65 months). No postoperative complications, including intestinal and vascular complications, nerve injuries, and postoperative infections, were associated with PLLD. At one month after surgery, visual analog scale (3.12±1.44versus6.76±2.31,P<0.05) was significantly lower than the baseline and was sustained until 24 months after surgery (3.25±1.78versus6.76±2.31,P<0.05). Besides that, Japanese Orthopaedic Association score (25.25±3.21versus11.78±2.38,P<0.05) was increased when compared to the baseline.Conclusions. PLLD was a promising, mini-invasive, and effective treatment for lumber disc herniation.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yong Yu ◽  
Ye Jiang ◽  
Fuling Xu ◽  
Yuhang Mao ◽  
Lutao Yuan ◽  
...  

Abstract Background Percutaneous endoscopic lumbar discectomy (PELD) has become popular for the treatment of symptomatic lumbar disc herniation (LDH). The very highly up-migrated lumbar disc herniation (VHUM-LDH) is difficult to remove under PELD. The purpose of this research is to investigate the feasibility, clinical efficacy and operative nuances of a novel VTT involving TELF for this type of herniation. Methods Eleven patients with very highly up-migrated LDH who underwent VTT involving TELF discectomy from May 2016 to May 2019 were included in this study. The operative time, length of hospital stay, and postoperative complications were recorded. Pre-and postoperative radiologic findings were investigated. All the patients were followed more than 1 year. The visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores and modified MacNab criteria were used to assess surgical efficacy. Results All the 11 patients underwent successful surgery. We compared the VAS, ODI, and JOA scores before and after surgery. The differences were statistically significant (P < 0.05). According to the modified MacNab criteria, 10 patients were assessed as “excellent”, 1 patient was assessed as “good” at the last follow up. Conclusion The novel VTT involving TELF discectomy is a supplement to the traditional PELD. This technique enables the endoscope with working cannula to get closer the sequestrated nucleus pulposus without irritating the exiting nerve root, and facilitates the nucleus pulposus be removed successfully under direct visualization. The VTT involving TELF discectomy can be a safe, effective and feasible surgical procedure for the treatment of LDH with very highly up-migrated.


2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091091
Author(s):  
Liu Guang-hui ◽  
Zhu Guang-yu ◽  
Liu Yu-zhang ◽  
Zhu Yong-Tao ◽  
Zhang Shi-min ◽  
...  

Objective This study was performed to investigate the effectiveness and safety of ultrasound-guided transforaminal nerve block in the treatment of lumbar disc herniation. Methods Sixty patients who underwent treatment for protrusion of a lumbar intervertebral disc in Wangjing Hospital from January 2016 to December 2017 were divided into the study group and the control group. The visual analog scale (VAS) pain scores, the Japanese Orthopaedic Association (JOA) scores of the lumbar vertebra, PRI (pain rating index), and PPI (present pain intensity) were recorded at 30 minutes, 1 week, and 3 months after the operation. Results There were significant differences in the VAS, JOA, PRI, and PPI scores between the study group and control group. Conclusion Ultrasound guidance can improve the efficacy and safety of transforaminal nerve block in the treatment of lumbar disc herniation and shorten the operative duration.


2021 ◽  
Vol 26 (1) ◽  
pp. 1-45
Author(s):  
Yoshiharu Kawaguchi ◽  
Shiro Imagama ◽  
Motoki Iwasaki ◽  
Takashi Kaito ◽  
Masao Koda ◽  
...  

2021 ◽  
Author(s):  
Jiale Zhang ◽  
Xu Zhai ◽  
Xue Wang ◽  
Liuqing Wang ◽  
Hongxuan Tong ◽  
...  

Abstract BackgroundLumbar disc herniation (LDH) is one of the common diseases in orthopedics and traumatology, which is caused by nucleus pulposus herniation stimulating cauda equina nerve, nerve root and intervertebral disc degeneration. Its clinical manifestations are low back pain, radiation pain of lower limbs and cauda equina symptoms, which seriously affect the quality of life of patients. At present, oral analgesics are commonly used in clinical non drug therapy for LDH, but oral analgesics will produce gastrointestinal reactions and other side effects. Thunder-fire moxibustion is one kind of moxibustion method, which has been applied widely for treating pain syndromes in China. The aim of our research is to design a randomized controlled trial of thunder-fire moxibustion in the treatment of lumbar disc herniation to explore whether it is safer and more effective than oral analgesic drugs.Methods90 patients will be randomly divided into thunder-fire moxibustion group and acetaminophen group. The intervention included 10 days as a course of treatment, lasting for 20 days. The acetaminophen group took two acetaminophen sustained-release tablets every other day, while the thunder fire moxibustion group will be treated with thunder fire moxibustion once every other time for 30 minutes. Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) and oswestry disability index (ODI) will be used as the main the observation indexes. Meanwhile, the occurrence of adverse events (AES) will also be recorded. The assessment will be conducted at baseline and at the end of the first and second course of treatment.DiscussionThe aim of this study is to determine whether thunder-fire moxibustion is more effective than acetaminophen in the treatment of patients with LDH.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR2000036079. Registered on 21 August 2020.


2019 ◽  
Vol 23 (2) ◽  
pp. 251-258 ◽  
Author(s):  
Yu Chen ◽  
Ruoxian Song ◽  
Weimin Huang ◽  
Zhengqi Chang

OBJECTIVEThe authors sought to investigate the efficiency of percutaneous endoscopic discectomy (PED) in adolescent patients with lumbar disc herniation (LDH), compare PED outcomes in adolescent patients with those in young adult LDH patients as controls, and discuss relevant technical notes.METHODSThis was a retrospective study involving 19 adolescent LDH patients (age > 13 and < 18 years, 20 discectomies) and 38 young adults (age < 40 years, 38 discectomies) who also had LDH and were matched to the adolescent group for sex and body mass index. The combined cohort included 51 male patients (89.5%) and 6 female patients (10.5%), with an average age of 26.7 years (range 14–39 years). The operated levels included L3–4 in 1 patient (1.7%), L4–5 in 22 patients (37.9%), and L5–S1 in 35 patients (60.4%). Two adolescents (10.5%) exhibited apophyseal ring separation and one (5.3%) had had previous PED. All patients underwent PED under local anesthesia. Outcomes were evaluated through a visual analog scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the modified MacNab grading system.RESULTSThe mean duration of follow-up was 41.7 months (range 36–65 months). The outcomes in adolescents were satisfactory and comparable with previously reported outcomes of microsurgical discectomy (MD) and conventional open discectomy (COD). The adolescent patients had a faster and better recovery course than the adult patients (p < 0.01). One adolescent patient (5.3%) exhibited recurrence and 2 adults (5.3%) experienced transient dysesthesia; the complication rates were comparable in the 2 age groups (p = 0.47). Prolonged duration of symptoms (p < 0.01) and disc degeneration (p = 0.01) were correlated with lower postoperative JOA values; patients with extrusions had higher postoperative JOA values than those with protrusions (p = 0.01).CONCLUSIONSPED may yield favorable results in the treatment of adolescent LDH in terms of short- to medium-term follow-up; restricted discectomy and a conservative rehabilitation program might be advisable. Further long-term studies are warranted to address this rare disease entity.


Author(s):  
Yu Xia ◽  
Qiongyue Zhang ◽  
Xiang Gao ◽  
Keran Wang ◽  
Xun Zhang ◽  
...  

Abstract Background Posterior percutaneous endoscopic lumbar discectomy (PELD) has become a preferred procedure for the treatment of simple lumbar disc herniation (LDH) but has rarely been reported for distant upward migration. The purpose of this research was to investigate the feasibility, safety, clinical efficacy and technical points of posterior PELD combined with the vertical anchoring technique (VAT) for the treatment of LDH with distant upward migration. Methods Thirteen patients with distant upward migrated LDH who underwent posterior PELD combined with the VAT from March 2016 to May 2018 were selected. Among these cases, the herniated disc was located at L3/4 in 2 patients, L4/5 in 9 patients and L5/S1 in 2 patients. The operative time, length of hospital stay and postoperative complications were recorded. The visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores and modified MacNab criteria were used to assess surgical efficacy. Results All 13 patients underwent successful surgery. We compared the VAS, ODI and JOA scores before and after surgery. The differences were statistically significant (P < 0.05). According to the modified MacNab criteria, 10 patients were assessed as “excellent”, 2 patients were assessed as “good” and 1 patient was assessed as “fair” at the last follow-up. The rate of satisfactory outcomes was 92.3%. Conclusion Posterior PELD combined with the VAT is a safe and feasible procedure for the treatment of LDH with distant upward migration and represents a new approach for this type of surgery.


Sign in / Sign up

Export Citation Format

Share Document