Factors for Predicting Favorable Outcome of Percutaneous Epidural Adhesiolysis for Lumbar Disc Herniation

Background. Lower back pain is a common reason for disability and the most common cause is lumbar disc herniation. Percutaneous epidural adhesiolysis has been applied to relieve pain and increase the functional capacity of patients who present this condition.Objectives. In this study, we retrospectively evaluated the factors which predict the outcome of percutaneous epidural adhesiolysis in patients who were diagnosed with lumbar disc herniation.Methods. Electronic medical records of patients diagnosed with lumbar disc herniation who have received percutaneous epidural adhesiolysis treatment were reviewed. The primary outcome was the factors that were associated with substantial response of ≥4 points or ≥50% of pain relief in the numerical rating scale pain score 12 months after the treatment.Results. Multivariate logistic regression analysis demonstrated that the presence of high-intensity zone (HIZ) at magnetic resonance imaging was a predictor of substantial response to percutaneous epidural adhesiolysis for 12 months (P=0.007). The presence of a condition involving the vertebral foramen was a predictor for unsuccessful response after 12 months (P=0.02).Discussion and Conclusion. The presence of HIZ was a predictor of favorable long-term outcome after percutaneous epidural adhesiolysis for the treatment of lower back pain with radicular pain caused by lumbar disc herniation.

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Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

Global Spine Journal ◽

10.1177/2192568220976089 ◽

2021 ◽

pp. 219256822097608

Author(s):

Dinesh Kumarasamy ◽

Shanmuganathan Rajasekaran ◽

Sri Vijay Anand K. S ◽

Dilip Chand Raja Soundararajan ◽

Ajoy Prasad Shetty T ◽

...

Keyword(s):

Patient Satisfaction ◽

Back Pain ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Rating Scale ◽

Lumbar Disc ◽

Modic Changes ◽

P Value ◽

Functional Scores

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

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Lumbar Disc Herniation in Heavy Manual Workers: Conventional Microdiscectomy versus (MIS) TLIF with Unilateral Fixation

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9791 ◽

2021 ◽

pp. 32

Author(s):

Mohamed Alqazaz

Keyword(s):

Back Pain ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Rating Scale ◽

Lumbar Disc ◽

Disc Prolapse ◽

Outcome Score

Introduction: Conventional discectomy is a common surgical method for treating lumbar disc prolapse. The situation may differ in heavy manual workers who may have more pronounced degenerative spine disease, broad-based disc herniations, and are expected to be exposed postoperatively to the same preoperative manual stress. This study was aimed at comparing the clinical outcomes in patients operated for conventional discectomy versus those operated for TLIF with unilateral spinal fixation. Methodology: Sixty patients underwent surgeries for lumbar disc herniation. They were divided into two groups; the microscopic conventional discectomy group and the fusion (TLIF and unilateral TPF) group. They were operated between 2017 and 2019. Participants were evaluated pre- and postoperatively at 3, 6, 9, and 12 months’ intervals. Pain was scored by Visual Analogue Scale (VAS) for both lower limb and back pain. The clinical outcomes were compared using the Prolo economic and functional rating scale and a new outcome score. Result: The two groups of patients were fairly homogeneous and comparable. Workload exposure to repetitive vibration was the biggest risk for disc prolapse and surgery (28.3%). Fusion group showed better clinical outcomes parameter including better VAS for back pain, better Prolo economic and functional rating scale, and better new clinical outcome score. In comparison, the discectomy group showed significantly higher recurrence rate and reoperation during the follow-up period. During the 12 months’ follow-up visit, when the patients were asked if, under the same circumstances, they would undergo the procedure again, 71.6% of the patients (43 patients) answered affirmatively and this reflects their satisfaction with the results of their surgeries. This satisfaction was reported in 27 patients (90%) in the fusion group and 16 patients (53.4%) in the discectomy group. Conclusion: Heavy manual workers treated with unilateral transforaminal interbody fusion reported less pain and lower disability scores all over the follow-up period. This technique is preferable to conventional discectomy because it reduces back and leg pain while avoiding the possibility of recurrence by heavy duties and maintains stability of the lumbar spine. We proposed a new clinical outcome score to monitor the clinical outcomes of spine surgery in heavy manual workers. It relates the outcomes to the hours of work, sick leaves, and patient satisfaction with surgery. In our group of patients, it showed significant improvement in the fusion group in comparison to the discectomy group.

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Long-Term Outcome of Patients who Underwent Percutaneous Nucleotomy for Lumbar Disc Herniation: Results after a Mean Follow-up of 5 Years

Acta Neurochirurgica ◽

10.1007/s007010050070 ◽

1998 ◽

Vol 140 (2) ◽

pp. 108-113 ◽

Cited By ~ 16

Author(s):

E. Kotilainen ◽

S. Valtonen

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Term Outcome ◽

Long Term Outcome

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Rasterstereographic Analysis of Lateral Shift in Patients with Lumbar Disc Herniation: A Case Control Study

Advances in Orthopedics ◽

10.1155/2018/6567139 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Britta K. Krautwurst ◽

Jürgen R. Paletta ◽

Sylvia Mendoza ◽

Adrian Skwara ◽

Melvin Mohokum

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pelvic Tilt ◽

Lumbar Disc ◽

Lateral Shift ◽

Healthy Controls ◽

Low Back

Objective. Detection of a lateral shift (LS) in patients with diagnosed disc herniation compared to healthy controls. Summary of Background Data. A specific lateral shift (LS) pattern is observed in patients with disc herniation and low back pain, as shown in earlier studies. Methods. Rasterstereography (RS) was used to investigate the LS. Thirty-nine patients with lumbar disc herniation diagnosed by radiological assessment and low back pain and/or leg pain (mean age 48.2 years, mean BMI 28.5, 28 males and 11 females) and 36 healthy controls (mean age 47.4 years, mean BMI 25.7, 25 males and 11 females) were analysed. LS, pelvic tilt, pelvic inclination, lordotic angle, and trunk torsion were assessed. Results. The patient group showed a nonsignificant increase in LS, that is, 5.6 mm compared to the healthy controls with 5.0 mm (p = 0.693). However, significant differences were found between groups regarding pelvic tilt in degrees (patients 5.9°, healthy controls 2.0°; p = 0.016), trunk torsion (patients 7.5°, controls 4.5°; p = 0.017), and lordotic angle (patients 27.5°, healthy controls 32.7°; p = 0.022). The correlation between pain intensity and the FFbH-R amounted 0.804 (p = < 0.01), and that between pain intensity and the pain disability index was 0.785 (p < 0.01). Discussion. Although some studies have illustrated LS with disc herniation and low back pain, the present findings demonstrate no significant increase in LS in the patient group compared to healthy controls. Conclusion. The patients with lumbar disc herniation did not demonstrate an increased LS compared to healthy controls. Other parameters like pelvic tilt and inclination seemed to be more suitable to identify changes in posture measured by RS in patients with low back pain or disc herniation.

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Association between pain and gait instability in patients with lumbar disc herniation

Journal of International Medical Research ◽

10.1177/03000605211039386 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110393

Author(s):

Keunjae Lee ◽

Eun-San Kim ◽

Boyoung Jung ◽

Sang-Won Park ◽

In-Hyuk Ha

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Rating Scale ◽

Lumbar Disc ◽

Linear Regression Analysis ◽

Lumbar Pain ◽

Multivariate Linear Regression Analysis ◽

Cross Sectional ◽

Gait Symmetry ◽

Symmetry Index

Objective To determine whether pain is associated with gait instability in patients with lumbar disc herniation (LDH). Methods This retrospective cross-sectional study used data from electronic medical records. Among patients with lumbar back pain caused by LDH between January 2017 and July 2019, patients that underwent gait analysis were included. LDH was diagnosed using magnetic resonance imaging. An OptoGait photoelectric cell system was used for gait evaluation. Instability was measured using a gait symmetry index. Multivariate linear regression analysis was performed to determine the association between lumbar pain and gait instability. Results A total of 29 patients (12 females [41.4%] and 17 males [58.6%]; mean ± SD age, 40.6 ± 12.0 years) with LDH were enrolled in the study. With each 1-point increase in lumbar pain on the numeric rating scale, the symmetry index of the stance phase (0.33; 95% confidence interval [CI] 0.04, 0.62), swing phase (0.78; 95% CI 0.14, 1.43) and single support (0.79; 95% CI 0.15, 1.43) increased. Conclusions Gait instability in patients with LDH may occur due to an increase in pain.

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Association between temperature and back pain among lumbar disc herniation patients

10.1101/2020.01.15.20017558 ◽

2020 ◽

Author(s):

Cai Chen ◽

Dandan Wang ◽

Fanjie Liu ◽

Hao Qin ◽

Xiyuan Li ◽

...

Keyword(s):

Back Pain ◽

Ambient Temperature ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Linear Models ◽

Lumbar Disc ◽

Average Temperature ◽

Distributed Lag ◽

And Gender ◽

The Relationship

AbstractPurposeThis paper was designed to critically provide empirical evidence for the relationship between temperature and intensity of back pain among people with lumbar disc herniation (LDH).MethodsDistributed lag linear and non-linear models (DLNM) was used to evaluate the relationship between lag-response and exposure to ambient temperature. Stratification was based on age and gender.ResultsWhen daily average temperature was on the rage of 15-23□, the risk of hospitalization was at the lowest level for men group. About below 10□, risk for male hospitalization could keep increase when lag day were during lag0-lag5 and lag20-lag28. 40<age≤50 group was little affected when they exposed to ambient temperature.

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Gait adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing

European Spine Journal ◽

10.1007/s00586-010-1639-8 ◽

2010 ◽

Vol 20 (3) ◽

pp. 491-499 ◽

Cited By ~ 34

Author(s):

Yun Peng Huang ◽

Sjoerd M. Bruijn ◽

Jian Hua Lin ◽

Onno G. Meijer ◽

Wen Hua Wu ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Low Back ◽

Arm Swing ◽

Pain Patients

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Microsurgical Excision of Herniated Lumber Disc in Pediatric Population

Neuroscience and Neurological Surgery ◽

10.31579/2578-8868/008 ◽

2018 ◽

Vol 2 (3) ◽

pp. 01-05

Author(s):

Ahmed Zaher

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pediatric Population ◽

Lumbar Disc ◽

Radicular Pain ◽

University Hospital ◽

Csf Leak ◽

Degree Relative ◽

History Of

Lumbar disc herniation is a relatively rare disorder among children and adolescent population compared to adults. The objectives of this work are to study the lumbar disc herniation in pediatric population and determine the surgical outcome of lumbar microdiscectomy in such population. Patients and methods: A series of 32 pediatric patients less than 18 years operated by microdiscectomy at Mansoura University hospital during the period from January 2005 to March 2015 were retrospectively analyzed. Clinical presentation, physical signs, predisposing factors, radiological investigations and operative findings were retrieved from medical records. Improvement of pain was assessed by visual analogue scale. Results: The study included 17 females (53.1%) and 15 males (46.9%) ranging in age from 10 to18 years (mean, 14.2 year). The patients were followed up for periods ranging from three to 115 months (mean, 55 months). All patients had radicular pain (100%) with additional back pain in twenty one patients (65.63%), twenty eight patients (87.5%) presented by sciatic pain while six patients (18.75%) showed femoral neuralgia. Straight leg raising test was positive in 90.62%. L4/5 was the commonest affected level in eighteen patients (56.25%) while twelve patients (37.5%) had disc herniation at L5-S1 level and only two patients had herniation at L3-4 disc level. Family history of lumbar disc herniation in first degree relative was positive in twenty one patients (65.63%). History of relevant trauma was documented in only twelve patients (37.5%). During surgery the disc was soft, rubbery and well hydrated in 90.6% of cases. Subligamentous disc herniation was observed in 81%, while 12.5% of patients had disc bulge with intact annulus and only 6.5% had extruded disc. All patients showed significant improvement of radicular pain at the time of discharge while back pain continued to improve during early postoperative follow up. Low back pain and radicular pain equally improved after three months despite instant postoperative improvement of radicular pain. Postoperative complications were rare and included one case of wound infection, one case of iatrogenic CSF leak and new neurological deficit in another case. Conclusion: Lumbar disc herniation in pediatric population differs from that of adults in many aspects. Microdiscectomy is safe and reliable procedure for management of pediatric lumbar disc herniation with good outcome and minimal morbidity

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