Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification

Purpose To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients’ performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification. Patients and methods Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging. In all patients entering the study the severity of pain was recorded according to the visual analog scale criteria before and one and three months after the end of treatment. Oswestry Low Back Pain Disability Index (ODI) was used to compare patients’ performance before and after the treatment. Results In total 128 patients (60 females and 68 males) with mean age of 40.1 ± 10.7 entered the study. The patients were divided into eight groups based on MSU classification each including 16 patients. The reduction of pain severity and ODI score compared to baseline was statistically significant in all groups both in the first month and the third month after treatment. There was also a statistically significant difference between groups regarding the reduction of pain and ODI score indicating significantly worse treatment outcomes in groups 1-C, 2-C and 2-AB. Conclusion Based on our findings it seems that MSU classification can be used in patients’ selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation.

Download Full-text

Ozone injection therapy for intervertebral disc herniation

British Medical Bulletin ◽

10.1093/bmb/ldaa032 ◽

2020 ◽

Vol 136 (1) ◽

pp. 88-106

Author(s):

Filippo Migliorini ◽

Nicola Maffulli ◽

Jörg Eschweiler ◽

Marcel Bestch ◽

Markus Tingart ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Lumbar Disc ◽

Current Evidence ◽

Intervertebral Disc Herniation ◽

Low Back ◽

Ozone Therapy ◽

Ozone Injection

Abstract Introduction Lumbar disc herniation (LDH) is a common cause of low back pain (LBP). Recently, in the setting of LBP caused by LDH, a growing interest in ozone therapies has been observed. Source of data Recent published literatures. Areas of agreement Being low back pain more common in the elderlies, exploring conservative alternatives to the surgical intervention is of especial interest. Areas of controversy Efficacy and feasibility of ozone injections for LDH is debated. Several clinical studies showed controversial results, and the true benefit has not yet been clarified. Growing points Systematically summarize current evidences, analyze the quantitative available data and investigate the role of percutaneous ozone therapy for LDH. Areas timely for developing research Current evidence encourage the use of ozone therapy for LBP from LDH. These conclusions should be interpret in light of the limitations of the present study.

Download Full-text

Study of the Feasibility of Conventional MR Images and Magnetic Resonance (MR)/Ultra-Short Echo Time (UTE) Technique in the Evaluation of Lumbar Disc Degeneration in the Axial Plane

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2021.3360 ◽

2021 ◽

Vol 11 (3) ◽

pp. 817-821

Author(s):

Peng Tang ◽

Jingtao Xu ◽

Wei Liu ◽

Yu Li ◽

Wei Fan ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Disc Degeneration ◽

Intervertebral Disc Degeneration ◽

Structural Integrity ◽

Low Back ◽

Pain Group ◽

Cartilage Endplate ◽

Significant Difference

The advantage and value of magnetic resonance (MR)-ultra-short echo time (UTE) technique in the displaying the structures of degenerative intervertebral discs were observed through evaluating the lumbar disc degeneration in the axial plane by conventional MR image and MR-UTE technique. A total of 160 examinees screened by inclusion and exclusion criteria were enrolled, and a total of 800 intervertebral disks were involved, and the degree of intervertebral disc degeneration was classified by conventional MR image classification method. After the first echo image of MR-UTE technique was integrated with the contour, the image entered UTE cartilage endplate, fibrous ring and osseous endplate. The integrity of the intervertebral disc from the above and below the intervertebral disc and the correlation of the structural endplate with the integrities of cartilage endplate, fibrous ring and osseous endplate under double echo sequence were analyzed, and the correlation analysis of the two categorical variables was conducted using rank correlation analysis. Under the MR-UTE sequence, there was no statistical significant difference in structural integrity constituent ratio (intact structure only on one side, incomplete structure on both side) between the non-low back pain group and the low back pain group (P > 0.05), the proportion of complete structure disappearance was lowest, and the proportion of partial structure disappearance was highest; there was a significant difference in the structural integrity of fibrous ring between the non-low back pain group and the low back pain group (P < 0.05), there was a statistical significant difference in structural integrity of fibrous rings between the two groups (P < 0.05); there was a statistical significant difference in pain degree between the partial structure disappearance group and the complete structure disappearance group (P < 0.05). There was no significant difference in pain degree between the groups (intact structure only on one side and incomplete structure on both side); conventional MR images showed no significant difference in the intervertebral disc degeneration degree between the non-low back pain group and low back pain group (P > 0.05), and the intervertebral disc degeneration degree had no significant correlation with the lower back pain. MR-UTE sequence and T2WI sequence showed that there was a correlation between different intervertebral disc degeneration degrees and the structural integrity distributions of cartilage endplate, osseous endplate and fibrous rings in two groups of patients with or without low back pain (P < 0.05). Whether low back pain exists or not has little effect on the intervertebral disc degeneration degree on T2WI. MR-UTE double echo sequence scan reveals that the intervertebral disc degeneration degree is positively related to the integrity and integrity distribution of cartilage endplate, fibrous ring and bone endplate.

Download Full-text

To study the effect of Triamcinolone injection for low back pain due to lumbar disc herniation

Bhutan Health Journal ◽

10.47811/bhj.58 ◽

2018 ◽

Vol 4 (1) ◽

pp. 55-59

Author(s):

Tashi Wangchuk ◽

Kunzang P. Wangmo ◽

Thinley Norbu

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Low Back ◽

Trauma History ◽

Pain Scores ◽

Significant Difference ◽

Epidural Steroid

Introduction: Low back pain is one of the most common complaints in the general population which represents a significant public health problem. Epidural Steroid Injection is being considered as a simple, effective and minimally invasive treatment modality for lumbar disc herniation. However, most studies only find a short-term benefit. In Bhutan, till date, no study has been done in Bhutan on this subject. The objective of our study was to find the effect of epidural steroid injection for low back pain due to lumbar disc herniation. Methods: An observational one-year-period study completed in Jigme Dorji Wangchuck National Referral Hospital. Symptomatic and positive Magnetic Resonance Imaging patients with lumbar disc herniation were included in our study. Pain scores were collected using Numeric Rating Scale at three different points of study. We also included patients’ age, weight and trauma history as some of the independent variables to study their associations with pain scores. The data obtained were analyzed using the Stata software program. One way repeated measures ANOVA was used to assess the significant difference in pain score. Results: Out of 100 participants recruited for the study, 91 of them completed demographic data and only 81 patients completed follow-up till 4 weeks post-treatment for demographic analysis and analytical analysis, respectively. There was a significant difference in pain scores in all three different points of study (p <0.01). No significant difference was observed in the pain scores amongst different age groups, gender, occupation and trauma history (p >0.05) at all three points of study. Conclusion: Our study observed a significant short-term benefit from epidural Triamcinolone injection for symptomatic lumbar disc herniation.

Download Full-text

Evaluation of therapeutic efficacy of epidural steroid injections in lumbar spine with patients of chronic low back pain

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174717 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1218

Author(s):

Saket Jati ◽

Mohammad Danish ◽

Tanveer Sheikh ◽

Ajay Varun

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Disc Herniation ◽

Chronic Low Back Pain ◽

Therapeutic Efficacy ◽

Low Back ◽

Steroid Injections ◽

Epidural Steroid Injections ◽

Epidural Steroid

Background: Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in managing chronic low back pain (LBP) along with surgical intervention. Cost effectiveness and affordability has become the cornerstone of evidence-based medicine, and has an influence on coverage decisions, especially in developing countries such as India. LBP is a common problem. The aim of this study was to find the therapeutic efficacy of epidural steroid injections (ESIs) in chronic LBP.Methods: 50 patients presenting with LBP with or without radiculopathy treated with ESIs were prospectively followed for average duration of 12 months.Results: Fifty patients were included in this study with average age 51.02±7.1, out of these 26 (52%) were males and 24 (48%) females. Significant pain relief (>50%) was demonstrated in 43 (71%) of patients and functional status improvement was demonstrated by a reduction of 40% in Oswestry disability index (ODI) score in 49 (81%) patients.Conclusions: ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.

Download Full-text

The substantial clinical benefit of comprehensively considering low back pain and radiating pain caused by lumbar intervertebral disc herniation

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200244 ◽

2021 ◽

pp. 1-7

Author(s):

Se Hwan Jeon ◽

Young-Mo Yang ◽

Yoon Jae Lee ◽

Me-Riong Kim ◽

Eun-Jung Kim ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Disc Herniation ◽

Clinical Benefit ◽

Rating Scale ◽

Intervertebral Disc Herniation ◽

Low Back ◽

Substantial Clinical Benefit ◽

Lumbar Intervertebral Disc Herniation ◽

The Mean

BACKGROUND: Patients with lumbar disc herniation (LDH) may experience low back pain (LBP) and radiating pain (RP). Currently, there is no substantial clinical benefit (SCB) of assessing both LBP and RP due to LDH. OBJECTIVE: To determine enhanced SCB values by simultaneously assessing LBP and RP. METHODS: We retrospectively evaluated hospitalized LDH patients with concomitant LBP and RP between June 1, 2012, and May 31, 2013, and determined the numeric rating scale (NRS) and Oswestry Disability Index (ODI) scores at admission and discharge. Furthermore, the area under the receiver operating characteristic curve (AUC) was computed to assess diagnostic accuracy. RESULTS: SCB as per NRS for both LBP and RP was -2.50 in the 186 enrolled patients (AUC: 0.699 and 0.704, respectively). SCB as per ODI was -18.78 (AUC: 0.771). SCB for the mean of the two NRS scores for LBP and RP was -2.75 (AUC: 0.757). SCB for NRS score with a smaller change in LBP and RP was -3.50 (AUC: 0.767). CONCLUSIONS: SCB may be determined by comprehensively considering LBP and RP and choosing the mean NRS or NRS score with a small change.

Download Full-text

Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195791 ◽

2019 ◽

Vol 6 (1) ◽

pp. 1

Author(s):

Godson E. Anyanwu ◽

Remigius T. Ekwunife ◽

Emmanuel C. Iyidobi ◽

Cajetan U. Nwadinigwe ◽

Henry C. Ekwedigwe ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Intervertebral Disc ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Low Back ◽

Inclusion Criteria ◽

Laptop Computer ◽

Disc Herniations

Background: Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.Methods: The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.Results: A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).Conclusions: That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age.

Download Full-text

Influence of Physiological Loading on the Lumbar Spine of National Level Athletes in Different Sports

Journal of Human Kinetics ◽

10.1515/hukin-2015-0148 ◽

2016 ◽

Vol 50 (1) ◽

pp. 115-123 ◽

Cited By ~ 3

Author(s):

Mansoorehossadat Rozan ◽

Vahid Rouhollahi ◽

Amit Rastogi ◽

Dilip Kumar Dureha

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Lumbar Spine ◽

Intervertebral Disc ◽

National Level ◽

Low Back ◽

Basketball Players ◽

Physiological Loading ◽

Lumbar Vertebral Body ◽

Significant Difference

AbstractThe lumbar spine is subjected to considerable stress during many athletic efforts. The purpose of this study was to assess the effects of physiological loading on the lumbar spine in national male players of different games, which may be predictive of the future development of low back pain and injury symptoms. Thirty-four national players (12 cricket players, 12 field hockey players, and 10 basketball players) underwent magnetic resonance imaging, and selected geometric variables including intervertebral disc angles, the Farfan ratio, the lumbar body index, the compression deformity ratio, the biconcave deformity ratio and the anterior wedge deformity ratio were measured using KINOVEA-0.8.15 software and syngo fast view software and calculated using specific formulas. The results indicated a significant difference in the intervertebral disc angle between the three groups at the L2/3, L3/4 and L4/5 levels. In relation to the lumbar vertebral body shape and size, significant differences were found in the lumbar index at the L2 level, in the biconcave deformity at the L1 and L2 levels and in relation to the anterior wedge deformity at L2 between the three selected groups. Our data suggest that the different physiological loadings in the selected sports play an important role in the development of degenerative changes of the lumbar spine, which may be considered a risk factor for future injury and/or low back pain in each specific sport because of the unique demands of each discipline.

Download Full-text

Spontaneous Resorption Of A Lumbar Disc Herniation In A Patient With Multiple Myeloma: A Rare Association

10.21203/rs.3.rs-41644/v1 ◽

2020 ◽

Author(s):

Xingchen Yao ◽

Yanzhe Wei ◽

Lei Qi ◽

Xinru Du

Keyword(s):

Multiple Myeloma ◽

Low Back Pain ◽

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Leg Pain ◽

Herniated Disc ◽

Intervertebral Disc Herniation ◽

Low Back

Abstract Background: The phenomenon of spontaneous resorption of a herniated disc (HD) is a common occurrence. In literature, there are many studies attempting to explain the mechanism for regression, including imaging techniques and immunohistologic analyses. Nevertheless, the exact mechanism remains uncertain. In addition, the connection between HD regression and general conditions of patients is not concerned yet. Here we report a case of spontaneous resorption of a lumbar disc herniation in a patient with multiple myeloma, which had not reported before.Case presentation: An illustrative patient, a 42-year-old Chinese man, was admitted to our hospital with a disc herniation at L5-S1, experiencing 2-months history of low back pain and 1-month left leg pain. He was treated conservatively with medication and physical therapy. Then he was symptom-free after 2 months. The low back pain of the patient recurred with the herniated lumbar disc disappearing after 2 years. The disappearance demonstrated by magnetic resonance imaging (MRI). And besides, the patient was diagnosed with multiple myeloma (MM). The emergence of MM might result in the recurred backache, and the process of HD resorption might be accelerated by the high serum Vascular endothelial growth factor (VEGF) of the MM patient.Conclusions: For patients who suffering from intervertebral disc herniation together with diseases upregulating VEGF level, such as MM, surgical treatment should be limited and the conservatively treating time can be lengthened.

Download Full-text