scholarly journals The Effectiveness of Moxibustion for Treating of Lumbar Disc Herniation(LDH): A Protocol for Systematic Review and Meta-ananlysis

2020 ◽  
Author(s):  
Zenan Wu ◽  
Jun Xiong ◽  
Guixing Xu ◽  
Zhengyun Zuo ◽  
Yi Yang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Clinical Symptoms ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
The Body ◽  
Lumbar Pain ◽  
Cochrane Library ◽  
Disc Herniations

Abstract Background: Lumbar disc herniation (LDH) refers to lumbar disc degeneration or external pressure, resulting in annulus fibrosus rupture, nucleus pulposus protrusion or bulging, compression of nerve roots, cauda equina nerve, and then some clinical symptoms of a clinical syndrome, clinical symptoms are often manifested as unilateral or bilateral lumbar pain, leg numbness. L3/L4,L4/L5, and L5/S1 intervertebral disc herniations are common in the lesion sites of lumbar disc herniations, and the incidence rate is as high as 90%. Typical manifestations are tenderness at the corresponding surface of the body. This disease is a common and frequently-occurring disease in the department of rehabilitation and acupuncture of the hospital, and is a common cause of lumbago and leg pain. At present, the common external treatment for LDH includes many methods,mostly acupuncture and moxibustionMethods: We're going to use systematic electronic search, including PubMed,MEDLINE, Cochrane library, SinoMed,CNKI,WF,VIPand checked references of retrieved articles. Randomized controlled trials (RCTs) on acupotomy treatment in LDH patients will be searched for independently by 2 reviewers in the databases from their inception to August 2020. We will combine data from clinically homogenous studies in a fixed effect meta-analysis using RevManV.5.3.5, and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Discussion: The results of this review will provide reliable evidence for effectiveness and safety of moxibustion for treating LDH.Systematic review registration: CRD42020187626

scholarly journals Recurrent Lumbar Disc Herniation: A Review

2017 ◽  
Vol 9 (2) ◽  
pp. 202-209 ◽  
Author(s):  
Nicholas Shepard ◽  
Woojin Cho
Keyword(s):  
Risk Factors ◽  
Surgical Management ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Cochrane Library ◽  
Disc Disease ◽  
Disc Herniations ◽  
Invasive Techniques ◽  
Recurrent Lumbar Disc Herniation

Study Design: Narrative review. Objectives: To identify the risk factors and surgical management for recurrent lumbar disc herniation using a systematic review of available evidence. Methods: We conducted a review of PubMed, MEDLINE, OVID, and Cochrane Library databases using search terms identifying recurrent lumbar disc herniation and risk factors or surgical management. Abstracts of all identified articles were reviewed. Detailed information from articles with levels I to IV evidence was extracted and synthesized. Results: There is intermediate levels III to IV evidence detailing perioperative risk factors and the optimal surgical technique for recurrent lumbar disc herniations. Conclusions: Multiple risk factors including smoking, diabetes mellitus, obesity, intraoperative technique, and biomechanical factors may contribute to the development of recurrent disc disease. There is widespread variation regarding optimal surgical management for recurrent herniation, which often include revision discectomies with or without fusion via open and minimally invasive techniques.

scholarly journals Comparison of Endoscopic Discectomy Versus Non-Endoscopic Discectomy for Symptomatic Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110206
Author(s):  
Wei-Shang Li ◽  
Qi Yan ◽  
Lin Cong
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Complication Rate ◽  
Controlled Trial ◽  
Lumbar Disc ◽  
Length Of Hospital Stay ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Endoscopic Discectomy

Study Design: Systematic review. Objective: The authors aimed to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with non-endoscopic discectomy (NED) for treatment of symptomatic lumbar disc herniation (LDH). Methods: A systematic search was performed on PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure for randomized controlled trial from inception until August 13, 2020. Trials which investigated multiple operative approaches on lumbar disc herniation were identified without language restrictions. Results: In total, 25 trials involving 2258 patients with symptomatic LDH were included. Twenty trials performed the comparison between ED and NED. Five trials performed the comparison between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). The operative time of micro-endoscopic discectomy (MED) was longer than open discectomy (OD). The length of hospital stay of percutaneous endoscopic lumbar discectomy (PELD) was shorter than fenestration discectomy (FD). Significant differences in intraoperative blood loss volumes were found between PELD with FD and MED with OD. The complication rate of PELD was lower than FD (PELD: 4.3%; FD: 14.6%) and the complication rate of full-endoscopic discectomy (FE) was lower than microscopic discectomy (MD) (FE: 13.4%; MD: 32.1%). Conclusions: PELD and FE have the advantage of limiting intraoperative damages. ED and NED can be both considered sufficient to achieve good clinical outcomes. PETD and PEID are able to achieve similar results but the learning curve of PETD was steeper. More independent high-quality RCTs with sufficiently large sample sizes performing cost-effectiveness analyzes are needed.

scholarly journals Spontaneous and rapid resolution of a massive lumbar disc herniation

2021 ◽  
Vol 12 ◽  
pp. 352
Author(s):  
Dinesh Naidoo
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Spontaneous Recovery ◽  
Surgical Intervention ◽  
Nonoperative Management ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Neurological Deficits ◽  
Lumbar Surgery ◽  
Disc Herniations

Background: Most lumbar disc herniations can be successfully treated conservatively. However, massive lumbar disc herniations are often treated surgically to avoid permanent cauda equina syndromes/neurological deficits and potential litigation. Nevertheless, here, we present a 51-year-old female who refused lumbar surgery due to coronavirus disease 2019 (COVID-19) and sustained a full spontaneous recovery without surgical intervention. Case Description: A 51-year-old female presented with a massive lumbar disc herniation at the L5S1 level. Despite refusing surgery for fear of getting COVID-19, she spontaneously neurologically improved without any residual neurological or radiographic sequelae. Conclusion: Although the vast majority of patients with massive lumbar disc herniations are managed surgically, there are rare instances in which nonoperative management may be successful.

scholarly journals Caudal Lumbar Disc Herniations Are More Likely to Require Surgery for Symptom Resolution

2020 ◽  
pp. 219256822090584
Author(s):  
Anmol Gupta ◽  
Shivam Upadhyaya ◽  
Caleb M. Yeung ◽  
Peter J. Ostergaard ◽  
Harold A. Fogel ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Nonoperative Management ◽  
Lumbar Disc ◽  
Strong Association ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Motor Deficits ◽  
Disc Herniations ◽  
The Impact

Study Design: Retrospective study. Objectives: We examined the impact that location of a lumbar disc herniation has on the likelihood that a patient will require surgery after at least 6 weeks of nonoperative management. Methods: Using ICD-10 codes M51.26 and M51.27, we identified patients at a single academic institution from 2015 to 2016 who received a diagnosis of primary lumbar radicular pain, had magnetic resonance imaging confirming a lumbar disc herniation, and underwent at least 6 weeks of nonoperative management. Patients experiencing symptoms suggesting cauda equina syndrome or progressive motor deficits were excluded. Results: Five hundred patients met inclusion/exclusion criteria. Twenty-nine (5.8%) had L3-L4 herniations, 245 (49.0%) had L4-L5 herniations, and 226 (45.2%) had L5-S1 herniations. Overall, 451 (90.2%) patients did not undergo surgery within 1 year of diagnosis. Nonsurgical patients had an average herniation size occupying 31.2% of the canal, compared with 31.5% in patients who underwent surgery. While herniation size, age, sex, and race failed to demonstrate a statistical association with the likelihood for surgery, location of disc herniation demonstrated a strong association. L3-L4 and L4-L5 herniations had odds ratios of 0.19 and 0.45, respectively, relative to L5-S1 herniations ( P = .0047). Patients were more than twice as likely to require a surgery on an L5-S1 herniation in comparison with an L4-L5 herniation ( P < .05). L3-L4 herniations rarely required surgery. Conclusions: Patients with caudal lumbar disc herniations were more likely to require surgery after at least 6 weeks of conservative management than those with disc herniations in the mid-lumbar spine.

scholarly journals The efficiency of rehabilitation programs in the case of unoperated lumbar disc herniations

2019 ◽  
Vol 12 (23) ◽  
pp. 26-31
Author(s):  
Mihaela Varga ◽  
Ana Maria Vutan
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Health Assessment ◽  
Exercise Program ◽  
Well Being ◽  
Medical Rehabilitation ◽  
Lumbar Pain ◽  
Family Doctors ◽  
Disc Herniations

AbstractIntroduction: More and more young people with low back pain address family doctors or orthopaedists, being subsequently directed to the medical rehabilitation centres. Recent studies have shown that the medication only, prescribed in these cases, is not sufficient for the complete reintegration of these people into the workplace and into society. Physical exercises play an important role in the rehabilitation of these subjects.Aim: We conducted this study starting from the hypothesis that regular exercise can reduce pain and improve the well-being of patients diagnosed with lumbar disc herniation.Methods: The study was conducted at the “Politehnica” University of Timisoara within the Department of Physical Education and Sports, between September and November 2019. Ten subjects diagnosed (both clinically and by imaging) with lumbar disc herniation were included in the study. All patients followed an exercise program 3 times a week, for 90 days. As evaluation methods we used: the subjective pain evaluation scale (VAS scale) and the health assessment questionnaire (HAQ).Results: All the parameters followed in this study were improved following the application of the physical exercise program (muscle stretching, toning of the back and abdomen muscles, and as a result of the correct implementation of the notions of ergonomics at work and at home). In conclusion, we consider it is necessary to implement a protocol of exercises performed regularly for a long period in the case of patients with lumbar pain secondary to disc herniation.

scholarly journals Comparison of Different Operative Approaches for Lumbar Disc Herniation: A Network Meta- Analysis and Systematic Review

2021 ◽  
pp. E381-E392
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Reoperation Rate ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Complication Rates ◽  
Dural Tear

BACKGROUND: New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches. OBJECTIVES: The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different surgical approaches for lumbar disc herniation (LDH). STUDY DESIGN: NMA of randomized controlled trials (RCTs) for multiple treatment comparisons of LDH. METHODS: The PubMed, Embase, MEDLINE, Ovid, and Cochrane Library databases were searched for RCTs comparing different surgical approaches for patients with LDH from inception to February 10, 2020. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in WinBUGS version 1.4.3 using a random effects consistency model. The primary outcomes were disability and pain intensity. The secondary outcomes were complications and reoperation. The PROSPERO number was CRD42020179406. RESULTS: A total of 22 trials including 2529 patients and all 5 different approaches (open discectomy or microdiscectomy [OD/MD], microendoscopic discectomy [MED], percutaneous endoscopic discectomy [PED], percutaneous discectomy [PD], and tubular discectomy [TD]) were retrospectively retrieved. PED had the best efficacy in improving patients’ dysfunction with no statistical significance (probability = 50%). PD was significantly worse than OD/MD, MED, and PED in relieving patients’ pain (standardized mean differences: 0.87 [0.03, 1.76], 0.94 [0.06, 1.88], and 1.02 [0.13, 1.94], respectively). There was no statistically significant difference between any 2 surgical approaches in dural tear; intraoperative, postoperative, and overall complications; or reoperation rate. PED had the lowest dural tear rate and the lowest intraoperative and overall complication rates (probability = 51%, 67%, and 33%, respectively). TD had the lowest postoperative complication and reoperation rates (probability = 35% and 39%, respectively). LIMITATIONS: The limitations of this NMA include the inconsistent follow-up times, the criteria for complications, and the reasons for reoperation. CONCLUSIONS: Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH. KEY WORDS: Lumbar disc herniation, network meta-analysis, minimally invasive surgery, surgical approaches, efficacy, safety

scholarly journals Treatment of cauda equina syndrome due to lumbar disc herniation with percutaneous endoscopic lumbar discectomy

2020 ◽  
Author(s):  
Hai-Chao He ◽  
Yong-jin Zhang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Lumbar Pain ◽  
Limb Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Throughout the last decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the treatment of Cauda Equina Syndrome (CES) due to lumbar disc herniation with percutaneous endoscopic lumbar discectomy (PELD). This study aims to evaluate the feasibility and clinical efficacy of PELD for CES caused by disc herniation.Methods: Between October 2012 and April 2017, 15 patients CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the objects of study, who underwent PELD. All patients were followed up for at least two years. The patients’ lumbar pain and limb pain were evaluated using visual analogue scale (VAS) scores. Patient's satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 3 days, 3 months, 6 month and the last follow-up.Results: The VAS score for lumbar pain was 6.67±1.05 preoperatively and 3.27±0.96, 2.73±0.46, 2.40±0.51, and 1.80±0.41, at 3 days, 3 months, 6 months and the last follow-up postoperatively respectively. The VAS score for limb pain was 7.13±1.19 preoperatively and 2.93±0.80, 2.60±0.51, 2.20±0.56, and 1.47±0.52, at 3 days, 3 months, 6 months and the last follow-up postoperatively respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, excellent was obtained in 8 of 15 patients, good was obtained in 5 patients, and fair was obtained in 2 patients, and 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient of cerebrospinal fluid leakage, and one patient developed recurrent herniation and who finally acquired satisfactory result after reoperation.Conclusion: PELD could be used as an alternative surgical method for the treatment of CES due to lumbar disc herniation in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

Unilateral changes of the multifidus in persons with lumbar disc herniation: a systematic review and meta-analysis

2020 ◽  
Vol 20 (10) ◽  
pp. 1573-1585
Author(s):  
Sjoerd Stevens ◽  
Anouk Agten ◽  
Annick Timmermans ◽  
Frank Vandenabeele
Keyword(s):  
Systematic Review ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis

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

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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