Analysis of the effect of midazolam on pain in a rat model of lumbar disc herniation based on the p38 MAPK signaling pathway / 中国骨伤

OBJECTIVE@#To investigate the effect of midazolam on pain in lumbar disc herniation model rats based on p38 MAPK signaling pathway.@*METHODS@#Fifty SPF-grade Sprague-Dawley healthy rats, half male and half female, were selected and randomly divided into normal group, model group, and low-dose, medium-dose, high-dose groups. Model group and low-dose, medium-dose, high-dose groups were initially modeled for lumbar disc herniation. Intraperitoneal injection of saline was performed in rats of normal and model groups; and in the low-dose, medium-dose, and high-dose groups, intraperitoneal injection of midazolam was performed with doses of 30, 60, and 90 mg/kg, respectively. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), substance P (SP), neuropeptide Y (NPY) were detected in the serum of rats by enzyme-linked immunoassay. The expression of p38 MAPK and matrix metalloproteinase-3(MMP-3) protein were detected by Western blot in the tissues of rats of each group.@*RESULTS@#The levels of TNF-α, IL-1β and β-EP were higher and the level of 5-HT was lower in the model group than in the normal group(P<0.05);the levels of TNF-α, IL-1β and β-EP were lower and the level of 5-HT was higher in the low-dose, medium-dose and high-dose groups than in the model group(P<0.05). The levels of SP and NPY increased in the model group compared with the normal group (P<0.05) and the levels of SP and NPY decreased in the low-dose, medium-dose and high-dose groups compared with the model group (P<0.05). The expression of p38 MAPK and MMP-3 increased in the model group compared with the normal group (P<0.05); the expression of p38 MAPK and MMP-3 decreased in the low-dose, medium-dose and high-dose compared with the model group(P<0.05).@*CONCLUSION@#Midazolam may ameliorate the immune inflammatory response in rats with a model of lumbar disc herniation, possibly regulated through the p38MAPK signaling pathway.

Feasibility of enlarging the ventral space by using a drill under spinal endoscopy in the treatment of severe free lumbar disc herniation / 中国骨伤

OBJECTIVE@#To evaluate the clinical efficacy of spinal endoscopy in the treatment of severe free lumbar disc herniation and explore the feasibility and application of microscopic drills to expand ventral space.@*METHODS@#Thirty patients with severe free lumbar intervertebral disc herniation treated by spinal endoscopic technique from April 2019 to March 2021 were collected, including 19 males and 11 females;aged from 19 to 76 years with an average of (44.03±16.92) years old. All patients had a single segmental lesion with prolapse of the nucleus pulposus. Among them, there were 3 cases on L2,3, 3 cases on L3,4, 15 cases on L4,5, and 9 cases on L5S1. During operation, posterior bone of vertebral body and pedicle notch were removed by a drill under the endoscope to enlarge the ventral space. And the free nucleus pulposus was exposed and completely removed. The intraoperative blood loss, operation time, hospital stay and postoperative neurological complications were recorded, and Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were compared before operation, 2 days, 3 months and 1 year after operation, and Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All operations were successful and the free nucleus pulposus was completely removed. Pain in the lower back and legs was significantly relieved on the day after operation. Two patients experienced transient pain and numbness in lower limbs after operation, and no serious nerve injury complications occurred. ODI and VAS at each time point after surgery were significantly lower than those before surgery (P<0.01), and JOA score was significantly higher than before surgery (P<0.01). The excellent and good rates of Macnab were 66.67% (20/30), 83.33% (25/30) and 90.00% (27/30) on 2 days, 3 months and 1 year after operation, respectively.@*CONCLUSION@#For severe free lumbar intervertebral disc herniation, using of a drill under endoscope to expand the ventral space can smoothly remove the free nucleus pulposus and avoid nerve damage.

Comparison of clinical efficacy between percutaneous endoscopic transforaminal discectomy and coblation nucleoplasty in the treatment of inclusive lumbar disc herniation / 中国骨伤

OBJECTIVE@#To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments.@*METHODS@#A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods.@*RESULTS@#①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05).@*CONCLUSION@#Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.

Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy for lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy (VPTED) and traditional percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation.@*METHODS@#The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December, 2020 was retrospectively analyzed. There were 38 males and 22 females, aged from 26 to 58 years old with an average of (43.63±8.48) years, 47 cases were on L4,5 segment and 13 cases were on L5S1 segment. Among them, 32 were treated with VPTED (group A) and 28 were treated with traditional PTED (group B). The general conditions of all the patients were recorded, including intraoperative fluoroscopy times, operation time, hospital stay and surgical complications during follow-up. The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score of low back pain, Oswestry disability index (ODI) were used to evaluate the clinical efficacy between two groups.@*RESULTS@#All patients were followed up from 9 to 15 months with an average of (12.10±1.16) months. There was no statistical difference of preoperative general data between two groups. The operation time, fluoroscopy times and hospital stay were (70.47±5.87) min, (13.66±1.34) times and (6.31±0.69) d in group A, and (90.71±7.66) min, (22.82±2.48) times and (6.54±0.92) d in group B. The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(P<0.05). There was no significant difference in hospital stay between two groups (P>0.05). No obvious surgical complications were found during the follow-up in both groups. The arthroplasty area ratio in group A was (29.72±2.84)% and (29.57±2.20)% in group B, respectively, with no significant difference (P>0.05). There was no significant difference in VAS, ODI and JOA score between two groups before operation and at the final follow-up(P>0.05), but the final follow-up was significantly improved(P<0.05).@*CONCLUSION@#The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation. Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel, and can significantly reduce the operation time and intraoperative fluoroscopy times.

Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion / 中国骨伤

OBJECTIVE@#To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion.@*METHODS@#From February 2010 to June 2018, 64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group, there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy, including 27 cases of single segment fusion and 6 cases of double segment fusion, aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group, there were 22 males and 9 females performed with traditional open fusion revision, including 25 cases of single-segment fusion and 6 cases of double segment fusion, aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time, intraoperative blood loss, fluoroscopy times, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed.@*RESULTS@#All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group, operation time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (P<0.05), and the fluoroscopy times of observation group were significantly increased compared with control group(P<0.05). The VAS of low back and lower limb, and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (P<0.05). The VAS of low back at each point and ODI at 1, 3 months after operation in observation group was significantly reduced compared with control group(P<0.05), however there was no significant difference in VAS for lower limb between two groups (P>0.05). The difference of complications between two groups was statistically significant (P<0.05).@*CONCLUSION@#Compared with traditional open fusion revision surgery, percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss, shortening ambulation time and the length of postoperative hospital stay, and promoting pain and functional improvement, and decrease incidence of complications. However, long-term clinical efficacy needs further study.

A case-control study of minimally invasive transforaminal interbody fusion with the assistance of robot and traditional fluoroscopy in the treatment of single-space lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the safety and nail placement accuracy of fluoroscopy-assisted and robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of single-space lumbar disc herniation.@*METHODS@#The clinical data of 52 patients with single-space lumbar disc herniation treated by MIS-TLIF from March 2019 to February 2020 were retrospectively analyzed. Among them, 24 patients were treated by robot-assisted MIS-TLIF(group A) and 28 patients were treated by fluoroscopy-assisted MIS-TLIF (group B). The intraoperative blood loss, operation time, intraoperative fluoroscopy times, preoperative and postoperative visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) scores and operation-related complications were recorded in two groups. Gertzbein-Robbins grade according to CT scan was used to evaluate the nail placement after operation. Grade A and B were evaluated as satisfactory nail placement, and grade C, D, and E were evaluated as error placement. Babu's method was used to evaluate the screw's invasion to the superior articular process.@*RESULTS@#The operation time, intraoperative blood loss and intraoperative fluoroscopy times in group A were less than those in group B(P<0.05).VAS and JOA scores of all patients at the final follow-up were significantly improved compared with those before operation(P<0.05), but there was no statistically significant difference between the groups(P>0.05). There were 96 and 112 screws in group A and group B, respectively. Three days after operation, according to the Gertzbein-Robbins grade to evaluate the nail placement accuracy, there were 90 screws of grade A, 5 of grade B, 1 of grade C, no grade D and E in group A;there were 84 screws of grade A, 16 of grade B, 8 of grade C, 4 of grade D, no grade E in group B;the difference between two groups was statistically significant(Z=-3.709, P=0.000). The satisfactory rate of screw placement in group A was 98.96% (95/96), and that of group B was 89.29% (100/112), the difference between two groups was statistically significant (χ2=8.254, P=0.004). Three days after operation, the invasion of superior facet joints by pedicle screws was evaluated according to Babu's method, including 90 screws in grade 0, 4 in grade 1, 2 in grade 2, and 0 in grade 3 in group A;86 in grade 0, 12 in grade 1, 10 in grade 2 and 4 in grade 3 in group B, and the difference was statistically significant(Z=-3.433, P=0.001). There were no serious spinal cord, nerve and vascular injuries and other operation-related complications caused by screw implantation failure in both groups. All patients were followed up from 6 to 12(9.06±1.60) months. The neurological symptoms improved well after operation. During the follow-up period, there was no recurrence of symptoms, loosening or breakage of the internal fixation.@*CONCLUSION@#Compared with the traditional fluoroscopy-assisted MIS-TLIF, the spinal robot-assisted MIS-TLIF not only has more minimally invasive and safer, but also has higher accuracy in nail placement, lower incidence of upper articular process invasion, and more accurate decompression targets, which can be used for minimally invasive treatment of single-space lumbar disc herniation.

Comparison of two endoscopic spine surgical techniques

SUMMARY OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.

Clinical effect of lever positioning manipulation for lumbar disc herniation and its influence on Cobb angle / 中国骨伤

OBJECTIVE@#To observe the clinical effect of lever positioning manipulation for the treatment of lumbar disc herniation and its effect on Cobb angle.@*METHODS@#From December 2017 to November 2018, 67 patients with lumbar disc herniation were included in the study. The patients were randomly divided into treatment group and control group by digital table method. There were 34 cases in the treatment group, including 20 males and 14 females, with an average age of (36.09±8.26) years old and a course of (13.79±15.50) months. Treatment group was treated with lever positioning manipulation. There were 33 cases in the control group, including 18 males and 15 females, with an average age of(36.48±7.81) years old and a course of (12.82±15.68) months. Control group was treated with lumbar slanting manipulation. Two groups were treated 3 times a week, once every other day, 6 times for a course of treatment, after 2 courses of treatment, the changes of Cobb angle before and after treatment were compared between two groups by imaging. The symptoms and signs were scored with reference to clinical evaluation standard;overall efficacy was evaluated with reference to "Diagnostic Efficacy Criteria of Traditional Chinese Medicine Syndrome" issued by the State Administration of Traditional Chinese Medicine for lumbar disc herniation.@*RESULTS@#One patient in each group dropped out. The symptom and sign scores of treatment group and control group before treatment were 18.56± 4.81, 18.61±3.72, while after treatment were 9.41±5.19, 13.55±3.68;treatment group was significantly lower than control group after treatment (@*CONCLUSION@#Both the lever positioning manipulation and the lumbar slanting manipulation methods are effective for the treatment of lumbar disc herniation, but clinical effect of lever positioning method on lumbar disc herniation is more significant, and the effect on Cobb angle is more obvious. It is worthy of promotion.

Analysis on clinical effects of two surgical approaches in percutaneous spinal endoscopy for LS disc herniation / 中国骨伤

OBJECTIVE@#To analyze the clinical effects, complications and operational key points of the percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating LS disc herniation.@*METHODS@#The clinical data of 158 patients with L5S1 disc herniation treated from July 2015 to March 2018 were restospectively analyzed. According to different surgical approaches, the patients were divided into PETD group or PEID group, 79 cases in each group. In PETD group, there were 41 males and 38 females, with an average age of (41.38±6.25) years and course of disease of (10.06±3.14) months. In PEID group, there were 43 males and 36 females, with an average age of (41.18±5.78) years and course of disease of (9.99±2.83) months. The operation length, intraoperative blood loss, intraoperative fluoroscopy times, days of hospital stay, and complications were recorded between two groups. Visual analogue score (VAS), Japanese Orthopedic Association(JOA) score, Oswestry Disability Index(ODI), modified Macnab criteria were used to assessed clinical effects after operation.@*RESULTS@#All patients completed surgery and were followed up for more than 1 year. (1) There were no significant differences in the intraoperative blood loss or hospitalization length between two groups(>0.05). The operation length and intraoperative fluoroscopy times in PETD group were significantly higher than in PEID group (0.05). (3)The excellence rate was 89.87% (71 / 79) in PETD group and 87.34% (69 / 79) in PEID group at the latest follow-up, with no statistical significance(>0.05). (4)Complications occurred in 2 cases in PETD group and in 3 cases in PEID group, with no significant differences between two groups.@*CONCLUSION@#The short term efficacy of the PETD is equal to that of the PEID for the LS disc herniation, but PEID is superior in the operation length, the access of stereotaxic puncture and intraoperative fluoroscopy times. The complications can be effectively reduced by following the indications, mastering the endoscopic technique, operating carefully and being familiar with the key points of common complications.

Application of pain pressure threshold test in lumbar intervertebral disc herniation study / 中国骨伤

OBJECTIVE@#To quantify pain pressure threshold(PPT) in the patients with lumbar intervertebral disc herniation before and after treatment, and to study the clinical effects of the PPT test in lumbar intervertebral disc herniation.@*METHODS@#From January to December 2017, 59 patients with lumbar intervertebral disc hernation were treated, and another 59 normal persons were recruited as the normal control group. Visual analogue scale (VAS) was used to measure the patient's subjective pain intensity at admission, and the pain threshold of lumbar posterior joints was measured by the tenderness gauge. The pain threshold was measured three times with an interval of 1 min at the most painful posterior joints and the contralateral posterior joints, and the average value was recorded as the T-value.All patients were treated with one course of conservative treatment ( spine fixed-point rotation reduction plus routine dehydration and anti-inflammation). VAS score and pain threshold of posterior lumbar joints were measured after the treatment. One lumbar posterior joint was randomly selected in the normal control group to measure the pain threshold.@*RESULTS@#(1)The patient group and the normal control group were comparable. There was no significant difference in age, body height, body weight and BMI between the two groups(>0.05). (2) The pressure pain threshold test was consistent:variance analysis on the T-value before treatment [(4.72±2.14) kg / cm, (4.96±2.10) kg / cm, (5.11±2.09) kg / cm] of the affected posterior joint, the T-value after treatment [(7.38±2.36) kg / cm, (7.62±2.51) kg / cm, (7.58±2.47) kg / cm], the T-value of before treatment [(7.18±2.80) kg / cm, (7.19±2.68) kg / cm, (7.20±2.69) kg / cm] of the contralateral posterior joint, T value after treatment [(9.54±2.89) kg / cm, (9.76±3.01) kg / cm, (9.77±3.09) kg / cm]; and normal joint T-value [(12.23±1.56) kg / cm, (12.51±1.48) kg / cm, (12.6±1.63) kg / cm] showed that there were no significant differences in the three successive measurements of pain threshold (>0.05). (3) After conservative treatment, the pain threshold of the affected side[(7.58±2.38) kg / cm] and the contralateral lumbar posterior joints [(9.70±2.92) kg / cm] increased significantly, but T-value of the affected side was still lower than that of the contralateral side, and T value of the both sides were lower than that of the normal group [(12.48±1.44) kg / cm]. The T-value of the affected side and the contralateral side had significant difference between before and after treatment (0.05).@*CONCLUSION@#The pressure pain threshold test can accurately evaluate the pain intensity and its changing patterns in the lumbar posterior joint. The pain pressure threshold test is clinically significantin the lumbar disc herniation.

A comparative study on the surface electromyography of lumbosacral multifidus muscle in patients with lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the degeneration of lumbosacral multifidus muscle in patients with lumbar disc herniation.@*METHODS@#Thirty-five healthy volunteers and 35 patients with unilateral L lumbar disc herniation from December 2015 to September 2017 were recruited. There were 20 males and 15 females in each group, aged from 25 to 55 years old. In healthy volunteers group, the mean age was (35.66±8.73) years old and the BMI was (21.85±1.94) kg /m. In patients with lumbar disc herniation, the mean age was (36.09±7.70) years old, the BMI was (21.50±1.78) kg /m, the VAS score was 4.40±0.88, the course of disease was (11.20±7.14) months. Surface electromyography analysis was performed on the multifidus muscle of the two groups. The average myoelectric amplitude of the multifidus muscle in the two groups were compared.@*RESULTS@#The average myoelectric amplitude of the multifidus muscle of healthy volunteers was (48.84±7.77) µV on the left and (49.13±7.86) µV on the right. There was no significant difference between the two sides (>0.05). The average myoelectric amplitude of multifidus muscle in patients with lumbar disc herniation was(48.82±8.14) µV on the healthy side and (42.81±7.00) µV on the affected side, and the difference was statistically significant between two sides(0.05). There was significant difference in the average myoelectric amplitude of multifidus muscle between the affected side of lumbar disc herniation and on the left of healthy volunteers, and also between the affected side of lumbar disc herniation and on the right of healthy volunteers(<0.05).@*CONCLUSION@#Patients with chronic lumbar disc herniation have an imbalance in myoelectric activity, and the muscle strength of the multifidus muscle on the affected side is significantly reduced.

Overview of risk factors for failed percutaneous transforaminal endoscopic discectomy in lumbar disc herniation / 中国骨伤

The lumbar disc herniation is a common and recurrent disease in the department of orthopedics. At present, the treatment means mainly include conservative treatment and surgical treatment. Compared with traditional open surgery, percutaneous transforaminal endoscopic discectomy (PTED) is safe, effective, economical and minimally invasive. It is widely used in minimally invasive treatment of lumbar disc herniation. However, the clinical reports of the failure of PTED are also common. According to the research reports of domestic and foreign scholars, there are varieties of risk factors for surgical failures, including the selections of patients, indications, surgical approaches and anesthesia methods preoperative. Occurrences of surgical complications including infection or left pains, and reasonable rehabilitation exercise after the operation are related to failures. There is no unified conclusion at present. In this paper, we reviewed the literatures about failed PTED, and try to make an overview about the general situation of failed operation in clinical practice, the risk factors for failures and the countermeasures.

Analysis of clinical effect of Xiaosui Huahe decoction for the treatment of 130 patients with giant lumbar intervertebral disc herniation / 中国骨伤

OBJECTIVE@#To explore the clinical effect of conservative treatment for giant lumbar intervertebral disc herniation and analyze the factors affecting its resorption.@*METHODS@#From January 2013 to December 2016, the clinical data of 130 patients with giant lumbar intervertebral disc herniation were collected. The patients were classified according to the characteristics of Iwabuchi displacement and "bull eye sign", Xiaosui Huahe decoction of traditional Chinese medicine conservative treatment was used in the patients. There were 93 males and 37 females, aged from 15 to 64 years old with an average of(37.11±13.96) years old; with the disease duration ranging from 1 day to 8 years with an average of(11.82±20.45) months. Rate of intervertebral disc herniation was measured by Futian's method, and clinical effect was evaluated by JOA score.@*RESULTS@#All the patients were followed up from 13 to 48 months with an average of(21.45±11.87) months, and there were no significant differences in follow-up time between different imaging types(>0.05). The absorption rate 95 patients with persistent conservative treatment was(44.08±35.70)%. The absorption rate of Iwabuchi displacement positive group and "bull eye sign" positive group was significantly higher than the average value(<0.05). The rate of excellent and good JOA scores in 95 patients was 78.95%, 81.05% and 78.95% at 3, 6 and 12 months after treatment, respectively(<0.05). Finally 35 patients accepted surgical treatment, the rate of excellent and good JOA scores was 100% at 3, 6, 12 months after treatment(<0.05).@*CONCLUSIONS@#The clinical effect of Xiaosui Huahe decoction conservative treatment is satisfactory for giant lumbar intervertebral disc herniation. Patients with Iwabuchi displacement and "bull's eye sign" had significant herniation resorption.

Thirty cases of femoral head osteonecrosis misdiagnosed as lumbar disc herniation / 中华老年医学杂志

Objective To analyze the causes for the femoral head osteonecrosis misdiagnosed as lumbar disc herniation.Methods Thirty cases of lumbar disc herniation receiving lumbar CT and MRI were collected,and the causes of misdiagnoses were analyzed.Results Twenty-nine cases with femoral head osteonecrosis were misdiagnosed as lumbar disc herniation.And the diagnosis of femoral head osteonecrosis was missed in a single case of lumbar disc herniation combined with femoral head necrosis.Conclusions The major factors of misdiagnoses and missed diagnosis are the neglect of physical examination,lack of detailed clinical history data collection,excessive reliance on imaging findings,and the absence of necessary differential diagnosis of similar symptoms.

MR conventional sagittal-axial plane and coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation technique in diagnosis of extraforaminal lumbar disc herniation / 中国医学影像技术

Objective To compare the diagnostic value of MR conventional sagittal-axial plane and coronal iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) technique in diagnosis of extraforaminal lumbar disc herniation (ELDH).Methods Totally 32 patients with ELDH confirmed by surgery underwent preoperative MR sagittal-axial plane and coronal IDEAL scanning.Disc herniation,nerve involvement,nerve angle,nerve deep impression,nerve thinning or truncation,nerve adhesion unsmooth and nerve swelling were analyzed between the two methods.Results Disc herniation,nerve involvement and number of reduction or disappearance of surrounding fat had no statistically significant differences between the two methods (all P＞0.05),while nerve angle,nerve deep impression,nerve thinning or truncation,nerve adhesion unsmooth and nerve swelling were significantly different between the two methods (all P＜0.05).Surgical operation confirmed that 32 patients with nerve compression were consistent with findings by IDEAL.Conclusion MR sagittal-axial plane and coronal IDEAL both can be used to diagnose ELDH,but their display ability of nerve compression is different.Coronal IDEAL is superior to conventional sagittal-axial plane and is an effective imaging method,being able to display nerve compression more intuitively,clearly and comprehensively.

The effective of percutaneous endoscopic lumbar discectomy for L5/S1 disc herniation via an interlaminar approach versus a transforaminal approach / 中国医师杂志

Objective To compare the clinical results of percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) in L5/S1 disc herniation.Methods A total of 102 patients with L5/S1 disc herniation in our hospital from September 2014 to June 2016 were enrolled in this study.Fifty-two patients underwent percutaneous endoscopic interlaminar discectomy (PEID group) and 50 patients underwent percutaneous endoscopic transforaminal discectomy (PETD group).The surgical effectiveness was assessed according to Visual Analog Scale (VAS),Oswestry Disability Index (ODI),and modified MacNab criteria.The frequencies of intraoperative radiation exposure,operation time and complication rates were compared between the groups.Results All the patients completed follow up with a mean of 15.0 months (range,10-20 months).In the PEID group,the mean operation time was 44-72 (58.3 ± 12.0)minutes and the intraoperative frequencies of radiation exposure were 3-6(3.8 ±2.1)seconds.For the PETD group,the mean operation time was 52-96(82.4 ± 16.0) minutes and the intraoperative radiation time was 13-34 (24.1 ± 10.1) seconds.There were significant differences in operation time and radiation frequency between the two groups (P ＜ 0.05).The postoperative VAS and ODI were obviously improved in both groups when compared with preoperation (P ＜ 0.05),but there were no significant differences between the two groups (P ＞ 0.05).There was no statistically significant difference considering the satisfactory rates according to the MacNab criteria between PEID group (96.1％) and PETD group (96.0％).Conclusions The treatment of L5/S1 disc herniation through lamina or intervertebral foramen approach is both effective.PEID can significantly reduce the frequencies of intraoperative radiation exposure and operation time.

The research progress on the correlation between metabolic syndrome and lumbar disc herniation / 中国医师杂志

Metabolic syndrome is a group of clinical syndromes characterized by overweight or obesity, hypertension, dyslipidemia, impaired glucose metabolism, and insulin resistance.It is a group of metabolic associated risk factors.Lumbar disc herniation (LDH) is one of the most common diseases nowadays, and its risk factors include obesity, diabetes, and abnormal blood lipid.In recent years, the relationship between LDH and metabolic syndrome (MetS) has been valued by scholars.Although some studies have suggested that MetS is related to LDH, the study of the correlation between MetS and LDH at home and abroad is relatively rare.To explore the possibility of using MetS for the prevention and control of LDH, this paper reviews the research progress of the relationship among MetS, the various components, and LDH.

Comparative study of percutaneous transforaminal endoscopic discectomy and minimally invasive ozone therapy in the treatment of lumbar disc herniation combined with lumbar canal stenosis / 中国医师进修杂志

Objective To compare the efficacy of percutaneous transforaminal endoscopic discectomy with minimally invasive ozone therapy in the treatment of lumbar disc herniation combined with lumbar canal stenosis. Methods The clinical data of 90 patients with lumbar disc herniation combined with lumbar canal stenosis from May 2015 to May 2017 were analyzed retrospectively. The patients were divided into 2 groups according to the method of operation, control group (45 patients received minimally invasive ozone therapy), and observation group (45 patients received percutaneous transforaminal endoscopic discectomy). The basic surgical conditions, visual analog score (VAS), Oswestry dysfunction index (ODI), Japanese Orthopedic Association (JOA) score and efficacy were compared between 2 groups.Results The operation time in observation group was significantly longer than that in control group:(81.93 ± 17.02)min vs.(42.41 ± 15.69)min,postoperative hospitalization time was significantly shorter than that in control group: (1.27 ± 1.05) d vs. (4.29 ± 2.03) d, and there were statistical differences(t=-9.571 and 3.742,P<0.01).The VAS 1 week and 1 month after operation in observation group was significantly lower than that in control group:(4.29 ± 1.39)scores vs.(5.91 ± 1.51) scores and(2.53 ± 0.69)scores vs.(3.25 ± 0.94)scores,and there was statistical difference(P<0.01 or<0.05).The ODI and JOA score 3 months after operation in observation group were significantly better than those in control group: (13.24 ± 5.86) scores vs. (27.83 ± 8.91) scores and (24.24 ± 3.09) scores vs. (20.95 ± 6.25) scores, and there were statistical differences (P<0.01). The eligible rate in observation group was significantly higher than that in control group: 86.67%(39/45)vs.68.89%(31/45),and there was statistical difference(χ2=4.114,P<0.05).Conclusions Percutaneous transforaminal endoscopic discectomy compared with minimally invasive ozone therapy for lumbar disc herniation combined with lumbar canal stenosis is more effective,with shorter postoperative length of stay,more obvious pain relief and more quick lumbar function recovery after operation.

Application progress of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar intervertebral disc herniation / 中国医师杂志

Lumbar intervertebral disc herniation (LDH) is a syndrome caused by various reasons such as nucleus pulposus protrusion,compression of nerve root and herniation of nucleus pulposus,and stimulation of nerve root and cauda equina nerve.It is one of the most common diseases in orthopedics.There are a variety of surgical treatments for this disease,including traditional open surgery and minimally invasive techniques.At present,the minimally invasive technique represented by percutaneous transforaminal endoscopy has gradually replaced the traditional open surgery as the mainstream because of its advantages of less trauma,faster recovery and fewer complications.This article will systematically expound the application and progress of percutaneous lumbar intervertebral foraminoscopy in the treatment of lumbar disc herniation from the development course,indications,operation skills,matters needing attention,curative effect analysis,complications and so on.

Effect of low-temperature plasma radiofrequency ablation and ozone injection on the quality of life of patients with lumbar disc herniation / 中国医师杂志

Objective To investigate the curative effect of low temperature plasma radiofrequency ablation and ozone injection in the treatment of lumbar disc herniation (LDH) and its effect on the quality of life of patients.Methods 240 patients with LDH who were treated in Xining First People's Hospital from December 2015 to February 2017 were enrolled in the study.The patients were divided into low temperature plasma group (low temperature plasma radiofrequency ablation therapy) and ozone injection group (ozone injection therapy) by random number table method,with 120 cases in each group.The operative indexes,complications,and visual analogue scale (VAS) score at different time points,numbness and muscle strength indexes and WHO quality of life scale (WHOQOL-BREF) score were compared between the two groups.The clinical efficacy was compared between patients with different image credit type in two groups.Results The operation time,hospitalization time and the cost of treatment in the ozone injection group were less than that of the low temperature plasma group (P ＜ 0.05).There was no significant difference in VAS score and numbness score between the two groups at different time points (P ＞ 0.05).The abdominal time and the supine crouch time in the low temperature plasma group in 3 months after operation were longer than those in the ozone injection group (P ＜ 0.05).The excellent rate of the lateral type in low temperature plasma group in 3 months and 6 months after operation was higher than that in the ozone injection group (P ＜0.05).The physiological field score,psychological field score and total score in WHOQOL-BREF of low temperature plasma group in 1 month,3 months and 6 months after operation were significantly higher than those of ozone injection group (P ＜ 0.05).There was no significant difference in the incidence of complications between the two groups (P ＞ 0.05).Conclusions Low temperature plasma radiofrequency ablation has better effect in the treatment of lateral LDH,and it can improve lumbar and dorsal muscle strength and lumbar abdominal muscle strength more obviously,improve the quality of life of the patients,but the operation time and hospitalization time are longer,and the cost of treatment is higher.