Curative Effect of Percutaneous Transforaminal Endoscopic Spine System in the Treatment of Lumbar Disc Herniation Complicated with Nerve Root Canal Stenosis / 中山大学学报(医学科学版)

ObjectiveTo explore the clinical efficacy of percutaneous transforaminal endoscopic spine system （TESSYS） in the treatment of lumbar disc herniation （LDH） complicated with nerve root canal stenosis. MethodsA retrospective study was done on 40 LDH patients complicated with nerve root canal stenosis who underwent TESSYS in our hospital from April 2019 to April 2021. The clinical efficacy of the patients was evaluated by the modified Mac Nab criteria 12 months after the surgery. We also measured and analyzed the scores of visual analogue scale （VAS）， Oswestry disability index （ODI） and Japanese orthopaedic association （JOA）， the changes of structural parameters of lumbar spine and inflammatory factor levels preoperatively， 6 and 12 months after the surgery. ResultsAll the 40 cases successfully underwent the surgery and follow-ups， with a 12-month post-operative clinical excellent and good rate of 90%. The preoperative， 6-month and 12-month post-operative VAS scores were （7.38±2.06）， （2.36±0.87） and （1.62±0.82）， respectively. The respective ODI scores were （55.54±11.19）， （26.52±7.61） and （18.14±4.36）； JOA scores （13.93±2.10）， （20.26±1.35） and （22.34±1.88）. The post-operative scores of VAS， ODI and JOA were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative lumbosacral angles were （37.23±6.84）° and （27.37±4.31）°， respectively， with the respective lumbar curvatures of （13.48±3.06） mm and （22.36±4.51） mm. The post-operative lumbosacral angle and lumbar curvature were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative high-sensitivity C-reactive protein （hs-CRP） levels were （3.43±0.61） mg/L and （5.18±0.70） mg/L， respectively， with the respective tumor necrosis factor alpha （TNF-α） levels of （1.44±0.27） mg/L and （2.07±0.44） mg/L. The post-operative levels of hs-CRP and TNF-α were significantly higher than those before the surgery （P<0.05）. ConclusionIn the treatment of LDH complicated with nerve root canal stenosis， TESSYS achieves a good clinical effect， improves the structure and function of the lumbar spine， reduces the degree of lumbar spine pain， and has a mild post-operative inflammatory reaction.

Clinical Effect Evaluation of Acupuncture Combined with Five-Step Reduction for Treating Swimmers with Intervertebral Disc Herniatio / 医用生物力学

Objective To investigate the clinical effect of acupuncture combined with five-step reduction method for treating intervertebral disc herniation (IDH). Methods A total of 80 patients meeting the requirement of IDH were selected and randomly divided into control group, acupuncture group, five-step reduction massage group and acupuncture combined five-step reduction method group. Each group included 20 subjects, who received two courses of treatment for 1 month. After the treatment, the therapeutic effects of acupuncture, five-step reduction massage, acupuncture combined with five-step reduction massage were evaluated. The observation indicators included back pain JOA scale, McGill pain scale, quality of life QOL scale, gravitational moment and muscle moment. Results After the intervention treatment, compared with control group, the JOA, McGill, QOL, gravitational moment and muscle moment of patients in acupuncture group, five-step reduction massage group, acupuncture combined five-step reduction method group were significantly improved (P<0.05), and the improvement effect in combined treatment group was more significant (P<0.01). Conclusions Acupuncture combined with five-step reduction method significantly improved the symptoms of lumbar disc herniation in swimmers.

Different entry points of needle knife for lumbar disc herniation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH).@*METHODS@#A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed.@*RESULTS@#Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group.@*CONCLUSION@#The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.

Kinematic Differences Between Patients with Lumbar Disc Herniation and Healthy People in Three Daily Activities Based on Refined Trunk Model / 医用生物力学

Objective To establish a refined model of trunk composed of different lumbar segments, lumped thoracic spine and pelvis, analyze the kinematic differences between patients with lumbar disc herniation (LDH) and healthy people during three daily activities, and to compare the refined trunk model with the simplified trunk model adopting the whole lumbar segment, and discuss the necessity of using the refined trunk model for kinematic analysis of LDH patients. Methods Motion capture system NDI was used to collect kinematic parameters of each segment from 15 healthy people and 7 male LDH patients during level walking, trunk flexion and contralateral pickup, then the kinematic differences between patients and healthy people by the two models were compared respectively. Results During level walking, the rotation of the thoracic segment and pelvis for LDH patients increased, while no significant change was found in motion angle of the whole lumbar segment, and the rotation angle of L4-5 segment significantly reduced. During trunk flexion, the flexion angles of all lumbar segments for LDH patients were reduced by varying degrees, and the flexion angle of L3-4 segment was significantly different from that of healthy people. During contralateral pickup, the performance on the sagittal plane was similar to that during flexion. However, the lateral bending angles of L3-4 segment and L4-5 segment for LDH patients were significantly lower than those for healthy people. ConclusionsLDH patients mainly restrict the motion of injured lumbar segments in daily activities. During some motions, only refined model can discover the abnormal motion of injured lumbar segments. Therefore, it is necessary to subdivide the lumbar spine into 5 independent segments for analyzing the kinematic characteristics of LDH patients.

Finite Element Study of Lumbar Disc Herniation Loaded with Muscle Force / 医用生物力学

Objective To investigate the effect of muscle function on structural stress in patient with lumbar disc herniation (LDH), by observing the stress changes in LDH lumbar-pelvis finite element model loaded with muscle force. Methods One normal healthy volunteer and one LDH patient were selected. Their CT data were collected to establish two corresponding normal and LDH lumbar-pelvis finite element models, and their gait data were also simultaneously collected to drive the AnyBody musculoskeletal model. The muscle force around the lumbar and pelvis as well as the hip-joint force were obtained as the loading condition. Self-loading of the normal and LDH model as well as the normal model loaded with LDH muscle forces were conducted seperately. Then the stress changes in L4 and L5 intervertebral discs and sacroiliac joints under two above loading conditions were compared. Results The stress curve of normal model loaded with LDH muscle force showed a unimodal stress curve, instead of a bimodal curve, and such trend of stress-time curve was as same as the trend of the LDH model during self-loading. But the stress difference in L4 and L5 intervertebral discs and sacroiliac joint of the normal model loaded with LDH muscle force was smaller than that in the LDH model during self-loading. Conclusions Abnormal muscle function of LDH could lead to abnormal joint stress of the intervertebral discs and sacroiliac joint. Structural imbalance itself could lead to stress imbalance, and muscle as a driving factor was an important cause of anomaly structural dynamic stress, thus leading to abnormal joint motion patterns. Therefore, attention should be paid to assessment of the imbalance of peripheral muscle function in clinical treatment of LDH.

Effects of needling depth on clinical efficacy of lumbar disc herniation: a systematic review / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the effects of needling depth on clinical efficacy of lumbar disc herniation (LDH).</p><p><b>METHODS</b>Ten electronic databases, including China National Knowledge Infrastructure (CNKI), VIP Database, Chinese Biomedical Literature Database (CBM), Wanfang Database, MEDLINE, CENTRAL, CINAHL PLUS, AMED, Embase, PsycINFO, and 6 registry platforms of clinical trials were searched. All randomized controlled trials (RCTs) that compared the effect of needling depth on clinical efficacy of LDH were collected; in addition, the reference lists of the studies included were hand searched. Data were extracted independently by two reviewers. RevMan 5.3 was applied to carry out statistical analysis.</p><p><b>RESULTS</b>Totally 8 716 articles were retrieved, and 10 RCTs were included after screening, involving 1 116 patients. The results showed the effects of deep acupuncture onrelievingpain, reducing the Oswestry disability index (ODI), improving total effective rate and Japanese Orthopaedic Association (JOA) were superior to those of shallow acupuncture in patients with LDH.</p><p><b>CONCLUSION</b>It is preliminarily indicated that deep acupuncture is helpful to improve the therapeutic effect of LDH; however, due to the low research quality and small sample size, the evidence is insufficient, and more high-quality researches are needed to further confirm the results.</p>

Association of lumbar disc herniation with the interaction between environmental factors and Fas/FasL/Caspase-9 apoptosis-associated gene polymorphisms / 西安交通大学学报(医学版)

Objective To investigate the etiologic roles of apoptosis-associated genes,environmental factors and their interactions in lumbar disc herniation (LDH).Methods A case-control trial was conducted.We recruited 128 outpatients with LDH as case group and 132 normal people matched by age and gender as control group.Peripheral venous blood samples were collected and DNA was extracted from leukocytes.By using a modified Brucker Autoflex MALDI-TOF mass spectrometer,we analyzed 3 genes with 9 polymorphic sites,namely,Fas-1377G/A rs2234767,Fas-670G/A rs1800682,Fas rs2147420,Fas rs2296603,Fas rs7901 656,Fas rs1 57101 9,FasL-844C/T rs7631 10,CASP-9-1263A > G rs4645978,and CASP-9-712C > T rs4645981.The correlations between polymorphism of Fas,FasL and CASP-9 genes and the risk of LDH were evaluated by non-conditional Logistic regression model.Multiple Logistic regression model was performed to assess the interaction between apoptosis-associated genes and environment factors,such as lumbar vertebral loads,bed type,spare-time exercises and spare-time activities. Results There were preferable balances in case and control groups in age and gender without significant differences.However,the two groups differed significantly (P G (rs4645978),and FasL-844C/T TT and CASP-9-1263A>G GG genotypes might be the high risk genotypes of LDH.The gene-environment interaction analysis revealed that super-multiplicative and sub-multiplicative interactions respectively between FasL-844TT genotype and lumbar vertebral loads (3-4 level),and between CASP-9-rs4645978 GG and lumbar vertebral loads (3-4 level).Conclusion FasL,CASP-9 genes and lumbar vertebral loads and their interactions play important roles in the pathogenesis of LDH.It suggests that the risk of LDH may be codetermined by environmental factors and inherited susceptibility genes,and that the mechanisms of interactions vary in different genotypes and the same or different environmental factors.

Minimally invasive nucleoplasty combined with Oxygen-Ozone therapy for the treatment of lumbar disc herniation / 中国矫形外科杂志

[Objective]To explore the mechanism of nucleoplasty combined with oxygen-ozone for the treatment of lumbar disc herniation，and to evaluate its therapeutic effects.[Method]From June 2005 to June 2006，62 patients with lumbar disc herniation were treated by nueleoplasty combined with oxygen-ozone，34 were male and 28 were female，ranging in age from 32 to 76 years，with an average of 53.4 years.The course of this disease ranged from 3 to 56 months，meanly 1.3 years.Thirteen patients had the herniation at L4.5 and L3，4，thirty two patients at L4、5，eight patients at L4、5 and L5S1，and nine patients at L5S1.The curative effect was assessed by using a modified MacNab method.[Result]After 25～35 months'follow-up，there were no servious complications in all 62 cases.According to modified MacNab assessment，50 cases(80.7%)achieved excellent outcomes，8 cases(12.9%)good，2 cases(3.2%)fair and 2 cases(3.2%)poor.The excellent and good rate was 93.5%.[Conclusion]The micro-invasive technique of nueleoplasty combined with oxygen-ozone is effective in the treatment of lumbar disc herniation，and it has maximized the clinical effect and minimized the local damage：it also expanded adaptive cases with lumbar disc herniation and enlarged the applicable scope of minimally invasive technique in treating lumbar disc hemiation.

Analysis of the relative factors and reoperative methods of reoperation to lumbar disc herniation / 中国矫形外科杂志

[Objective]To analyze the relative factors of reoperation to lumbar disc herniation(LDH)and to discuss the three methods for reoperation.[Method]By retrospectively studying and analyzing etiopathogenisis in 102 cases,who were made at least one reoperation,and other(1 327) LDH patients underwent an initial standard discectomy in our department from 1999 to 2004.Then studied several relative factors,such as age,interval time between the initial operation to the first reoperation,was made stastistic analysises.Combined with the statistic results,the clinical outcomes of patients who underwent three different reoperative methods were evaluated.[Result]A total of 102 cases underwent at least one reoperadon,11 of them had multiple(two or more)reoperations.Among these patients 58 cases suffered from recurrent LDH,40 suferred from postoperative stenosis or instability and 4 had postoperative intervertebral-space-infection.Forty-eight cases(47.06%)were performed single discectomies again,20(19.61%)undergone decompressions by laminectomy and 34(33.33%)had decompressions,bone-grafting and fixed with spinal instrumentations.There were 16 patients in all interbody-fusion surgeries and the number increasd year by year.Higher reoperation rate was seen in patients with the initial operation taking place less than 1 year comparing,more than those with the initial operation performing more than 1 year ago(P

Evaluation on Physical Performance of the Patients with Lumbar Disc Herniation(review) / 中国康复理论与实践

@#Physical performance is an ability with which the sufferers of lumbar disc herniation(LDH) achieve daily work and basic physical activity,including daily activities(such as the diverting movement from standing to sitting),functioning state of nerves and muscles,dailyworking ability and walking gait,etc.;abilities of body performance relative to pains,such as walking ten meters with loads,sit-stand test and Tread mill walk,etc.Most of current rehabilitation evaluation may be influenced by the subjective factors of the examinee or the examiner,but intelligent device for energy expenditure and activity(IDEEA) may be helpful to evaluate physical performance of the LDH patients in a complete,quantity-fixing,systematic and dynamic way.

Clinical Observation on 34 Cases of Lumbar Disc Herniation Treated by Acupuncture with Combination of Front and Back Points / 中医杂志

Objective To observe effect of acupuncture with combination of front and back points in the treatment of lumbar disc herniation(LDH).Methods The 64 LDH cases were randomized into the treatment group(34 cases) which was treated with the combination of front and back points and control group(30 cases) which was treated with the routine selection of points.The effect of two groups was compared to observe the Visual Analogue Scale(VAS) scores and the improvement in Japan Orthopedics Association(JOA) scores.Results After treatment the curative and remarkably effective rates in the treatment group were higher than those in the control group(P