Objective To comprehensively investigate the incidence of resorption of lumbar disc herniation, and provide reference data for clinical decision-making. Methods Seven electronic databases (PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Wangfang data and Chongqing VIP database) were searched for relevant studies that might have reported morphologic changes in lumbar disc herniation when reporting the follow-up results of patients with lumbar disc herniation treated non-surgically from inception to March, 2020. Articles were screened according to inclusion and exclusion criteria, and the total number of patients, number of patients with resorption, and other important data were extracted for analysis. Random effect models were used for meta-analysis, and subgroup analysis, sensitivity analysis, meta-regression analysis, and Egger’s test were performed. Results A total of 15712 articles were identified from these databases, and 48 were eligible for analysis. A total of 2880 non-surgically treated patients with lumbar disc herniation were included in the meta-analysis, 1740 of whom presented resorption. Meta-analysis revealed that the incidence of resorption was 0.60 [95% confidence interval (CI) (0.46, 0.72)]. In subgroup analyses, studies that quantitatively measured the resorption of lumbar disc herniation yielded statistically higher pooled incidence [0.73, 95%CI (0.60, 0.85)] than those that used qualitative methods [0.51, 95%CI (0.34, 0.69)] (P=0.0252). The pooled incidence gradually increased in randomized controlled trials (RCTs) [0.50, 95%CI (0.15, 0.85)], non-RCT prospective studies [0.59, 95%CI (0.48, 0.70)] and retrospective studies [0.69, 95%CI (0.36, 0.95)], but the difference was not statistically significant (P=0.7523). The pooled incidence varied from 0.58 [95%CI (0.54, 0.71)] to 0.62 [95%CI (0.49, 0.74)] after the sequential omission of each single study. There was no significant change in the pooled incidence [0.62, 95%CI (0.43, 0.79)] when only low-risk RCTs and high-quality non-RCT studies were included, comparing with original meta-analysis results. Meta-regression showed that measurements partially caused heterogeneity (R2=15.34%, P=0.0858). Egger’s test suggested that there was no publication bias (P=0.4622). Conclusions According to current research, there is an overall incidence of resorption of 60% [95%CI (46%, 72%)] among non-surgically treated patients with lumbar disc herniation. The probability of resorption should be fully considered before making a decision on surgery.
ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
ObjectiveTo summarize the research progress of resorption of lumbar disc herniation (RLDH). Methods The literature on RLDH at home and abroad in recent years was reviewed to summarize its influencing factors, pathogenesis, imaging findings, and predictive effect, as well as its influence on the treatment selection of lumbar disc herniation (LDH). ResultsThe main mechanism of RLDH is the combined effect of inflammatory response and neovascularization. Age, smoking, body mass index, and clinical manifestations are the influencing factors. Studies have shown that the annular enhancement around the nucleus pulposus on enhanced MRI images is the characteristic imaging manifestation of RLDH, which is a predictor of whether RLDH occurs. In the treatment of LDH, cyclooxygenase 2 inhibitors may have a negative impact on RLDH. ConclusionThe occurrence of RLDH suggests that strict conservative treatment is the first choice for LDH treatment, but surgery is still an important treatment method when the patient’s symptoms and imaging symptoms don’t significantly improved after conservative treatment.
To compare the effectiveness of microdiscectomy and macrodiscectomy on the single-level lumbar disc protrusion (LDP). Methods Between November 2002 and October 2005, 241 patients with LDP underwent 2 surgical procedures: microdiscectomy (group A, 93 cases) and macrodiscectomy (group B, 148 cases). All patients had singlelevel LDP. In group A, there were 51 males and 42 females with an average age of 32.3 yeares (range, 18-47 years); there were 23cases of protrusion, 52 cases of prolapse, and 18 cases of sequestration with an average disease duration of 8.5 months (range, 1-18 months), including 8 cases at L2,3 level, 11 cases at L3,4 level, 35 cases at L4,5 level, and 39 cases at L5, S1 level. In group B, there were 81 males and 67 females with an average age of 31.8 years (range, 16-50 years); there were 37 cases of protrusion, 85 cases of prolapse, and 26 cases of sequestration with an average disease duration of 9.3 months (range, 1-20 months), including 9 cases at L2,3 level, 15 cases at L3,4 level, 63 cases at L4,5 level, and 61 cases at L5, S1 level. There was no significant difference in age, sex, segment level, type, or disease duration between 2 groups (P gt; 0.05). Results Immediate back and sciatic pain rel ief was achieved in 225 (93.4%) patients after operation. The satisfactory rates were 91.4% in group A and 87.8% in group B at 1 week after operation, showing no significant difference (P gt; 0.05). The length of incision, amount of bleeding, amount of drainage, and hospital ization time in group A were significantly fewer than those in group B (P lt; 0.05); while the operative time in group A was longer than that in group B, but showing no significant difference (P gt; 0.05). Dural laceration occurred in 4 cases of groupA and 5 cases of group B, superficial infections of incision occurred in 5 cases of group B and intervertebral space nfections occurred in 4 cases of group B, and epidural hematoma occurred in 1 case of group A. The perioperative compl ication rate (5.4%, 5/93) in group A was significantly lower (P lt; 0.05) than that in group B (9.5%, 14/148). LDP recurred in 4 cases (4.3%) of group A and in 9 cases (6.1%) of group B postoperatively, showing no significant difference (P gt; 0.05); of them, 11 cases received second operation and 2 cases were treated conservatively. All cases were followed up 36-77 months (mean, 51.4 months). There were significant differences in visual analog scale (VAS) and Oswestry disabil ity index (ODI) between 2 groups at the last follow-up and preoperation (P gt; 0.05), but there was significant difference in VAS at 1 week postoperatively between 2 groups (P lt; 0.05). VAS and ODI were obviously improved at 1 week and last follow-up when compared with preoperation (P lt; 0.05). There was no significant difference in the improvement rates of VAS and ODI between 2 groups at last follow-up (P gt; 0.05). According to cl inical evaluation of Modified Macnab criteria, the excellent and good rate was 90.3% in group A and 86.5% in group B at final follow-up (P gt; 0.05). Conclusion Both macrodiscectomy and microdiscectomy are effective for LDP, furthermore microdiscectomy is less invasive than macrodiscectomy. Microdiscectomy is recommended to treat single-level LDP.
Lumbar disc herniation is one of the most common causes of low back and leg pain in clinic. There are a lot of non-surgical therapeutic methods widely used in clinic for treating lumbar disc herniation. The author assessed the available systematic reviews of non-surgical methods in treating lumbar disc herniation which had been published in these years, and finally a total of 13 systematic reviews were retrieved including 1 about conservative treatments, 8 Chinese medicine treatments, and 4 percutaneous treatments, such as chemonucleolysis and epidural steroid injection. The results showed that the conservative treatments included injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture. But no evidence was found to show that any of the above treatments was clearly superior to others including no treatment for patients with lumbar disc herniation. The outcomes from some reviews showed that Chinese medicine treatments were safer and comprehensive treatment of traditional Chinese medicine was relatively effective compared with single treatment. Electro-acupuncture, compared with conventional therapy (bed rest, waist protection, pelvic traction, manual or physical therapy) and oral medications as well, was safe and effective in alleviating pain and improving overall function. Chinese medicinal fumigation combined with traction was more effective than single treatment. Percutaneous treatment of chemonucleolysis had much better short-term effectiveness. Percutaneous epidural steroid injection also had certain effects. To summarize, Chinese medicine and percutaneous treatments may be effective in treating lumbar disc herniation. However, more clinical trials are needed, since current evidence is of low quality.
Objective To observe the effect of titanium mesh cage with self-locked titanium plate on the cervicalinter-body fusion after anterior discectomy of multilevel cervical intervertebral disc protrusion. Methods The therapeuticeffect of 18 patients who received the treatment of titanium mesh cage with self-locked titanium plate from September 2004 to June 2007 were retrospectively analyzed, including 11 males and 7 females (aged 32-75 years, 54 years on average). The course of disease was 6 months to 15 years (5.8 years on average). Sixteen patients suffered sensory dysfunction in l imbs. Concerning the muscle strength of extremities, 3 cases were on the second level, 12 were on the third level, 1 was on the fourth level, and 2 were on the fifth level. Sixteen cases had pyramidal sign, 13 had retention of urine and feces, 8 had sexual dysfunction, and 7 combined with symptoms of nerve root type. Twelve cases were consecutive multilevel and 6 cases were discontinuous multilevel. The mean JOA scores were 8.30 ± 1.21 preoperatively. X-ray films and MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord preoperatively. The height of involved intervertebral space was (6.40 ± 0.87) mm on X-ray films preoperatively. Results All the incisions were healed by first intention. All the patients were followed up for 6-36 months (18 months on average). The recovery of extremities motor function was better than that of sensory function at the early stage after operation. Muscular tension decreased after operation and mobil ity of l imbs was improved. The operated segments were instantly stable and sol id fusion was observed at 3-6 months after operation. JOA scores at 6 months after operation was 12.60 ± 0.78 with an improvement rate of 51.8%, indicating significant difference wasevident when compared with the JOA scores before operation (P lt; 0.05). The height of involved intervertebral space increased significantly to (8.20 ± 0.46) mm postoperatively, indicating the difference was significant (P lt; 0.05). According to Odom’s evaluation scale, 17 patients were graded as excellent and 1 as good. No death and compl ications of spinal cord, nerve, trachea and esophagus were observed. The cage witnessed no translocation. Conclusion Titanium mesh cage with self-locked titanium plate is more stable and effective for the treatment of multilevel cervical intervertebral disc protrusion.
【摘要】 目的 探讨纳米羟基磷灰石/聚酰胺66（nano-hydroxyapatite polyamide66，n-HA/PA66）颈椎融合器在颈椎间盘突出症前路手术重建中的临床疗效。 方法 2008年12月-2010年6月，对14例颈椎间盘突出症患者行前路椎间盘切除、椎管减压，以n-HA/PA66椎间融合器支撑植骨、钢板螺钉内固定治疗。随访时间3～12个月，平均6.3个月；随访时以日本矫形外科学会（Japan Orthopaedic Assoctiation， JOA）评分改善率评价患者神经功能恢复情况，复查X线片评估椎间融合器植骨融合情况，包括椎间高度及椎间融合器下沉情况。 结果 14例患者均成功完成颈椎前路减压手术以及椎间融合器的安放固定。所有患者术前症状均得到不同程度的改善，术后3、6、12个月的JOA改善率分别为87.0%、94.0%、97.0%。影像学检查显示所有患者植骨融合，椎间高度及椎间融合器的位置维持良好，无下沉、移位。 结论 n-HA/PA66颈椎间融合器具有早期支撑稳定功能，可有效维持颈椎椎间高度；术后植骨融合率高且便于X线片观察，是颈椎间盘突出症患者前路手术植骨的理想支撑材料，但长期效果需进一步随访观察。【Abstract】 Objective To evaluate the clinical effect of artificial cervical vertebra fusion apparatus of n-HA/PA66 in anterior reconstruction of cervical intervertebral disc herniation. Methods From December 2008 to June 2010, 14 patients with cervical intervertebral disc herniation underwent anterior cervical discectomy,spinal canal decompression,spinal canal decompression and reconstruction by n-HA/PA66 composite artificial vertebral body combined with plate instrumentation. The patients were followed up for 3 to 12 months with an average of 6.3 months. Neurological function was evaluated by improvement rate of JOA score and situations of the supporting body was observed by X-ray in 3,6,and 12 months after the surgery.The intervertebral height,the 1ocations, and the fusion rate of the supporting body were assessed in order to evaluate the stability of the cervical spine and alignment improvements. Results All the patients had undergone the operation successfully.The preoperative symptoms improved to varying degrees.JOA improvement rate were 87.0%, 94.0%, and 97.0% 3,6,and 12 months after the operation,respectively.Imaging studies showed that in all cases graft fusion were achieved,and cervical alignments,intervertebral height,cervical spine stability and the locations of the artificial vertebral body were well maintained.No displacement and subsidence of the artificial vertebral body occurred. Conclusion n-HA/PA66 artificial vertebral body can provide early cervical spine support and stability and cervical intervertebral height.It has a high rate of graft fusion and is convenient to observe by X-ray.Therefore,n-HA/PA66 can be taken as an ideal graft for anterior degenerative cervical spine operation,but further follow-up study is still needed to evaluate the long-term effects.
Objective To evaluate the cl inical results of posterior microendoscopic foraminotomy in the treament of cervical radiculopathy and cervical intervertebral disc protrusion. Methods From February 2004 to June 2007, 24 cases of cervical radiculopathy received posterior microendoscopic foraminotomy. There were 16 males and 8 females, aging 42-68 years (59 years on average), including 16 cases of cervical radiculopathy and 8 cases of cervical intervertebral disc protrusion.The course of disease was 6-15 months. The affected intervertebral discs were C4, 5 in 8 cases, C5, 6 in 12 cases, and C6, 7 in 4 cases. The radiological examinations showed that 8 protrusions included 6 soft tissue protusions and 2 rigid tissue protusions, and that cervical radiculopathy were caused by yellow l igament hypertrophy, Luschka’s joint hyperplasia, and abnormal position of facet joint. According to Japanese Orthopedic Association (JOA), the score before operation was (12.60 ± 1.52) points. Results The operation time was 90 to 120 minutes (100 minutes on average), the bleeding during operation was 100 to 150 mL (120 mL on average). Nerve root pain were rel ieved completely in 19 cases and were rel ieved partly in 4 cases. One case of calcified nucleus pulposus had neurological traction injury and recovered completely after 3 months. All cases were followed up 24-36 months (28 months on average). The radiological examinations after operation showed the intervertebral disc site was decompressed completely and the height of intervertebral disc and the cervical segmental al ignment were normal. At 24 months postoperatively, the JOA score was (16.10 ± 0.29) points, showing significant difference when compared with that of preoperation (P lt; 0.01). Conclusion The posterior microendoscopic foraminotomy can get to the operation site with miniincision, decrease tissue damage during operation, and avoid narrow intervertebral space, so it has satisfactory cl inical results.