Background: Lumbar disc herniation is a common injury among athletes, especially those who practice disciplines with repetitive flexion movements, twisting and axial loading on the spine, such as weightlifting, gymnas...Background: Lumbar disc herniation is a common injury among athletes, especially those who practice disciplines with repetitive flexion movements, twisting and axial loading on the spine, such as weightlifting, gymnastics, hockey and American football. In refractory cases to conservative treatment, microscopic discectomy or full endoscopic discectomy are used as surgical options to relieve pain and restore patient functionality. However, the ideal time for a return to sports activities remains a matter of debate due to variations in recovery times and risks of complications associated with each technique. Methods: A review was conducted, including articles published in the last 33 years (1991-2024), as it was the earliest date matching our search criteria. Clinical studies, systematic reviews, meta-analyses, and clinical guidelines were included. Results: The most common complications when returning to sport prematurely include recurrence of the hernia, persistent pain (VAS leg 7 or higher after surgery) and reduced physical performance. The return to full activity rate of patients who underwent microdiscectomy reaches up to 90%, while the endoscopic technique shows a success rate that reaches 99%. Return to play meantime was 5.19 months (range 1.00 - 8.7 months) and mean time of 4.6 months (range 2 - 8 months) with Microdiscectomy and full endoscopic discectomy respectively. Conclusions: There is no unanimous consensus on the exact timing of return to sport due to variability in recovery times and clinical outcomes. In both techniques, evidence highlights the need for a multidisciplinary approach that integrates surgeons, physical therapists and trainers to optimize recovery and ensure a safe return.展开更多
Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of...Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of 100 patients with lumbar disc herniation treated at Xianning Matang Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were divided into a control group of 50 patients treated with Duhuo Jisheng decoction and a study group of 50 patients treated with Duhuo Jisheng decoction combined with warm acupuncture and moxibustion.The TCM syndrome scores,lumbar function,lumbar pain,and lumbar activity were compared between the two groups.Results:After intervention,the TCM syndrome scores,ODI,and VAS scores of both groups showed a decreasing trend compared to before intervention,and the decreasing trend was more significant in the study group(P<0.05).After intervention,the JOA and lumbar activity indicators of both groups showed an increasing trend compared to before intervention,and the increasing trend was more significant in the study group(P<0.05).Conclusion:Duhuo Jisheng decoction combined with warm acupuncture and moxibustion is an effective and safe treatment method for lumbar disc herniation,which can improve lumbar function and activity.展开更多
BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible ...BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible nerve root.Percutaneous transforaminal endoscopic discectomy(PTED)is a minimally invasive and effective method to treat FLLDH.However,no report has investigated PTED combined with SNRB to treat FLLDH.AIM To explore the diagnosis and treatment process,surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.METHODS This is a multicenter center,retrospective,observational study.Between January 2020 and January 2022,32 patients were initially diagnosed with FLLDH.All the patients were identified using SNRB to determine the responsible segment and involved nerve roots.Because of poor symptomatic control following SNRB,2 patients were excluded.30 patients diagnosed with FFLDH underwent PTED.The clinical characteristics,operative and postoperative outcomes,complication and subsequent follow-up were collected.RESULTS 30 patients who underwent SNRB combined with PTED were followed up.The average visual analogue scale(VAS)-leg score,VAS-back score,Oswestry disability index(ODI)score at the Follow-up(1 day,1 month,3 months and last follow-up)were significantly different compared per-operation.According to the modified Macnab efficacy evaluation standard,the satisfaction degree at the last follow-up was excellent(28,93.33%),good(1,3.33%),medium(1,3.33%)and poor(0,0%).CONCLUSION SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots.Combination therapy offers several advantages including minimal invasiveness,precision,effectiveness,safety and low recurrence rates.展开更多
Objective To observe the changes of sciatic nerve conduction velocity （SNCV） and interleukin-1α （IL-1α）, phospholipase A2 （PLA2） and prostaglandin E2 （PGE2） in neucleus pulposus tissue in experimental rabbit...Objective To observe the changes of sciatic nerve conduction velocity （SNCV） and interleukin-1α （IL-1α）, phospholipase A2 （PLA2） and prostaglandin E2 （PGE2） in neucleus pulposus tissue in experimental rabbits with lumbar disc herniation （LDH） ; and discuss the mechanism of LDH treated with bloodletting on Wěizhōng （委中 BL40）. Methods 40 normal named control group, LDH model group, BL40 group New Zealand rabbits were randomized into 4 groups, and comparative point group. The experimental LDH model was prepared by the self-made LDH animal pathological modeling device. Bloodletting on BL40 or on comparative point was applied for 7 days. BL-410 physiological signal recorder was used to record SNCV. Enzyme-linked immunosorbent assay （ELISA） and radioimmunology methods were used to determine the contents of IL-1α and PLA2 in neucleus pulposus tissue and PGE2 in serum. Results In BL40 group, SNCV was significantly increased after treatment comparing with that before treatment （P〈0. 01 ）, and the difference in SNCV value before and after treatment was significantly bigger than that in model group and comparative point group （P〈0.05）. Bloodletting on BL40 reduced the contents of IL-1α and PLA2 in neucleus pulposus tissue and serum PGE2 in LDH rabbits, which indicated significant difference or very significant results in the comparison with model and comparative point groups （P〈0.01 or 0. 05）. Conclusion Bloodletting speeded up rapidly SNCV and reduced the contents of inflammatory factors, i.e. IL-1α, PLA2 and serum PGE2 in LDH rabbits, which indicated that alleviation of local inflammatory reaction is probably one of the mechanisms on LDH treated by bloodletting on BL40.展开更多
BACKGROUND The technique of percutaneous endoscopic lumbar discectomy(PELD)as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations.However,due to the different anatomic charac...BACKGROUND The technique of percutaneous endoscopic lumbar discectomy(PELD)as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations.However,due to the different anatomic characteristics of the upper lumbar spine,conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus.Therefore,the purpose of this study was to describe a novel surgical technique,two-level PELD,for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.CASE SUMMARY A 60-year-old male presented with a complaint of pain at his lower back and right lower limb.The patient received 3 mo of conservative treatments but the symptoms were not alleviated.Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg,and preoperative visual analog scale(VAS)score for the lower back was 6 points and for the right leg was 8 points.Magnetic resonance imaging(MRI)demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body.According to physical examination and imaging findings,surgery was the primary consideration.Therefore,the patient underwent surgical treatment with two-level PELD.The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively.The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.CONCLUSION Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.展开更多
Objective To discuss the clinical efficacy on lumbar disc herniation （LDH） treated with acupuncture and massage manipulations. Methods One hundred and twenty-four cases of LDH were treated with acupuncture at Taicho...Objective To discuss the clinical efficacy on lumbar disc herniation （LDH） treated with acupuncture and massage manipulations. Methods One hundred and twenty-four cases of LDH were treated with acupuncture at Taichong （太冲LR 3）, Neiting （内庭 ST 44）, Zulinqi （足临泣 GB 41）, Yaotongdian （腰痛点 lumbar pain point）, Tuntangdian （臀痛点 buttock pain point） and Zuogushenjingdian （坐骨神经点 sciatic point） and massage manipulations [including gunfa （rolling technique）, yizhichan tuifa （one-finger pushing technique）, qianyin doudong fa （shaking technique under traction）, anyofa （pressing technique） and zuoyou cebanfa （bilateral pulling technique）], once a day, for 3 weeks totally. The lower back pain scoring system of the Japanese Orthopedic Association （JOA） was adopted for the scoring before and after treatment to assess the efficacy. Results At the end of treatment, JOA score was reduced to （0.95±0.32） points as compared with （6.14±0.97） points before treatment （P〈0.01）. Concerning to the efficacy improvement rate, 96 cases were excellent, 12 cases good, 5 cases fair and 3 cases poor. 116 cases received the follow-up visit for 6 months averagely and no case of recurrence was reported. Conclusion Acupuncture combined with massage manipulate can relieve rapidly acute pain in the lumbar region and legs and acts directly on the foci. This therapy is safe and effective, achieves the high clinical curative rate and brings less pain to the patients.展开更多
Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis an...Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.展开更多
Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain p...Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.展开更多
We want to explore the analgesic brain effect of the moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation(LDH)and myofascial pain syndrome(MPS).In an assessor-blinded observational st...We want to explore the analgesic brain effect of the moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation(LDH)and myofascial pain syndrome(MPS).In an assessor-blinded observational study,we will include 15 LDH and 15 MPS.They will accept same treatment of heat-sensitive moxibustion at Yaoyangguan(GV3).The resting-state functionality magnetic resonance imaging image data of brain activities before and after treatment will be analyzed by mean fractional amplitude of low-frequency fluctuation,regional homogeneity analysis and brain functional connection.We select seed of first sensory cortex,second sensory cortex,insula cortex,periaqueductal gray and anterior cingulate cortex as the regions of interest to analyse the relationship between brain functional connectivity of pain-related networks and clinical data.Our study could disclose key brain targets and central response characteristics of the analgesic brain effect and the brain functional connection of heat-sensitive moxibustion.展开更多
Objective:To observe the differences in clinical therapeutic effect on acute attack of lumbar disc herniation(LDH) treated with electroacupuncture(EA) of different wave patterns so as to optimize EA wave pattern in th...Objective:To observe the differences in clinical therapeutic effect on acute attack of lumbar disc herniation(LDH) treated with electroacupuncture(EA) of different wave patterns so as to optimize EA wave pattern in the treatment of acute attack of LDH.Methods:A total of 108 patients were randomized into three groups,i.e.,a disperse-dense wave,an intermittent wave and a continuous wave group,36 cases in each one.In all of three groups,Shangliao(上髎BL31),Ciliao(次髎BL32),Zhongliao(中髎BL33) and Xialiao(下髎BL34) were selected bilaterally as the main acupoints,which is generally termed as Baliao(八髎BL31 to BL34,bilateral).In each group,the corresponding wave pattern was used in EA.The treatment lasted 20 min each time,once daily,totally for 10 days.Before and after treatment,the score of visual analogue scale(VAS) and the score of the lower back pain of Japanese orthopedic association(JOA) were observed in the patients of three groups and the overall therapeutic effect was evaluated.Results:After treatment,the VAS score was decreased and JOA score was increased in the patients of 3 groups,indicating statistical significance(all P <0.05).In comparison of VAS score before and after treatment among three groups,the score in the disperse-dense wave group was higher than the intermittent wave group and the continuous wave group,indicating statistical differences(both P <0.05).In comparison of JOA score before and after treatment among three groups,the score in the continuous wave group was higher than the intermittent wave group and the disperse-dense wave group,indicating statistical differences(both P <0.05).The total effective rate was 94.12% in the disperse-dense wave group,94.29% in the intermittent wave group and 97.14% in continuous wave group,without significant difference among groups(P> 0.05).Conclusion:Electroacupuncture of 3 different wave patterns all effectively relieves clinical symptoms of acute attack of lumbar disc herniation.Regarding pain release,electroacupuncture with disperse-dense wave is better than intermittent wave and continuous wave.Regarding the improvement of lumbar function,the effect of electroacupuncture with continuous wave is better than disperse-dense wave and intermittent wave.展开更多
OBJECTIVE:To evaluate the available evidence from randomized controlled trials(RCTs)of moxibustion alone for lumbar disc herniation(LDH)treatment.METHODS:A systematic search of 10 databases(until August 30,2021)was us...OBJECTIVE:To evaluate the available evidence from randomized controlled trials(RCTs)of moxibustion alone for lumbar disc herniation(LDH)treatment.METHODS:A systematic search of 10 databases(until August 30,2021)was used to identify studies that reported the response rate,visual analogue scale(VAS)score,Japanese Orthopedic Association(JOA)score,and Oswestry Disability Index(ODI)score.Study selection and data extraction were independently performed by two reviewers.Cochrane criteria for risk of bias were used to assess the methodological quality of the trials.The Grading of Recommendations Assessment,Development,and Evaluation Methodology(GRADE)were also used to test the quality of the result evidence.RESULTS:Nineteen RCTs,including 1888 patients,met the inclusion criteria.Five studies showed no difference between moxibustion and acupuncture on response rate[risk ratio(RR)=1.07,95%CI(0.98,1.16),P=0.11].Meanwhile,six studies suggested that there is no significant difference between moxibustion and acupuncture on VAS score[mean difference(MD)=-0.43,95%CI(-0.91,0.05),P=0.08].Eight studies implied that there is no significant difference between moxibustion and acupuncture on JOA score[MD=0.84,95%CI(-1.27,2.96),P=0.44].Two studies indicated that moxibustion may have equivalent effects for treating LDH in the VAS score in comparison with drug therapy[MD=-1.16,95%CI(-2.63,0.31),P=0.12].The evidence level of results was determined to be very low to low.CONCLUSIONS:Based on the existing evidence,moxibustion may not be suitable for treating LDH alone,but it may be applied as an adjuvant treatment.Furthermore,well-designed RCTs with high quality and larger samples are still needed to evaluate the efficacy and safety of moxibustion alone for LDH treatment.展开更多
BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open d...BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.展开更多
BACKGROUND Surgery is often indicated for patients with massively prolapsed intervertebral disc herniation.The interlaminar endoscopic spine system(iLESSYS)Delta 6-mm working channel endoscope has advantages over othe...BACKGROUND Surgery is often indicated for patients with massively prolapsed intervertebral disc herniation.The interlaminar endoscopic spine system(iLESSYS)Delta 6-mm working channel endoscope has advantages over other systems.The aim of this study was to explore the benefits and complications of using the iLESSYS Delta for the treatment of massively prolapsed intervertebral disc herniation.AIM To explore the clinical benefits of treating massively prolapsed lumbar intervertebral disc herniation with the iLESSYS Delta endoscope.METHODS In this study,the data of 37 patients who underwent surgery with the iLESSYS Delta endoscope at The Affiliated Hospital of Qingdao University were retrospectively analyzed.Intraoperative blood loss,operation time,and complications were collected.The visual analog scale(VAS),oswestry disability index(ODI),and modified MacNab criteria were determined before and at 1 d,3 mo,and 6 mo after surgery.RESULTS The mean intraoperative blood loss was 20.4±1.2 mL.The mean operation time was 97.3±12.4 min.The VAS scores for leg and back pain decreased from 68.0±7.3,34.4±8.5 before operation to 2.5±1.7,5.5±1.9 at 6 mo after surgery,respectively.The ODI also decreased from 60.2±7.3 to 17.9±3.4 at 6 mo after surgery.The improvement rate of the MacNab score was 86.4%,which was considered excellent.No spinal dural injury,nerve root injury,secondary protrusion of intervertebral disc,or myeloid hypertension was found during follow-up.CONCLUSION The iLESSYS Delta 6-mm working channel endoscope has several advantages in terms of clinical and functional benefits,complications,and low risk of residual vertebral pulp in treating patients with massively prolapsed intervertebral disc herniation.展开更多
Objective To explore therapeutic efficacy of warming needle moxibustion and electroacupuncture for postoperative pain in the waist and leg of lumbar disc herniation. Methods Forty-six cases were treated with warming n...Objective To explore therapeutic efficacy of warming needle moxibustion and electroacupuncture for postoperative pain in the waist and leg of lumbar disc herniation. Methods Forty-six cases were treated with warming needle moxibustion at Yaotu （腰突, extra point, the same segment of injured disc herniation）, regular acupuncture at Yaoyan （腰眼 EX-B 7）, Zhibian （秩边BL 54）, Huantiao （环跳 GB 30）, Weizhong （委中BL 40）, Yanglingquan （阳陵泉 GB 34） and electroacupuncture at Yaoto （腰突）, Zhibian （秩边 BL 54）, Yanglingquan （阳陵泉 GB 34）. The treatment was given once a day, 10 treatments made up one session, and the therapeutic effect was assessed after 2 sessions of treatment. Results After the treatment, 31 cases （67.4%） were cured, 14 cases （30.4%） were effective and i case （2.2%） was failed. The total effective rate was 97.8%. Conclusion The warming needle moxibustion combined with electroacupuncture has obvious therapeutic effect on postoperative pain in the waist and leg of lumbar disc herniation.展开更多
Objective： To compare the effect differences of electroacupuncture（EA） at Jiajǐ（夹脊 EX-B2） and conventional acupoints for lumbar intervertebral disc herniation（LIDH） and the factors influenced the effect duri...Objective： To compare the effect differences of electroacupuncture（EA） at Jiajǐ（夹脊 EX-B2） and conventional acupoints for lumbar intervertebral disc herniation（LIDH） and the factors influenced the effect during the way of data mining.Methods： A total of 160 patients of LIDH were randomly assigned into the EX-B2 group and the conventional acupoints group, 80 cases in each one. The patients in the EX-B2 group received EA at the symmetrical 2 acupoints of the bilateral EX-B2 on the lesion part. The patients in the conventional acupoints group received EA at the tender point of the lesion part, Zhibian（ 秩边BL54）, Huantiao（环跳 GB30）,weǐzhōng（委中BL40）, Chéngshān（承山BL57） and Fúyáng（跗阳BL59） on the affected side. The retain time of the needles is both 45 min. The treatment of the two groups is 3 times a week and for a connective 20 times. The modified Assessment Criteria for Low Lumbar Pain of Japanese Orthopedic Association（JOA）,Visual Analogue Scale（VAS） were evaluated before and after the treatment and at the 6-month follow up.Results：（1） Effective outcomes. JOA score： The JOA score of the patients in the EX-B2 group after treatment was（20.89 士 3.43）, and was（19.35 ±4.02） on the follow-up. Compared with the JOA score（12.35 ±4.42） in the same group before the treatment, there were statistical significant higher（both P0.05）. The JOA score in the EX-B2 group after treatment and on the follow-up were both higher than that of the conventional acupoints group at the same time point（both P0.05）. VAS score： The VAS score of the patients in the EX-B2 group on the 24 h after the first treatment was（4.09 ± 1.81）, and was（2.11 ± 1.30） after the treatment. Compared with the VAS score（4.09 ± 1.81） in the same group before the treatment, there were statistical significant lower（both P0.05）. The VAS score in the EX-B2 group on the 24 h after the first treatment and after treatment showed no statistical differences than that of the conventional acupoints group at the same time point（both P0.05）.（2）Related results from data mining： The middle-aged people and disease duration less than six months, their effect of the immediate treatment was the best. According to JOA score, EA at EX-B2 was better than EA conventional acupoints,either in the process of treatment effect, or in pertinence of the treatment, which were superior to EA conventional acupoints therapy; The best curative effect time of EA at EX-B2 was the first treatment after24 h, and the best curative effect of the conventional acupoints was after the first treatment. The age and disease duration also affected curative effect.Conclusion： The effect of EA at EX-B2 was superior to the conventional acupoints in treating LIDH.展开更多
BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneou...BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneous laser disc decompression.Unfortunately,all of these methods carry inherent risk of causing harm to the patient and,as such,there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH.The purpose of this report is to describe a non-invasive method for re-absorption of LDH.CASE SUMMARY A 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb.Her self-reported medical history included persistent postpartum low back pain from 7 years prior.Physical exam showed positivity for neck flexion test(Lindner sign)and supine abdomen test;the straight leg-raising test showed right 60(+)and left 80(-).Findings from standard imaging(magnetic resonance)and collective physical examinations indicated a L5/S1 herniated lumbar disc.Treatment consisted of three-dimensional(balanced regulating)spinal manipulation and acupuncture,upon which the LDH resolved by retraction.CONCLUSION Following L5/S1 herniated lumbar disc diagnosis,three-dimensional(balanced regulating)spinal manipulation combined with acupuncture therapy is an effective treatment.展开更多
Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accura...Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH.Methods:From databases such as CBM(Chinese biomedical literature database),VIP(China science and technology journal database),CNKI(China national knowledge infrastructure),WF(Wanfang database),Web of Science,Embase,Medline,and Cochrane Library,systematic reviews on acupuncture and/or moxibustion for LDH were retrieved,and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews(AMSTAR)list.Furthermore,the grading of recommendations assessment,development and evaluation(GRADE)system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement to evaluate the quality of the report.Results:A total of 18 systematic reviews were included,and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment.According to the AMSTAR score,there were 4 high-quality studies,13 moderate-quality studies,and 1 low-quality study.GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower.The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items,and 10 articles were in line with 10-19 of the 27 items.Conclusion:At present,acupuncture and/or moxibustion for LDH has a good curative effect.More importantly,its methodological quality was of moderate level and the report quality was generally good and relatively complete.However,the poor quality of the original research results was reflected in the quality of evidence.More studies are needed to make sure whether acupuncture is more effective than other treatment methods.展开更多
Objective: To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In t...Objective: To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In the period from March 2000 to December 2002, 9 patients with ELDH underwent disc resection with METRx system through intratransversal route and the clinical outcome was evaluated with Nakai standard. Results: The operation time ranged from 60 to 120 min with an average of 75 min; the blood loss ranged from 50 to 120 ml with an average of 60 ml; and the hospitalization time ranged from 5 to 19 d with an average of 13 d. No wound infection, neurological damages, pseudomeningocele or other complications occurred. The rate of excellent and good outcome was 88.9%. Conclusion: Disc removal in patients with ELDH can be done with METRx system and satisfactory results are obtained.展开更多
Intervertebral disc herniation(IVDH)is a common manifestation of intervertebral disc degeneration(IVDD)characterized by inflammation that results in the rupture of the annulus fibrosus(AF)and her-niation of the nucleu...Intervertebral disc herniation(IVDH)is a common manifestation of intervertebral disc degeneration(IVDD)characterized by inflammation that results in the rupture of the annulus fibrosus(AF)and her-niation of the nucleus pulposus(NP).While current clinical research primarily focuses on regulating the degenerative NP,the crucial role of the AF in maintaining the mechanical stability and metabolic balance of the intervertebral disc(IVD)has been overlooked.Resolving immunoregulation and AF repair is im-perative to effectively prevent recurrent herniation.Therefore,this study introduces a bioactive sealant(OD/GM/QCS-sEVs),which combines gelatin methacryloyl(GM)and oxidized dextran(OD)with quater-nized chitosan(QCS)and incorporates small extracellular vesicles(sEVs).The developed sealant possesses injectability,self-healing capabilities,tissue adhesiveness,and mechanical stability,with an average ad-hesive strength of 109.63 kPa.In vitro experiments demonstrate that OD/GM/QCS-sEVs effectively seal AF defects while preserving mechanical properties comparable to those of a normal IVD.Additionally,the sealant releases sEVs through a pH-responsive mechanism,thereby modulating macrophage polarization to the M2 phenotype via the NF-κB signaling pathway.This mechanism facilitates immunoregulation and anti-inflammatory effects,and promotes stem cell differentiation into fibrocartilage.Animal experiments confirm the ability of OD/GM/QCS-sEVs to seal defects,prevent proteoglycan loss,inhibit IVDD develop-ment,and promote AF regeneration.Overall,OD/GM/QCS-sEVs hold promise as an innovative bioactive sealant for recurrent herniation by resolving immunoregulation and AF regeneration.展开更多
Objective:To evaluate the effectiveness of different acupuncture treatments in the treatment of lumbar disc herniation.Methods:Searching PubMed,EMBASE,Cochrane Library,web of by computer Science,Chinese Journal Full-t...Objective:To evaluate the effectiveness of different acupuncture treatments in the treatment of lumbar disc herniation.Methods:Searching PubMed,EMBASE,Cochrane Library,web of by computer Science,Chinese Journal Full-text Database,Wanfang database,VIP database and Chinese biomedical literature database,the retrieval time is from the establishment of the database to January 1,2020.Two researchers conducted literature screening,quality evaluation and data extraction according to the nano platoon standard,and used stata16.0 for network meta-analysis.Results:a total of 69 RCTs were included,involving 6168 patients with lumbar disc herniation,5 kinds of acupuncture therapy(warm acupuncture,fire acupuncture,electroacupuncture,acupuncture thread embedding,general acupuncture).The results of network meta-analysis showed that the effect of electroacupuncture was inferior to that of warm acupuncture,acupuncture thread embedding,and the effect of general acupuncture was inferior to that of warm acupuncture,fire acupuncture,electroacupuncture,acupuncture thread embedding,and the difference was statistically significant.In terms of efficiency,acupuncture and moxibustion embedding thread>warming acupuncture and moxibustion>fire acupuncture>electroacupuncture>ordinary acupuncture.Conclusion:in the treatment of lumbar disc herniation,the clinical effect of acupuncture thread embedding is better than the other four interventions.However,the quality and quantity of literature in this study are limited,and the conclusion of this study needs to be verified by high-quality RCT with multiple centers and large samples.展开更多
文摘Background: Lumbar disc herniation is a common injury among athletes, especially those who practice disciplines with repetitive flexion movements, twisting and axial loading on the spine, such as weightlifting, gymnastics, hockey and American football. In refractory cases to conservative treatment, microscopic discectomy or full endoscopic discectomy are used as surgical options to relieve pain and restore patient functionality. However, the ideal time for a return to sports activities remains a matter of debate due to variations in recovery times and risks of complications associated with each technique. Methods: A review was conducted, including articles published in the last 33 years (1991-2024), as it was the earliest date matching our search criteria. Clinical studies, systematic reviews, meta-analyses, and clinical guidelines were included. Results: The most common complications when returning to sport prematurely include recurrence of the hernia, persistent pain (VAS leg 7 or higher after surgery) and reduced physical performance. The return to full activity rate of patients who underwent microdiscectomy reaches up to 90%, while the endoscopic technique shows a success rate that reaches 99%. Return to play meantime was 5.19 months (range 1.00 - 8.7 months) and mean time of 4.6 months (range 2 - 8 months) with Microdiscectomy and full endoscopic discectomy respectively. Conclusions: There is no unanimous consensus on the exact timing of return to sport due to variability in recovery times and clinical outcomes. In both techniques, evidence highlights the need for a multidisciplinary approach that integrates surgeons, physical therapists and trainers to optimize recovery and ensure a safe return.
文摘Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of 100 patients with lumbar disc herniation treated at Xianning Matang Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were divided into a control group of 50 patients treated with Duhuo Jisheng decoction and a study group of 50 patients treated with Duhuo Jisheng decoction combined with warm acupuncture and moxibustion.The TCM syndrome scores,lumbar function,lumbar pain,and lumbar activity were compared between the two groups.Results:After intervention,the TCM syndrome scores,ODI,and VAS scores of both groups showed a decreasing trend compared to before intervention,and the decreasing trend was more significant in the study group(P<0.05).After intervention,the JOA and lumbar activity indicators of both groups showed an increasing trend compared to before intervention,and the increasing trend was more significant in the study group(P<0.05).Conclusion:Duhuo Jisheng decoction combined with warm acupuncture and moxibustion is an effective and safe treatment method for lumbar disc herniation,which can improve lumbar function and activity.
基金Supported by the National Key R&D Program of China,No.Key Special Project for Marine Environmental Security and Sustainable Development of Coral Reefs 2022-3.5the National Natural Science Foundation of China,No.82102605,82472458,and 82272533.
文摘BACKGROUND Far lateral lumbar disc herniation(FLLDH)is a special type of lumbar disc herniation with high rate of missed diagnosis.Selective nerve root block(SNRB)has special advantages in identifying the responsible nerve root.Percutaneous transforaminal endoscopic discectomy(PTED)is a minimally invasive and effective method to treat FLLDH.However,no report has investigated PTED combined with SNRB to treat FLLDH.AIM To explore the diagnosis and treatment process,surgical technique and clinical efficacy of PTED combined with SNRB to treat FLLDH.METHODS This is a multicenter center,retrospective,observational study.Between January 2020 and January 2022,32 patients were initially diagnosed with FLLDH.All the patients were identified using SNRB to determine the responsible segment and involved nerve roots.Because of poor symptomatic control following SNRB,2 patients were excluded.30 patients diagnosed with FFLDH underwent PTED.The clinical characteristics,operative and postoperative outcomes,complication and subsequent follow-up were collected.RESULTS 30 patients who underwent SNRB combined with PTED were followed up.The average visual analogue scale(VAS)-leg score,VAS-back score,Oswestry disability index(ODI)score at the Follow-up(1 day,1 month,3 months and last follow-up)were significantly different compared per-operation.According to the modified Macnab efficacy evaluation standard,the satisfaction degree at the last follow-up was excellent(28,93.33%),good(1,3.33%),medium(1,3.33%)and poor(0,0%).CONCLUSION SNRB provides an effective method for the definite diagnosis of FLDH and responsible nerve roots.Combination therapy offers several advantages including minimal invasiveness,precision,effectiveness,safety and low recurrence rates.
文摘Objective To observe the changes of sciatic nerve conduction velocity （SNCV） and interleukin-1α （IL-1α）, phospholipase A2 （PLA2） and prostaglandin E2 （PGE2） in neucleus pulposus tissue in experimental rabbits with lumbar disc herniation （LDH） ; and discuss the mechanism of LDH treated with bloodletting on Wěizhōng （委中 BL40）. Methods 40 normal named control group, LDH model group, BL40 group New Zealand rabbits were randomized into 4 groups, and comparative point group. The experimental LDH model was prepared by the self-made LDH animal pathological modeling device. Bloodletting on BL40 or on comparative point was applied for 7 days. BL-410 physiological signal recorder was used to record SNCV. Enzyme-linked immunosorbent assay （ELISA） and radioimmunology methods were used to determine the contents of IL-1α and PLA2 in neucleus pulposus tissue and PGE2 in serum. Results In BL40 group, SNCV was significantly increased after treatment comparing with that before treatment （P〈0. 01 ）, and the difference in SNCV value before and after treatment was significantly bigger than that in model group and comparative point group （P〈0.05）. Bloodletting on BL40 reduced the contents of IL-1α and PLA2 in neucleus pulposus tissue and serum PGE2 in LDH rabbits, which indicated significant difference or very significant results in the comparison with model and comparative point groups （P〈0.01 or 0. 05）. Conclusion Bloodletting speeded up rapidly SNCV and reduced the contents of inflammatory factors, i.e. IL-1α, PLA2 and serum PGE2 in LDH rabbits, which indicated that alleviation of local inflammatory reaction is probably one of the mechanisms on LDH treated by bloodletting on BL40.
文摘BACKGROUND The technique of percutaneous endoscopic lumbar discectomy(PELD)as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations.However,due to the different anatomic characteristics of the upper lumbar spine,conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus.Therefore,the purpose of this study was to describe a novel surgical technique,two-level PELD,for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.CASE SUMMARY A 60-year-old male presented with a complaint of pain at his lower back and right lower limb.The patient received 3 mo of conservative treatments but the symptoms were not alleviated.Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg,and preoperative visual analog scale(VAS)score for the lower back was 6 points and for the right leg was 8 points.Magnetic resonance imaging(MRI)demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body.According to physical examination and imaging findings,surgery was the primary consideration.Therefore,the patient underwent surgical treatment with two-level PELD.The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively.The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.CONCLUSION Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.
文摘Objective To discuss the clinical efficacy on lumbar disc herniation （LDH） treated with acupuncture and massage manipulations. Methods One hundred and twenty-four cases of LDH were treated with acupuncture at Taichong （太冲LR 3）, Neiting （内庭 ST 44）, Zulinqi （足临泣 GB 41）, Yaotongdian （腰痛点 lumbar pain point）, Tuntangdian （臀痛点 buttock pain point） and Zuogushenjingdian （坐骨神经点 sciatic point） and massage manipulations [including gunfa （rolling technique）, yizhichan tuifa （one-finger pushing technique）, qianyin doudong fa （shaking technique under traction）, anyofa （pressing technique） and zuoyou cebanfa （bilateral pulling technique）], once a day, for 3 weeks totally. The lower back pain scoring system of the Japanese Orthopedic Association （JOA） was adopted for the scoring before and after treatment to assess the efficacy. Results At the end of treatment, JOA score was reduced to （0.95±0.32） points as compared with （6.14±0.97） points before treatment （P〈0.01）. Concerning to the efficacy improvement rate, 96 cases were excellent, 12 cases good, 5 cases fair and 3 cases poor. 116 cases received the follow-up visit for 6 months averagely and no case of recurrence was reported. Conclusion Acupuncture combined with massage manipulate can relieve rapidly acute pain in the lumbar region and legs and acts directly on the foci. This therapy is safe and effective, achieves the high clinical curative rate and brings less pain to the patients.
文摘Lumbar disc herniation is a common disease in the clinical context and does great harm to either the physical or mental health of patients suffering from this disease.Many guidelines and consensus for the diagnosis and treatment of lumbar disc herniation have been published domestically and internationally.According to the expert consensus,clinicians could adopt tailored and personalized diagnosis and treatment management strategies for lumbar disc herniation patients.
基金funded by the Scientific Research Innovation Program regarding Traditional Chinese Medicine of Guangzhou University of Chinese Medicine (Central mechanism of balanced acupuncture for lumbar disc herniationusing functional MRI), No. 09CX068
文摘Balanced acupuncture, a single-acupoint balance therapy, regulates the balance of the cerebral center, and is characterized by exerting quick effects and a short treatment course. A total of 20 low-back and leg pain patients with lumbar disc herniation were treated with balanced acupuncture or body acupuncture. Central mechanisms of vaded acupunctures were compared using resting-state functional MRI. Patients from both groups received functional MRI before and after acupuncture. Functional connectivity in brain regions that were strongly associated with the bilatera amygdala was analyzed utilizing AFNI software. Visual analogue scale scores were greater in the balanced acupuncture group compared with the body acupuncture group. Function of the endogenous pain regulation network was enhanced in patients in the balanced acupuncture group, but was not changed in the body acupuncture group. This result indicates that the analgesic effects of body acupuncture do not work through the central nervous system. These data suggest that balanced acupuncture exerts analgesic effects on low-back and leg pain patients with lumbar disc herniation by regulating the function of the endogenous pain regulation network.
基金Supported by Key Project of Jiangxi Provincial Youth Science Foundation:to Explore the Analgesic Mechanism of Brain Functional Network Regulation of moxibustion on Heat-sensitive Acupoints Based on rfMRI and MRS(No.20192ACB21007)Jiangxi Province Introduces and Cultivates Innovative and Entrepreneurial High-level Talent Projects:Brain Functional Network Regulation and Neurobiochemical Mechanism of Heat-sensitive Moxibustion Analgesia(No.jxsq2019201104)。
文摘We want to explore the analgesic brain effect of the moxibustion at heat-sensitized Yaoyangguan(GV3)in patients with lumbar disc herniation(LDH)and myofascial pain syndrome(MPS).In an assessor-blinded observational study,we will include 15 LDH and 15 MPS.They will accept same treatment of heat-sensitive moxibustion at Yaoyangguan(GV3).The resting-state functionality magnetic resonance imaging image data of brain activities before and after treatment will be analyzed by mean fractional amplitude of low-frequency fluctuation,regional homogeneity analysis and brain functional connection.We select seed of first sensory cortex,second sensory cortex,insula cortex,periaqueductal gray and anterior cingulate cortex as the regions of interest to analyse the relationship between brain functional connectivity of pain-related networks and clinical data.Our study could disclose key brain targets and central response characteristics of the analgesic brain effect and the brain functional connection of heat-sensitive moxibustion.
文摘Objective:To observe the differences in clinical therapeutic effect on acute attack of lumbar disc herniation(LDH) treated with electroacupuncture(EA) of different wave patterns so as to optimize EA wave pattern in the treatment of acute attack of LDH.Methods:A total of 108 patients were randomized into three groups,i.e.,a disperse-dense wave,an intermittent wave and a continuous wave group,36 cases in each one.In all of three groups,Shangliao(上髎BL31),Ciliao(次髎BL32),Zhongliao(中髎BL33) and Xialiao(下髎BL34) were selected bilaterally as the main acupoints,which is generally termed as Baliao(八髎BL31 to BL34,bilateral).In each group,the corresponding wave pattern was used in EA.The treatment lasted 20 min each time,once daily,totally for 10 days.Before and after treatment,the score of visual analogue scale(VAS) and the score of the lower back pain of Japanese orthopedic association(JOA) were observed in the patients of three groups and the overall therapeutic effect was evaluated.Results:After treatment,the VAS score was decreased and JOA score was increased in the patients of 3 groups,indicating statistical significance(all P <0.05).In comparison of VAS score before and after treatment among three groups,the score in the disperse-dense wave group was higher than the intermittent wave group and the continuous wave group,indicating statistical differences(both P <0.05).In comparison of JOA score before and after treatment among three groups,the score in the continuous wave group was higher than the intermittent wave group and the disperse-dense wave group,indicating statistical differences(both P <0.05).The total effective rate was 94.12% in the disperse-dense wave group,94.29% in the intermittent wave group and 97.14% in continuous wave group,without significant difference among groups(P> 0.05).Conclusion:Electroacupuncture of 3 different wave patterns all effectively relieves clinical symptoms of acute attack of lumbar disc herniation.Regarding pain release,electroacupuncture with disperse-dense wave is better than intermittent wave and continuous wave.Regarding the improvement of lumbar function,the effect of electroacupuncture with continuous wave is better than disperse-dense wave and intermittent wave.
基金Supported by the National Natural Science Foundation of China:Study on Multi-target Regulation Mechanism of Moxibustion on Rheumatoid Arthritis Based on Signal Pathway of Lipid Metabolism Network(No.81774383)Study on the Multi target Effect Mechanism of Moxibustion Intervention on Ankylosing Spondylitis Based on Metabolic Proteomics and System Bioinformatics Cross linking Analysis between Genomics(No.81904274)Supported by the"Research and Innovation Plan for Postgraduates in Jiangsu Province"of the Nanjing University of Chinese Medicine:Clinical Experimental Study on the Effect of Different Moxibustion Duration on Lumbar Disc Herniation(SJCX20_0524),Clinical Study on the Treatment of Lumbar Disc Herniation with Thunder Fire Moxibustion and Common Moxibustion(SJCX20_0525)。
文摘OBJECTIVE:To evaluate the available evidence from randomized controlled trials(RCTs)of moxibustion alone for lumbar disc herniation(LDH)treatment.METHODS:A systematic search of 10 databases(until August 30,2021)was used to identify studies that reported the response rate,visual analogue scale(VAS)score,Japanese Orthopedic Association(JOA)score,and Oswestry Disability Index(ODI)score.Study selection and data extraction were independently performed by two reviewers.Cochrane criteria for risk of bias were used to assess the methodological quality of the trials.The Grading of Recommendations Assessment,Development,and Evaluation Methodology(GRADE)were also used to test the quality of the result evidence.RESULTS:Nineteen RCTs,including 1888 patients,met the inclusion criteria.Five studies showed no difference between moxibustion and acupuncture on response rate[risk ratio(RR)=1.07,95%CI(0.98,1.16),P=0.11].Meanwhile,six studies suggested that there is no significant difference between moxibustion and acupuncture on VAS score[mean difference(MD)=-0.43,95%CI(-0.91,0.05),P=0.08].Eight studies implied that there is no significant difference between moxibustion and acupuncture on JOA score[MD=0.84,95%CI(-1.27,2.96),P=0.44].Two studies indicated that moxibustion may have equivalent effects for treating LDH in the VAS score in comparison with drug therapy[MD=-1.16,95%CI(-2.63,0.31),P=0.12].The evidence level of results was determined to be very low to low.CONCLUSIONS:Based on the existing evidence,moxibustion may not be suitable for treating LDH alone,but it may be applied as an adjuvant treatment.Furthermore,well-designed RCTs with high quality and larger samples are still needed to evaluate the efficacy and safety of moxibustion alone for LDH treatment.
文摘BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.
基金National Natural Science Foundation of China,No.81871804 and No.81672200.
文摘BACKGROUND Surgery is often indicated for patients with massively prolapsed intervertebral disc herniation.The interlaminar endoscopic spine system(iLESSYS)Delta 6-mm working channel endoscope has advantages over other systems.The aim of this study was to explore the benefits and complications of using the iLESSYS Delta for the treatment of massively prolapsed intervertebral disc herniation.AIM To explore the clinical benefits of treating massively prolapsed lumbar intervertebral disc herniation with the iLESSYS Delta endoscope.METHODS In this study,the data of 37 patients who underwent surgery with the iLESSYS Delta endoscope at The Affiliated Hospital of Qingdao University were retrospectively analyzed.Intraoperative blood loss,operation time,and complications were collected.The visual analog scale(VAS),oswestry disability index(ODI),and modified MacNab criteria were determined before and at 1 d,3 mo,and 6 mo after surgery.RESULTS The mean intraoperative blood loss was 20.4±1.2 mL.The mean operation time was 97.3±12.4 min.The VAS scores for leg and back pain decreased from 68.0±7.3,34.4±8.5 before operation to 2.5±1.7,5.5±1.9 at 6 mo after surgery,respectively.The ODI also decreased from 60.2±7.3 to 17.9±3.4 at 6 mo after surgery.The improvement rate of the MacNab score was 86.4%,which was considered excellent.No spinal dural injury,nerve root injury,secondary protrusion of intervertebral disc,or myeloid hypertension was found during follow-up.CONCLUSION The iLESSYS Delta 6-mm working channel endoscope has several advantages in terms of clinical and functional benefits,complications,and low risk of residual vertebral pulp in treating patients with massively prolapsed intervertebral disc herniation.
文摘Objective To explore therapeutic efficacy of warming needle moxibustion and electroacupuncture for postoperative pain in the waist and leg of lumbar disc herniation. Methods Forty-six cases were treated with warming needle moxibustion at Yaotu （腰突, extra point, the same segment of injured disc herniation）, regular acupuncture at Yaoyan （腰眼 EX-B 7）, Zhibian （秩边BL 54）, Huantiao （环跳 GB 30）, Weizhong （委中BL 40）, Yanglingquan （阳陵泉 GB 34） and electroacupuncture at Yaoto （腰突）, Zhibian （秩边 BL 54）, Yanglingquan （阳陵泉 GB 34）. The treatment was given once a day, 10 treatments made up one session, and the therapeutic effect was assessed after 2 sessions of treatment. Results After the treatment, 31 cases （67.4%） were cured, 14 cases （30.4%） were effective and i case （2.2%） was failed. The total effective rate was 97.8%. Conclusion The warming needle moxibustion combined with electroacupuncture has obvious therapeutic effect on postoperative pain in the waist and leg of lumbar disc herniation.
基金Supported by Shanghai Traditional Chinese Medicine Science and Technology innovation Project:no.ZYKC201601002~~
文摘Objective： To compare the effect differences of electroacupuncture（EA） at Jiajǐ（夹脊 EX-B2） and conventional acupoints for lumbar intervertebral disc herniation（LIDH） and the factors influenced the effect during the way of data mining.Methods： A total of 160 patients of LIDH were randomly assigned into the EX-B2 group and the conventional acupoints group, 80 cases in each one. The patients in the EX-B2 group received EA at the symmetrical 2 acupoints of the bilateral EX-B2 on the lesion part. The patients in the conventional acupoints group received EA at the tender point of the lesion part, Zhibian（ 秩边BL54）, Huantiao（环跳 GB30）,weǐzhōng（委中BL40）, Chéngshān（承山BL57） and Fúyáng（跗阳BL59） on the affected side. The retain time of the needles is both 45 min. The treatment of the two groups is 3 times a week and for a connective 20 times. The modified Assessment Criteria for Low Lumbar Pain of Japanese Orthopedic Association（JOA）,Visual Analogue Scale（VAS） were evaluated before and after the treatment and at the 6-month follow up.Results：（1） Effective outcomes. JOA score： The JOA score of the patients in the EX-B2 group after treatment was（20.89 士 3.43）, and was（19.35 ±4.02） on the follow-up. Compared with the JOA score（12.35 ±4.42） in the same group before the treatment, there were statistical significant higher（both P0.05）. The JOA score in the EX-B2 group after treatment and on the follow-up were both higher than that of the conventional acupoints group at the same time point（both P0.05）. VAS score： The VAS score of the patients in the EX-B2 group on the 24 h after the first treatment was（4.09 ± 1.81）, and was（2.11 ± 1.30） after the treatment. Compared with the VAS score（4.09 ± 1.81） in the same group before the treatment, there were statistical significant lower（both P0.05）. The VAS score in the EX-B2 group on the 24 h after the first treatment and after treatment showed no statistical differences than that of the conventional acupoints group at the same time point（both P0.05）.（2）Related results from data mining： The middle-aged people and disease duration less than six months, their effect of the immediate treatment was the best. According to JOA score, EA at EX-B2 was better than EA conventional acupoints,either in the process of treatment effect, or in pertinence of the treatment, which were superior to EA conventional acupoints therapy; The best curative effect time of EA at EX-B2 was the first treatment after24 h, and the best curative effect of the conventional acupoints was after the first treatment. The age and disease duration also affected curative effect.Conclusion： The effect of EA at EX-B2 was superior to the conventional acupoints in treating LIDH.
基金Supported by Major Science and Technology Innovation Projects of Shandong Province,No.2018CXGC1310Natural Foundation of Shandong Province,No.ZR2019MH134+2 种基金Project of Jinan"20 Universities",No.2019GXRC040Shandong Institute of Advanced Technology,Chinese Academy of Sciences,No.YJZX003Collaborative Innovation Center Project of quality Control of traditional Chinese Medicine and Construction of whole Industry chain in Colleges and Universities of Shandong Province,No.CYLXTCX2020-04.
文摘BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneous laser disc decompression.Unfortunately,all of these methods carry inherent risk of causing harm to the patient and,as such,there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH.The purpose of this report is to describe a non-invasive method for re-absorption of LDH.CASE SUMMARY A 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb.Her self-reported medical history included persistent postpartum low back pain from 7 years prior.Physical exam showed positivity for neck flexion test(Lindner sign)and supine abdomen test;the straight leg-raising test showed right 60(+)and left 80(-).Findings from standard imaging(magnetic resonance)and collective physical examinations indicated a L5/S1 herniated lumbar disc.Treatment consisted of three-dimensional(balanced regulating)spinal manipulation and acupuncture,upon which the LDH resolved by retraction.CONCLUSION Following L5/S1 herniated lumbar disc diagnosis,three-dimensional(balanced regulating)spinal manipulation combined with acupuncture therapy is an effective treatment.
基金The study was financially supported by the Major Program of the National Natural Science Foundation of China(No.81590951).
文摘Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH.Methods:From databases such as CBM(Chinese biomedical literature database),VIP(China science and technology journal database),CNKI(China national knowledge infrastructure),WF(Wanfang database),Web of Science,Embase,Medline,and Cochrane Library,systematic reviews on acupuncture and/or moxibustion for LDH were retrieved,and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews(AMSTAR)list.Furthermore,the grading of recommendations assessment,development and evaluation(GRADE)system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement to evaluate the quality of the report.Results:A total of 18 systematic reviews were included,and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment.According to the AMSTAR score,there were 4 high-quality studies,13 moderate-quality studies,and 1 low-quality study.GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower.The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items,and 10 articles were in line with 10-19 of the 27 items.Conclusion:At present,acupuncture and/or moxibustion for LDH has a good curative effect.More importantly,its methodological quality was of moderate level and the report quality was generally good and relatively complete.However,the poor quality of the original research results was reflected in the quality of evidence.More studies are needed to make sure whether acupuncture is more effective than other treatment methods.
文摘Objective: To study the feasibility and effects of disc resection in patients with extremely-lateral disc herrniation (ELDH) with microendoscopic tubular retractor (METRx) through intertransversal route. Methods: In the period from March 2000 to December 2002, 9 patients with ELDH underwent disc resection with METRx system through intratransversal route and the clinical outcome was evaluated with Nakai standard. Results: The operation time ranged from 60 to 120 min with an average of 75 min; the blood loss ranged from 50 to 120 ml with an average of 60 ml; and the hospitalization time ranged from 5 to 19 d with an average of 13 d. No wound infection, neurological damages, pseudomeningocele or other complications occurred. The rate of excellent and good outcome was 88.9%. Conclusion: Disc removal in patients with ELDH can be done with METRx system and satisfactory results are obtained.
基金supported by the National Natural Science Foundation of China(Grant Nos.51873069,52272276,52073103,52203164)the Zhongshan Innovation Project of high-end Scientific Research Institutions(Grant No.2020AG020)+2 种基金the Key-Area Research and Development Program of Guangdong Province(No.2020B090924004)Beijing Municipal Health Commission(Grant Nos.BMHC-2018-4,BMHC-2019-9,PXM2020026275000002)the Postdoctoral Research Foundation of China(No.2022M711183).
文摘Intervertebral disc herniation(IVDH)is a common manifestation of intervertebral disc degeneration(IVDD)characterized by inflammation that results in the rupture of the annulus fibrosus(AF)and her-niation of the nucleus pulposus(NP).While current clinical research primarily focuses on regulating the degenerative NP,the crucial role of the AF in maintaining the mechanical stability and metabolic balance of the intervertebral disc(IVD)has been overlooked.Resolving immunoregulation and AF repair is im-perative to effectively prevent recurrent herniation.Therefore,this study introduces a bioactive sealant(OD/GM/QCS-sEVs),which combines gelatin methacryloyl(GM)and oxidized dextran(OD)with quater-nized chitosan(QCS)and incorporates small extracellular vesicles(sEVs).The developed sealant possesses injectability,self-healing capabilities,tissue adhesiveness,and mechanical stability,with an average ad-hesive strength of 109.63 kPa.In vitro experiments demonstrate that OD/GM/QCS-sEVs effectively seal AF defects while preserving mechanical properties comparable to those of a normal IVD.Additionally,the sealant releases sEVs through a pH-responsive mechanism,thereby modulating macrophage polarization to the M2 phenotype via the NF-κB signaling pathway.This mechanism facilitates immunoregulation and anti-inflammatory effects,and promotes stem cell differentiation into fibrocartilage.Animal experiments confirm the ability of OD/GM/QCS-sEVs to seal defects,prevent proteoglycan loss,inhibit IVDD develop-ment,and promote AF regeneration.Overall,OD/GM/QCS-sEVs hold promise as an innovative bioactive sealant for recurrent herniation by resolving immunoregulation and AF regeneration.
基金National Natural Science Foundation of China(No.81873141)Beijing Science and technology plan capital clinical characteristic application research project(No.z16110000516009)。
文摘Objective:To evaluate the effectiveness of different acupuncture treatments in the treatment of lumbar disc herniation.Methods:Searching PubMed,EMBASE,Cochrane Library,web of by computer Science,Chinese Journal Full-text Database,Wanfang database,VIP database and Chinese biomedical literature database,the retrieval time is from the establishment of the database to January 1,2020.Two researchers conducted literature screening,quality evaluation and data extraction according to the nano platoon standard,and used stata16.0 for network meta-analysis.Results:a total of 69 RCTs were included,involving 6168 patients with lumbar disc herniation,5 kinds of acupuncture therapy(warm acupuncture,fire acupuncture,electroacupuncture,acupuncture thread embedding,general acupuncture).The results of network meta-analysis showed that the effect of electroacupuncture was inferior to that of warm acupuncture,acupuncture thread embedding,and the effect of general acupuncture was inferior to that of warm acupuncture,fire acupuncture,electroacupuncture,acupuncture thread embedding,and the difference was statistically significant.In terms of efficiency,acupuncture and moxibustion embedding thread>warming acupuncture and moxibustion>fire acupuncture>electroacupuncture>ordinary acupuncture.Conclusion:in the treatment of lumbar disc herniation,the clinical effect of acupuncture thread embedding is better than the other four interventions.However,the quality and quantity of literature in this study are limited,and the conclusion of this study needs to be verified by high-quality RCT with multiple centers and large samples.
