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
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 effect of Tai Chi and Qigong on patients with lumbar disc herniation(LDH).Methods Relevant data were retrieved from nine English and Chinese databases,including Cochrane Library,PubMed,and Wa...Objective To evaluate the effect of Tai Chi and Qigong on patients with lumbar disc herniation(LDH).Methods Relevant data were retrieved from nine English and Chinese databases,including Cochrane Library,PubMed,and Wanfang Data,etc.from inception to June 2024.All published randomized controlled trials assessing the effect of Tai Chi and Qigong on visual analog scale(VAS),Japanese Orthopedic Association(JOA)score,and other health indicators in participants with LDH compared to usual medical care or other treatments were included.Grey literature,trials involving the pushing of hands(Tui Shou)or Tai Chi with weapons,and trials with co-interventions(Tai Chi/Qigong plus another treatment)were excluded.Methodological quality was analyzed using the Cochrane risk of bias tool,and evidence quality was assessed using the Grading of Recommendations,Assessment,Development,and Evaluations(GRADE)tool.Results Fourteen trials(954 patients)were included in this study.Tai Chi and Qigong were associated with lower VAS pain scores(standardized mean difference−0.55,95%confidence interval[CI]−0.95 to−0.15,P=0.01),higher JOA scores(mean difference[MD]4.40,95%CI 2.62 to 6.18,P<.001)and straight leg raise test results(MD 9.40°,95%CI 7.64 to 11.15,P<0.001)in patients with LDH.Furthermore,compared with usual care,Tai Chi and Qigong showed enhanced effects on pain and JOA scores.When compared to other exercises or massage,the effect on pain scores was similar but that on JOA scores was significant.Conclusions Tai Chi and Qigong may have favorable effects on VAS pain and JOA scores compared with usual care,and on JOA scores compared with other exercises or massage in patients with LDH.Given the overall poor quality of the evidence,the results of current study should be interpreted cautiously.展开更多
BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a cu...BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a customized prescription.It disperses cold,relieves pain,removes cold from the meridians and viscera,and treats neuropathic pain.However,few studies have investigated its mechanism of pain relief.AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST.METHODS A total of 211 patients with LDH syndrome were divided into two groups:107 patients in the control group were treated with conventional massage combined with traction,and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST.The patients were treated for 4 wk.Indices of traditional Chinese medicine(TCM)syndrome score and serum inflammatory factor levels were measured.RESULTS After therapy,the TCM syndrome score in the observation group was significantly lower than that in the control group(P<0.05).The main symptoms,clinical signs,daily activities,and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy(P<0.05).The levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein were lower in the observation group than in the control group(P<0.05).In the observation group,superoxide dismutase levels were significantly higher,whereas malondialdehyde levels were significantly lower,compared with the control group(P<0.05).The overall efficacy rate in the observation group was 96.15%,which was substantially higher than that in the control group(88.79%;P<0.05).CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.展开更多
BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perfo...BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.展开更多
Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs ph...Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs pharmacotherapy and epidural injections in such treatments,which are associated with numerous adverse effects.Prolonged use can severely impair the liver and kidney functions of patients.Hence,the role of safe and effective traditional Chinese medicine techniques becomes pivotal.Among various traditional Chinese medicine approaches for treating LDH,fire dragon cupping,renowned for its remarkable efficacy,cost-effectiveness,and ease of application,is extensively utilised in clinical settings for managing LDH.Nonetheless,there is a scarcity of systematic and standardised evidence from evidence-based medicine studies.Therefore,conducting a meta-analysis is imperative.Methods:A comprehensive computerised search was conducted in databases including China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,EMbase,The Cochrane Library,Web of Science,and CINAHL.The search aimed to gather randomised controlled trials on fire dragon cupping therapy for LDH,spanning from the inception of these databases until December 2023.Two researchers independently screened the literature according to inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the studies included,utilising RevMan 5.3 software for meta-analysis.Results:The results show that the fire dragon cupping therapy group had better clinical effectiveness(relative risk=1.23,95%confidence interval(CI)(1.14,1.33),P<0.00001),less pain(standardized mean difference=–1.33,95%CI(–1.49,–1.16),P<0.00001),and some improvement in lumbar function(Japanese Orthopaedic Association scores:mean difference=3.37,95%CI(2.31,4.43),P<0.00001.Conclusion:The fire dragon cupping therapy significantly alleviates LDH,warranting its extensive application.However,considering the limitations in the number and quality of studies included,the aforementioned conclusion necessitates further validation through more high-quality research.展开更多
Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis,...Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis, clinical evidence is limited. Objective: The purpose of this study is to provide high-quality evidence to support the effectiveness of the traditional Chinese hot and humid compress in the treatment of LDH with qi stagnation and blood stasis. Methods: From October 2021 to November 2023, 86 patients with LDH of qi stagnation and blood stasis type were recruited in our hospital and divided into a control (n = 43) and an observation group (n = 43) according to the random number table method. The control group was given routine clinical treatment, and the observation group was treated with the hot and humid compress therapy for two weeks. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, TCM syndrome score, serum interleukin-6 (IL-6), serum interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were observed and compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated. Results: After treatment, the VAS score, TCM symptom score, and serum IL-6, IL-1β, and TNF-α levels decreased in both groups (P P P P P Conclusions: The hot and humid compress of traditional Chinese medicine can effectively relieve pain, restore lumbar function, improve TCM syndromes, reduce the level of inflammatory factors, and have a curative effect in treating LDH.展开更多
Pain catastrophization is one of the negative emotional factors and an important psychological factor associated with patients with lumbar disc herniation(LDH).Currently,the concept of pain catastrophization of LDH is...Pain catastrophization is one of the negative emotional factors and an important psychological factor associated with patients with lumbar disc herniation(LDH).Currently,the concept of pain catastrophization of LDH is relatively mature abroad;however,there are only few research studies on this in China.To understand the status quo of pain catastrophization(PC)in patients with LDH and its influencing factors,the intervention measures of PC and their efficacy were further analyzed.In the present paper,the research status of PC at home and abroad is briefly expounded,and the influencing factors and clinical intervention measures for PC are analyzed.This paper reviews the concept of PC,the assessment tools,influencing factors,and the relevant intervention measures.In order to evaluate the pain degree of patients,understand the incidence of pain in patients,and improve the cure rate and quality of life of patients,the basic situation of patients with pain disaster is summarized to provide reference for medical personnel.展开更多
Objective:To systematically evaluate the safety and efficacy of Mongolian medical warm acupuncture in the treatment of lumbar disc herniation(LDH).Methods:CNKI,Wanfang,VIP,Pubmed,Embase,Cochrane Library,and other data...Objective:To systematically evaluate the safety and efficacy of Mongolian medical warm acupuncture in the treatment of lumbar disc herniation(LDH).Methods:CNKI,Wanfang,VIP,Pubmed,Embase,Cochrane Library,and other databases were searched.The randomized controlled trials(RCTs)on the treatment of LDH with Mongolian medical warm acupuncture were manually searched in the Chinese Journal of Ethnic Medicine,Chinese Journal of Mongolian Medicine,Journal of Inner Mongolia University for Nationalities,and Journal of Inner Mongolia Medical University.The search time limit was from January 2000 to October 2023.RevMan5.4 software was used to analyze the included and excluded literature.Results:A total of 8 RCTs involving 1,042 patients with LDH were included,with 551 patients in the observation group and 491 patients in the control group.The results of the meta-analysis showed that a total of 8 randomized controlled trials were included in the treatment of LDH with Mongolian medical warm acupuncture compared with simple acupuncture(RR=1.18,95%CI=[1.12,1.23],P<0.00001).Conclusion:The total effective rate of Mongolian medical warm acupuncture for LDH is higher than that of simple acupuncture.However,due to the low quality of the literature included in this study,multi-dimensional,large sample size,and more rigorous clinical randomized trials are needed for further verification in the future.展开更多
Introduction: Lumbar disc herniation (LDH) refers to the rupture of the fibrous annulus of the intervertebral discs. Lumbar curvature may lead to the occurrence of lumbar disc degeneration. Fear of movement may worsen...Introduction: Lumbar disc herniation (LDH) refers to the rupture of the fibrous annulus of the intervertebral discs. Lumbar curvature may lead to the occurrence of lumbar disc degeneration. Fear of movement may worsen their disc herniation and cause further pain and injury. LDH conditions impact the individuals’ quality of life, to explore the relationship between lumbar curve, muscle strength, fear of movement and functional disability among patients with LDH. Methods: An electronic search was conducted on PubMed, Medline, Science Direct, Springerlink, Google Scholar and a hand search from reference lists was reviewed. Publications were included in human studies, patients 25 - 85 years of age, original studies and published in English language journals from January 2002 to December 2023. Result: In total, 64 articles were researched through the online search engines, and 9 papers were found through manual searches of reference lists. As a result, a total of 11 articles were included for the purpose of this review. The comprehensive analysis revealed the presence of eight cross-sectional studies, two retrospective studies and one experimental study. A minimum of 25 participants and a maximum of 360 participants were included. Ten studies included both genders, only one studies included healthy adults and patients with LDH but these studies didn’t mention gender. Results showed that the factors influencing LDH can be categorized into non-modifiable factors, such as gender, age, height or others. Modifiable factors included increased BMI, DM, smoking, alcohol, employment status, lifestyle and health problems or psychology. Conclusion: Females with greater VASC may be at risk of LDH. The lumbar extensor muscles indicated a localized disc herniation or nerve root pathology in patients with LDH. The fear of movement may lead to psychological consequences and reduce functional disability among patients with LDH.展开更多
Lumbar disc herniation(LDH)is a common orthopedic disease in clinical practice,with main symptoms of varying degrees of pain and functional impairment,seriously affecting the quality of work and life of patients,and a...Lumbar disc herniation(LDH)is a common orthopedic disease in clinical practice,with main symptoms of varying degrees of pain and functional impairment,seriously affecting the quality of work and life of patients,and also causing a certain degree of economic burden to the patient's family and society.At present,there are various conservative treatment methods for LDH in clinical practice.Conservative treatment has the characteristics of small trauma and high safety,which can achieve symptom relief and cure for most patients in clinical practice.This article aims to provide a scientific reference for the selection of treatment plans for LDH patients by reviewing relevant literature on conservative treatment of LDH that has been publicly reported both domestically and internationally in recent years.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
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
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.
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supported by a Seed Funding of the Beijing University of Chinese Medicine(90011451310034).
文摘Objective To evaluate the effect of Tai Chi and Qigong on patients with lumbar disc herniation(LDH).Methods Relevant data were retrieved from nine English and Chinese databases,including Cochrane Library,PubMed,and Wanfang Data,etc.from inception to June 2024.All published randomized controlled trials assessing the effect of Tai Chi and Qigong on visual analog scale(VAS),Japanese Orthopedic Association(JOA)score,and other health indicators in participants with LDH compared to usual medical care or other treatments were included.Grey literature,trials involving the pushing of hands(Tui Shou)or Tai Chi with weapons,and trials with co-interventions(Tai Chi/Qigong plus another treatment)were excluded.Methodological quality was analyzed using the Cochrane risk of bias tool,and evidence quality was assessed using the Grading of Recommendations,Assessment,Development,and Evaluations(GRADE)tool.Results Fourteen trials(954 patients)were included in this study.Tai Chi and Qigong were associated with lower VAS pain scores(standardized mean difference−0.55,95%confidence interval[CI]−0.95 to−0.15,P=0.01),higher JOA scores(mean difference[MD]4.40,95%CI 2.62 to 6.18,P<.001)and straight leg raise test results(MD 9.40°,95%CI 7.64 to 11.15,P<0.001)in patients with LDH.Furthermore,compared with usual care,Tai Chi and Qigong showed enhanced effects on pain and JOA scores.When compared to other exercises or massage,the effect on pain scores was similar but that on JOA scores was significant.Conclusions Tai Chi and Qigong may have favorable effects on VAS pain and JOA scores compared with usual care,and on JOA scores compared with other exercises or massage in patients with LDH.Given the overall poor quality of the evidence,the results of current study should be interpreted cautiously.
文摘BACKGROUND Lumbar disc herniation(LDH)commonly occurs during spinal surgery;LDH is on the increase in younger patients and is classified as"paralysis"and"back pain."Sanhanchushi Tongbi(SPST)is a customized prescription.It disperses cold,relieves pain,removes cold from the meridians and viscera,and treats neuropathic pain.However,few studies have investigated its mechanism of pain relief.AIM To observe the clinical therapeutic effects on LDH treated with self-prescribed SPST.METHODS A total of 211 patients with LDH syndrome were divided into two groups:107 patients in the control group were treated with conventional massage combined with traction,and 104 patients in the observation group were treated with a combination of the control regimen and self-prescribed oral SPST.The patients were treated for 4 wk.Indices of traditional Chinese medicine(TCM)syndrome score and serum inflammatory factor levels were measured.RESULTS After therapy,the TCM syndrome score in the observation group was significantly lower than that in the control group(P<0.05).The main symptoms,clinical signs,daily activities,and Japanese Orthopedic Association scores in the observation group were significantly higher than those in the control group after therapy(P<0.05).The levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein were lower in the observation group than in the control group(P<0.05).In the observation group,superoxide dismutase levels were significantly higher,whereas malondialdehyde levels were significantly lower,compared with the control group(P<0.05).The overall efficacy rate in the observation group was 96.15%,which was substantially higher than that in the control group(88.79%;P<0.05).CONCLUSION Self-prescribed SPST can reduce the levels of inflammatory and pain-causing factors as well as lumbar pain in patients with LDH.
基金Supported by National Natural Science Foundation of China(Regional Program),No.82060879,No.82360947Gansu Province Key Talent Project,No.2024-4+2 种基金Natural Science Foundation of Gansu Province,No.20JR10RA356Gansu Provincial Joint Research Fund,No.23JRRA1534National Administration of Traditional Chinese Medicine High Level Key Discipline Construction Project of Traditional Chinese Medicine(Traditional Chinese Orthopedics and Traumatology Science),No.203.
文摘BACKGROUND This reported procedure combines the orthopedic surgical robot with the unilateral biportal endoscopy-lumbar interbody fusion(UBE-LIF),utilizing the UBE's wide viewing field and operating space to perform minimally invasive decompressive fusion of the lesioned segment,and the orthopedic surgical robot's intelligence and precision to perform percutaneous pedicle screw placement.The advancement of this procedure lies in the superposition of advantages and offsetting disadvantages of the two new technologies,and the maximum effect of treatment is achieved with maximum minimization of invasiveness and precision under the monitoring of imaging instruments to maximize the benefit of patients,and this review reports a case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE for reference.CASE SUMMARY A 44-year-old patient presented to our hospital.Combining various clinical data,we diagnosed the patient with lumbar disc herniation with radiculopathy,lumbar spondylolisthesis,and lumbar spinal stenosis.We developed a surgical plan of"UBE decompression+UBE-LIF+orthopedic surgery robot-assisted percutaneous pedicle screw implantation for internal fixation".The results were satisfactory.CONCLUSION We present an extremely rare case of multiple-segment lumbar decompression and fusion surgery for lumbar disc herniation via robot-assisted UBE and achieved good results.Therefore,the technique is worthy of clinical promotion.
基金supported by the 2022 study on the effectiveness of Fire Dragon Cupping in treating cold-dampness obstructive type shoulder stiffness,funded by the Bao'an District Healthcare Research Project in Shenzhen(Shen Bao Ke[2023]No.13,Project No.2022JD237)2023 study on the therapeutic observation and mechanism exploration of Fire Dragon Cupping in cold-dampness obstructive type acute gout,funded by the Guangdong Provincial Administration of Traditional Chinese Medicine(Yue Zhong Yi Han[2023]No.205,Project No.20242077)+1 种基金National Clinical Key Specialty(Traditional Chinese Medicine)Construction Project(2013-239)Sanming Project of Medicine in Shenzhen(No.SZZYSM202206014).
文摘Background:The incidence of lumbar disc herniation(LDH)is notably high.Consensus among experts highlights non-surgical treatments as the primary therapeutic approach for LDH.Contemporary medicine frequently employs pharmacotherapy and epidural injections in such treatments,which are associated with numerous adverse effects.Prolonged use can severely impair the liver and kidney functions of patients.Hence,the role of safe and effective traditional Chinese medicine techniques becomes pivotal.Among various traditional Chinese medicine approaches for treating LDH,fire dragon cupping,renowned for its remarkable efficacy,cost-effectiveness,and ease of application,is extensively utilised in clinical settings for managing LDH.Nonetheless,there is a scarcity of systematic and standardised evidence from evidence-based medicine studies.Therefore,conducting a meta-analysis is imperative.Methods:A comprehensive computerised search was conducted in databases including China National Knowledge Infrastructure,WanFang Data,VIP,China Biology Medicine disc,PubMed,EMbase,The Cochrane Library,Web of Science,and CINAHL.The search aimed to gather randomised controlled trials on fire dragon cupping therapy for LDH,spanning from the inception of these databases until December 2023.Two researchers independently screened the literature according to inclusion and exclusion criteria,extracted data,and assessed the methodological quality of the studies included,utilising RevMan 5.3 software for meta-analysis.Results:The results show that the fire dragon cupping therapy group had better clinical effectiveness(relative risk=1.23,95%confidence interval(CI)(1.14,1.33),P<0.00001),less pain(standardized mean difference=–1.33,95%CI(–1.49,–1.16),P<0.00001),and some improvement in lumbar function(Japanese Orthopaedic Association scores:mean difference=3.37,95%CI(2.31,4.43),P<0.00001.Conclusion:The fire dragon cupping therapy significantly alleviates LDH,warranting its extensive application.However,considering the limitations in the number and quality of studies included,the aforementioned conclusion necessitates further validation through more high-quality research.
文摘Background: Although a number of studies have reported that the hot and humid compress from traditional Chinese medicine (TCM) is effective in treating lumbar disc herniation (LDH) with qi stagnation and blood stasis, clinical evidence is limited. Objective: The purpose of this study is to provide high-quality evidence to support the effectiveness of the traditional Chinese hot and humid compress in the treatment of LDH with qi stagnation and blood stasis. Methods: From October 2021 to November 2023, 86 patients with LDH of qi stagnation and blood stasis type were recruited in our hospital and divided into a control (n = 43) and an observation group (n = 43) according to the random number table method. The control group was given routine clinical treatment, and the observation group was treated with the hot and humid compress therapy for two weeks. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, TCM syndrome score, serum interleukin-6 (IL-6), serum interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were observed and compared between the two groups before and after treatment, and the clinical efficacy of the two groups was evaluated. Results: After treatment, the VAS score, TCM symptom score, and serum IL-6, IL-1β, and TNF-α levels decreased in both groups (P P P P P Conclusions: The hot and humid compress of traditional Chinese medicine can effectively relieve pain, restore lumbar function, improve TCM syndromes, reduce the level of inflammatory factors, and have a curative effect in treating LDH.
文摘Pain catastrophization is one of the negative emotional factors and an important psychological factor associated with patients with lumbar disc herniation(LDH).Currently,the concept of pain catastrophization of LDH is relatively mature abroad;however,there are only few research studies on this in China.To understand the status quo of pain catastrophization(PC)in patients with LDH and its influencing factors,the intervention measures of PC and their efficacy were further analyzed.In the present paper,the research status of PC at home and abroad is briefly expounded,and the influencing factors and clinical intervention measures for PC are analyzed.This paper reviews the concept of PC,the assessment tools,influencing factors,and the relevant intervention measures.In order to evaluate the pain degree of patients,understand the incidence of pain in patients,and improve the cure rate and quality of life of patients,the basic situation of patients with pain disaster is summarized to provide reference for medical personnel.
文摘Objective:To systematically evaluate the safety and efficacy of Mongolian medical warm acupuncture in the treatment of lumbar disc herniation(LDH).Methods:CNKI,Wanfang,VIP,Pubmed,Embase,Cochrane Library,and other databases were searched.The randomized controlled trials(RCTs)on the treatment of LDH with Mongolian medical warm acupuncture were manually searched in the Chinese Journal of Ethnic Medicine,Chinese Journal of Mongolian Medicine,Journal of Inner Mongolia University for Nationalities,and Journal of Inner Mongolia Medical University.The search time limit was from January 2000 to October 2023.RevMan5.4 software was used to analyze the included and excluded literature.Results:A total of 8 RCTs involving 1,042 patients with LDH were included,with 551 patients in the observation group and 491 patients in the control group.The results of the meta-analysis showed that a total of 8 randomized controlled trials were included in the treatment of LDH with Mongolian medical warm acupuncture compared with simple acupuncture(RR=1.18,95%CI=[1.12,1.23],P<0.00001).Conclusion:The total effective rate of Mongolian medical warm acupuncture for LDH is higher than that of simple acupuncture.However,due to the low quality of the literature included in this study,multi-dimensional,large sample size,and more rigorous clinical randomized trials are needed for further verification in the future.
文摘Introduction: Lumbar disc herniation (LDH) refers to the rupture of the fibrous annulus of the intervertebral discs. Lumbar curvature may lead to the occurrence of lumbar disc degeneration. Fear of movement may worsen their disc herniation and cause further pain and injury. LDH conditions impact the individuals’ quality of life, to explore the relationship between lumbar curve, muscle strength, fear of movement and functional disability among patients with LDH. Methods: An electronic search was conducted on PubMed, Medline, Science Direct, Springerlink, Google Scholar and a hand search from reference lists was reviewed. Publications were included in human studies, patients 25 - 85 years of age, original studies and published in English language journals from January 2002 to December 2023. Result: In total, 64 articles were researched through the online search engines, and 9 papers were found through manual searches of reference lists. As a result, a total of 11 articles were included for the purpose of this review. The comprehensive analysis revealed the presence of eight cross-sectional studies, two retrospective studies and one experimental study. A minimum of 25 participants and a maximum of 360 participants were included. Ten studies included both genders, only one studies included healthy adults and patients with LDH but these studies didn’t mention gender. Results showed that the factors influencing LDH can be categorized into non-modifiable factors, such as gender, age, height or others. Modifiable factors included increased BMI, DM, smoking, alcohol, employment status, lifestyle and health problems or psychology. Conclusion: Females with greater VASC may be at risk of LDH. The lumbar extensor muscles indicated a localized disc herniation or nerve root pathology in patients with LDH. The fear of movement may lead to psychological consequences and reduce functional disability among patients with LDH.
文摘Lumbar disc herniation(LDH)is a common orthopedic disease in clinical practice,with main symptoms of varying degrees of pain and functional impairment,seriously affecting the quality of work and life of patients,and also causing a certain degree of economic burden to the patient's family and society.At present,there are various conservative treatment methods for LDH in clinical practice.Conservative treatment has the characteristics of small trauma and high safety,which can achieve symptom relief and cure for most patients in clinical practice.This article aims to provide a scientific reference for the selection of treatment plans for LDH patients by reviewing relevant literature on conservative treatment of LDH that has been publicly reported both domestically and internationally in recent years.
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.
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.
