Paradoxical herniation associated with hyperbaric oxygen therapy after decompressive craniectomy: A case report

BACKGROUND Whether hyperbaric oxygen therapy(HBOT)can cause paradoxical herniation is still unclear.CASE SUMMARY A 65-year-old patient who was comatose due to brain trauma underwent decompressive craniotomy and gradually regained consciousness after surgery.HBOT was administered 22 d after surgery due to speech impairment.Paradoxical herniation appeared on the second day after treatment,and the patient’s condition worsened after receiving mannitol treatment at the rehabilitation hospital.After timely skull repair,the paradoxical herniation was resolved,and the patient regained consciousness and had a good recovery as observed at the follow-up visit.CONCLUSION Paradoxical herniation is rare and may be caused by HBOT.However,the underlying mechanism is unknown,and the understanding of this phenomenon is insufficient.The use of mannitol may worsen this condition.Timely skull repair can treat paradoxical herniation and prevent serious complications.

Surgical management of tegmen defects of the temporal bone and meningoencephalic herniation: our experience

1. Introduction The tegmental wall of the tympanic cavity is a thin plate of the temporal bone that separates the middle cranial fossa(MCF) from the ear. This anatomical region consists of two areas: an anterior one, comprised of the tegmen tympani(To′th et al., 2007), and a posterior one, formed by the tegmen antri and the tegmen mastoideum(Makki et al., 2011). In some patients, the tegmental region of the temporal bone can be interrupted, causing a tegmen defect(TD). A TD is sometimes associated with a meningoencephalic herniation(MEH), in which brain tissue herniates through a TD.

Clinical therapeutic effect of self-prescribed Sanhanchushi Tongbi on lumbar disc herniation

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.

Treatment of lumbar disc herniation with robot combined with unilateral biportal endoscopic technology:A case report

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.

A meta-analysis on the clinical efficacy of fire dragon cupping in the treatment of lumbar disc herniation

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.

Clinical Observation of the Hot and Humid Compress Therapy of Traditional Chinese Medicine in the Treatment of Qi Stagnation and Blood Stasis Type of Lumbar Disc Herniation

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.

Research progress of pain catastrophizing in patients with lumbar disc herniation

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.

Meta-Analysis of Efficacy and Safety of Mongolian Medical Warm Acupuncture in the Treatment of Lumbar Disc Herniation

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.

Muscle Strength, Lumbar Curve, Fear of Movement and Functional Disability among Patients with Lumbar Disc Herniation: A Review

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.

Effects of different moxibustion durations on lumbar disk herniation:a clinical study

Objective:To explore the best duration of moxibustion on lumbar disk herniation(LDH).Methods:A total of 88 patients were randomly divided into control group and 15-min,30-min,and 45-min moxibustion groups.The control group was treated with conventional therapy,while the other 3 groups were intervened with different moxibustion durations.Low back pain,dysfunction,lumbar function,and effective rates were evaluated before,in the first week and second week of intervention.Results:In low back pain,compared with the control group,the score of the 15-min group had no significant difference,but it was significantly lower in the 30-min and 45-min groups.In dysfunction and lumbar function,compared with the control group,the scores of the 15-min,30-min,and 45-min groups were significantly higher,and the scores of the 30-min and 45-min groups were significantly higher,but there was no significant difference between the 30-min and 45-min group.In effective rates,there was no significant difference between the control group and 15-min group;the effective rates of the 30-min and 45-min groups were significantly higher than those of the control group.Conclusions:Moxibustion has good therapeutic effect on LDH with specific moxibustion time.

Research Progress on Conservative Treatment of Lumbar Disc Herniation

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.

Network Meta-analysis of nerve block combined with Chinese medicine for lumbar disc herniation

Objective:To evaluate the clinical efficacy of Chinese medicine methods(acupuncture,tui na,acupuncture knife,traditional Chinese medicine,traction)combined with nerve block treatment for lumbar disc herniation using Bayesian mesh Meta-analysis.Methods:Randomized controlled studies of TCM methods combined with nerve block for lumbar disc herniation in CNKI,Wanfang,Vip,China Biomedical Literature Library,Pubmed,Web of science,and The Cochrance Library databases were searched for the period from the establishment of each database to May 2021.2 researchers independently followed the developed nerf criteria to Screening was performed.Bayesian model mesh Meta-analysis was performed using R,RStudio,and addis-1.16.6 software.Results:Twenty-seven papers with a total of 2074 subjects were finally included,involving six interventions,namely nerve block alone,herbal medicine combined with nerve block,acupuncture combined with nerve block,acupuncture combined with nerve block,traction combined with nerve block,and tui na combined with nerve block.The results of the net analysis showed that(1)in terms of efficiency,all interventions were better than simple nerve block except for traction combined nerve block,and acupuncture,acupuncture,tui-na and Chinese medicine combined nerve block were better than traction combined nerve block respectively,and the probability ranked first for acupuncture combined nerve block.(2)On the VAS score,except for traction combined with nerve block,other interventions were superior to simple nerve block,and the combination of herbal medicine,acupuncture,and acupuncture respectively was superior to traction combined with nerve block,and the intervention with the best probability ranking result was herbal medicine combined with nerve block.(3)There was no statistical difference between the two interventions compared in terms of JOA scores,and the probability ranked first for herbal medicine combined nerve block.Conclusion:Chinese medicine combined nerve block was superior to nerve block alone,and Chinese medicine combined nerve block and acupuncture combined nerve block measures were more effective in the treatment of LDH,and traction combined nerve block was less effective.

Meta-analysis of Clinical Efficacy of Warm Needling Acupuncture in the Treatment of Lumbar Disc Herniation

[Objectives]To evaluate the efficacy of warm needling acupuncture in the treatment of lumbar disc herniation(LDH)by Meta-analysis.[Methods]Randomized controlled trial of warm needling acupuncture in the treatment of lumbar disc herniation published from January 2000 to December 2021 was searched by Cochrane Library,PubMed,VIP,CNKI and Wanfang.After the quality evaluation of the literature,the Meta-analysis of the literature was carried out by using Review Manager 5.3.[Results]A total of 10 studies were included,involving a total of 980 patients.The results of Meta-analysis showed that warm needling acupuncture in the treatment of lumbar disc herniation could improve the total clinical effective rate,OR=5.38,95%CI(3.40,8.49),P<0.00001;decrease the VAS score,MD=-3.33,95%CI[-4.53,-2.12],z=5.42(P<0.00001);increase the JOA score,MD=-5.63,95%CI[-8.12,-3.14];improve the dysfunction,MD=-5.63,95%CI[-8.12,-3.14],z=4.43(P<0.00001);decrease inflammatory factors,MD=-11.09,95%CI[-13.60,-8.58],z=8.65(P<0.00001).And the recurrence rate was low,OR=0.33,95%CI[0.15,0.70],z=2.86(P=0.004).[Conclusions]Warm needling acupuncture could effectively treat lumbar disc herniation and relieve pain symptoms.However,due to the general poorness of literature quality and the low quality of evidence,high-quality randomized controlled trials are still needed.

Clinical Observation of Warm Needling Acupuncture of Mongolian Medicine in the Treatment of Lumbar Disc Herniation

[Objectives]To observe the clinical efficacy of warm needling acupuncture of Mongolian medicine in the treatment of lumbar disc herniation(LDH).[Methods]120 patients with lumbar disc herniation hospitalized in Inner Mongolia International Mongolian Hospital from June 2019 to June 2022 were randomly divided into observation group(n=60)and control group(n=60).The observation group was treated with warm needling acupuncture of Mongolian medicine,and the control group was treated with common acupuncture of Mongolian medicine,with two weeks as a course of treatment.The pain visual analogue scale(VAS)and Japanese orthopaedic association(JOA)score were observed before and after treatment,and the clinical efficacy was evaluated by the changes of clinical symptoms and signs of Mongolian medicine.[Results]The cure rate of the observation group was 71.7%,which was better than that of the control group(53.3%).The difference in the cure rate between the two groups was statistically significant,X 2=4.302,P=0.038.The total markedly effective rate(cured+markedly effective)of the observation group was 90.0%,while that of the control group was 83.3%.There was no significant difference in the total markedly effective rate between the two groups,X 2=1.154,P=0.283.The total effective rate(cured+markedly effective+effective)of the observation group was 100%,while that of the control group was 95.0%.There was no significant difference in the total effective rate between the two groups,and the continuous corrected chi-square value was 1.368 and 0.242.After treatment,the degree of low back pain,lower limb pain and dyskinesia were significantly improved in the two groups,the observation group was better than the control group,and the difference was statistically significant(P<0.05).[Conclusions]The warm needling acupuncture of Mongolian medicine was effective in the treatment of lumbar disc herniation,which is worth popularizing.

Functional Rehabilitation of Disc Herniation Treated with Combined Therapy

Current researches reveal that the number of cases diagnosed with operated lumbar disc herniation is growing rapidly, which should draw an increased attention to the treatment used. The objective of this study is to perform a comparative analysis between the application of a classical physical-kinetic program and the application of a combined kinetic program. This research will be conducted on 20 subjects with ages, between 40 - 50 years old, in INEMRCM Bucharest, for 14 days - 1 hour a day. Each subject underwent an invasive surgery for lumbar disc herniation on the L5-S1 vertebrae. During the research, the 2 patients will be given a physical-kinetic program, adapted to the pathology of the operated lumbar disc herniation. The purpose of this research is to check the efficiency of each kinetic program. Furthermore, through the muscular and articular evaluation made in the initial phase and the final phase, it will be possible to discuss the comparative evolution of the established kinetic program and the functional gain obtained. In conclusion, the research shows that mechanized therapy results in faster functional rehabilitation and physical exercise substantially improves quality of life.

Study of the Effect of Zhuang Medicine Aponeurotic System Triple Therapy on Lumbar Disc Herniation and Alpha-1 Acid Glycoprotein Level

Objective:To analyze the application effect of Zhuang medicine aponeurotic system triple therapy in the treatment of lumbar disc herniation and its effect on the level of alpha-1 acid glycoprotein(alpha-1 AGP).Methods:200 patients with lumbar disc herniation were selected and randomly divided into a treatment group and a control group,100 cases in each group.The control group was given conventional acupuncture,and the treatment group was treated with manipulation+fire needling+cupping.The alpha-1-AGP levels before and after treatment,as well as the lumbar spine function and pain scores before and after treatment,and the adverse reactions occurred during treatment between the two groups were compared.Results:Before treatment,there was no significant difference in alpha-1 AGP levels,lumbar function,and pain scores between the two groups(P>0.05).After treatment,the lumbar function scores of the two groups were significantly increased,with the treatment group having higher scores than the control group(P<0.05);the incidence of adverse reactions in the treatment group was 2.00%,which was much lower than the control group(P>0.05).Conclusion:Appropriate application of Zhuang medicine aponeurotic system triple therapy in the clinical treatment of lumbar disc herniation can promote the improvement of alpha-1 AGP index level,reduce the pain degree of patients,and improve their lumbar spine function.At the same time,Zhuang medicine also has significant advantages in terms of safety,while ensuring the efficacy and safety of the treatment.

DISCUSSION OF MECHANISM ON LUMBAR DISC HERNIATION TREATED WITH BLOODLETTING ON W■IZH■NG(委中BL40)

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.

Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report

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.

Paradoxical herniation after decompressive craniectomy provoked by mannitol:A case report

BACKGROUND Paradoxical transtentorial herniation is a rare but life-threatening complication of cerebrospinal fluid drainage in patients with large decompressive craniectomy.However,paradoxical transtentorial herniation after rapid intravenous infusion of mannitol has not been reported yet.CASE SUMMARY A 48-year-old male suffered from a right temporal vascular malformation with hemorrhage.In a coma,the patient was given emergency vascular malformation resection,hematoma removal,and the right decompressive craniectomy.The patient woke up on the 1st d after the operation and was given 50 g of 20% mannitol intravenously every 8 h without cerebrospinal fluid drainage.On the morning of the 7th postoperative day,after 50 g of 20% mannitol infusion in the Fowler’s position,the neurological function of the patient continued to deteriorate,and the right pupils dilated to 4 mm and the left to 2 mm.Additionally,computed tomography revealed an increasing midline shift and transtentorial herniation.The patient was placed in a supine position and given 0.9% saline intravenously.A few hours later,the patient was fully awake with purposeful movements on his right side and normal communication.CONCLUSION Paradoxical herniation may occur,although rarely,after infusing high-dose mannitol intravenously in the Fowler’s position in the case of a large craniectomy defect.An attempt should be made to place the patient in the supine position because this simple maneuver may be life-saving.Do not use high-dose mannitol when the flap is severely sunken.

Chinese Association for the Study of Pain:Expert consensus on diagnosis and treatment for lumbar disc herniation

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.