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.

Comparison of pain media and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc

Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.

Effect of “Tongji” electroacupuncture on pain and inflammatory factors in patients with lumbar disc herniation in remission stage

Background:Lumbar disc herniation is the most common back pain disorder characterized by lumbago-leg pain in clinical practice.The treatment of lumbar disc herniation in Western medicine mainly contains the operative or non-operative interventions(nerve block therapy,etc.)to relieve pain.Although the pain relief is fast and the short-term effect is clear,it often ignores the degeneration of intervertebral disc,resulting in recurrent symptoms,prolonged course of treatment,and easy to cause sequelae such as lumbar instability.Acupuncture has been used for a long time in the clinical treatment of lumbago-leg pain with definite and long-lasting effect.Methods:116 cases of lumbar disc herniation were randomly divided into treatment group(n=59)and control group(n=57).The control group was treated with oral analgesics,and the observation group was treated with“Tongji”electro-acupuncture(the acupoints were selected at 1.3 inch away from the midline after level T12(the 12th thoracic vertebra),L1(the 1st lumbar vertebra),L2(the 2nd lumbar vertebra),L3(the 3rd lumbar vertebra),L4(the 4th lumbar vertebra),L5(the 5th lumbar vertebra)and S1(the 1st sacral vertebra),the left and right sides are symmetrical)plus oral analgesics.Visual analog scale score and Japanese Orthopaedic Association score were evaluated before treatment and 5 days,10 days and 1 month after treatment,respectively.The contents of interleukin-6 and substance P in peripheral serum were detected by enzyme-linked immunosorbent assay method,and the total clinical effective rate was calculated.Results:Both the pain visual analog scale score and Japanese Orthopaedic Association score in the treatment group and the control group after treatment were improved as compared with those before treatment(P<0.05).There were also significant differences in these two scores between the treatment group and the control group(P<0.05).Furthermore,there was no significant difference between 1 month and 10 days after treatment(P>0.05),indicating the long-term effect of“Tongji”electroacupuncture on improving lumbago-leg pain was significant.After treatment,the contents of interleukin-6 and substance P in both the control group and the treatment group were lower than those before treatment,and there was significant difference between the control group and the treatment group(P<0.05 and P<0.01 respectively).The total effective rate after treatment was 94.92%,which was higher than that of 87.72%in the control group(P<0.01).Conclusion:The intervention of“Tongji”electroacupuncture plus the routine oral analgesic can significantly improve the lumbar function of patients with lumbar disc herniation,alleviate the pain and improve the clinical symptoms of lumbar disc herniation via decreasing the production of inflammatory factors interleukin-6 and substance P,suggesting a better curative effect than oral analgesic alone.

Effect of acupuncture combined with transforaminal endoscopic therapy on pain mediators,neural function and stress response in patients with lumbar disc herniationn

Objective: To study the effect of acupuncture combined with transforaminal endoscopic therapy on pain mediators, neural function and stress response in patients with lumbar disc herniation. Methods: A total of 118 patients with lumbar disc herniation who were treated in the hospital between January 2015 and January 2017 were collected and divided into control group (n=59) and observation group (n=59) by random number table method. The control group received transforaminal endoscopic therapy, and the observation group received acupuncture combined with transforaminal endoscopic therapy. The differences in the pain mediators, neural function and stress response were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum pain mediator contents, lower limb nerve conduction velocity and serum stress hormone contents were not statistically significant between the two groups. After treatment, serum PGE2, 5-HT, NO, Cor, INS and NE contents of both groups of patients were lower than those before treatment while serum β-EP contents as well as tibial nerve MCV, common peroneal nerve MCV, superficial peroneal nerve SCV and sural nerve SCV levels were higher than those before treatment, and serum PGE2, 5-HT, NO, Cor, INS and NE contents of observation group were lower than those of control group while serum β-EP content as well as tibial nerve MCV, common peroneal nerve MCV, superficial peroneal nerve SCV and sural nerve SCV levels was higher than those of control group. Conclusion: Acupuncture combined with transforaminal endoscopic therapy can effectively alleviate the pain, inhibit the stress response and optimize the neural function of lower limbs in patients with lumbar disc herniation.

Analgesic effects of balanced acupuncture versus body acupuncture in low-back and leg pain patients with lumbar disc herniation, as assessed by resting-state functional magnetic resonance imaging

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.

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.

CLINICAL OBSERVATION ON LUMBAR INTERVERTEBRAL DISC HERNIATION TREATED BY TRACTION COMBINED WITH ACUPUNCTURE

Objective: To observe the therapeutic effect of traction combined with acupuncture on lumbar intervertebral disc herniation (LIDH). Methods:Eighty-three patients diagnosed as LIDH were randomly divided into treatment group (n=42)and control group (n=41). In the treatment group, besides lumbar traction, electroacupuncture at Jiaji (EX-B 2, L 3～5), Shenshu (BL 23), Qihai (CV 6), Mingmen (GV 4), Huantiao (GB 30), Chengshan (BL 57) and Yanglingquan (GB 34) was added. In the control group, only lumbar traction was applied. Results: In treatment group, the cure plus markedly effective rate was 80.95% with a total effective rate of 92.86%, while in control group, it was 39.02% with a total effective rate of 80.48%. The therapeutic effect in the treatment group was obviously better than that in the control group (P<0.001). Conclusion: Lumbar traction plus EA can effectively alleviate or even eliminate clinical symptoms and signs of lumbar intervertebral disc herniation.

Isolation of <i>Gemella morbillorum</i>in Herniated Intervertebral Disc Tissue in a Lumbar Discectomy Patient: A Case Report

Back pain associated with lumbar disc herniation is a common musculoskeletal disorder that leads to absence at work place worldwide. Studies have proven in addition to the traditional factors, microbes play a role in disc herniation causing chronic back pain. A 34-year-old male who has not involved in any traumatic work but has a family history of disc herniation presented with lower back pain and numbness in his right leg. He had previously undergone lumbar discectomy at L4/L5 ten years back. Magnetic Resonance Imaging (MRI) showed L5/S1 right para central disc herniation impinging on the right S1 and S2 nerve roots. Standard protocols for disinfection of instruments, external skin and all transport media were adhered. Skin scrapings, muscle biopsy and excised disc tissue were obtained for anaerobic and aerobic bacterial cultures. Anaerobic microbial cultures of excised disc tissue following lumbar discectomy showed Gram positive growth. Further anaerobic isolation carried out using RapID ANA ID kit confirmed the growth as Gemella morbillorum. In addition, neither of the control samples (muscle nor skin) had any anaerobic growth indicating the absence of contamination. Aerobic bacterial growth was not present in the skin, muscles and disc cultures. The study findings add to the available literature, on the role of microorganisms in lumbar disc herniation and future treatment regimens with antibiotics.

The Clinical Outcomes of Transforaminal Percutaneous Endoscopic Discectomy in Treating Lumbar Disc Herniation: A Review

Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique started during the late 20th century. This process is done through microscopic view under local anesthesia. There is a growing but still insufficient evidence that lumbar EDS shows slightly better results in terms of minor tissue damage, shorter hospital stay, faster return to ordinary daily activities, and patient satisfaction. Recurrence rate still remains a matter of debate, and is related with the surgical skills of the surgeon. The complication rate seems to be similar in both of the techniques i.e., open and endoscopic. More randomized controlled trials, systematic reviews and meta-analysis are needed to clarify whether lumbar EDS can be considered comparable if not superior to standard open discectomy. In spite of lacking defined clinical evidence, lumbar EDS is without doubt a rapidly expanding PELD and its future developments are incredibly promising. Due to less complication rate this technique can be considered as a gold standard compared to the open discectomy. The surgeons still require more cadaveric practices for learning the curve and to approach the herniated disc area. The main objective of this review article is to show the clinical outcomes of the Transforaminal Percutaneous Endoscopic Discectomy in treating the lumbar disc herniation.

Effects of percutaneous intervertebral foraminal BEIS technique on patients with lumbar disc herniation

Objective:To compare the application effects of percutaneous percutanuous intervertebral foraminal BEIS(Broad Easy Immediate Surgery)technique on patients with lumbar disc herniation.Methods:Eighty-six patients with lumbar disc herniation treated in the Seventh People’s Hospital of Zibo City from Mary 2016 to May 2019 were selected and divided into control group and study group according to the simple randomization of random number table method,with 43 cases in each group.Patients in control group were treated with lamina fenestration while patients in study group were treated with percutanuous intervertebral foraminal BEIS technique.The surgical status and hospital stay,complications,pain[Visual Analogue Scale(VAS)score],Oswestry Disability Index(ODI)score and quality of life[MOS 36-item Short From Health Survey(SF-36)]were compared between the two groups.Results:The surgical time in study group was longer than that in control group,and the incision length was shorter than that in control group,and the fluoroscopy frequency was more than that in control group,and the intraoperative blood loss was less than that in control group,and the hospital stay was shorter than that in control group(P<0.05).There were no significant differences in the incidence rates of postoperative complications between the two groups(P>0.05).There were statistically significant differences in the between-group effects,timepoint effects and interaction effects of VAS pain score(P<0.05),and the VAS pain score in study group at 24 h and 1 w after surgery was significantly lower than that in control group(P<0.05).There were no statistically significant differences in the group-between effects and interaction effects of ODI score(P>0.05),and there were statistically significant differences in the time-point effects(P<0.05).There were statistically significant differences in the betweengroup effects,time-point effects and interaction effects of SF-36 score(P<0.05).The ODI score at 3 months after surgery in study group was lower than that in control group while the SF-36 score was higher than that in control group(P<0.05).Conclusion:Compared with traditional lamina fenestration,percutanuous intervertebral foraminal BEIS technique has the advantages of less trauma and quicker postoperative recovery in the treatment of lumbar disc herniation.Self-made simple locator can reduce the fluoroscopy frequency,improve the accuracy of positioning,further reduce surgical trauma and promote recovery of patients.

Systematic evaluation and meta-analysis of acupuncture treatment for residual pain after lumbar disc herniation

Objective:To systematically evaluate the effectiveness and safety of acupuncture in the treatment of postoperative residual pain in lumbar disc herniation,and to provide evidence for its clinical treatment.Methods:A randomized controlled trial(RCT)of all acupuncture treatments for postoperative lumbar disc herniation in PubMed,CBM,CNKI,Wanfang,VIP,E mbase,and Cochrane libraries was published by May 2019,followed by RevMan5.3 software for meta-analysis.Results:11 randomized controlled trials were included in 855 patients,including 428 in the experimental group and 427 in the control group,with a ratio of 1:1.The results of the meta-analysis showed that the overall effective rate of the experimental group[RR=1.22,95%CI(1.15,1.29),P<0.00001],visual analogue pain(VAS)score[MD=1.59,95%CI(1.22,1.95),P<0.00001],Japanese Orthopaedic Association evaluation treatment score(JOA)[MD=5.66,95%CI(2.58,8.74),P=0.0003],the incidence of adverse hair loss[RR=0.35,95%CI(0.18,0.71),P=0.003]were significantly better than the control group,the difference was statistically significant.Conclusion:Acupuncture has obvious advantages in the treatment of residual pain after lumbar disc herniation,which can significantly relieve postoperative pain and improve quality of life.However,the conclusions of this study need to be further verified by the large sample and high quality literature.

Meta-analysis of Huoxue huayu Chinese medicine compound combined with Intervertebral Pore Lens in the treatment of Lumbar Intervertebral Disc Herniation

Objective:A meta-analysis was performed to evaluate the difference of curative effect of Huoxue huayu Chinese medicine compound combined with intervertebral pore lens in the treatment of lumbar disc herniation.Methods:CNKI,VIP,CBM,PubMed and Web of Science were searched by computer and included in the clinical trial data about the treatment of lumbar disc herniation by the Huoxue huayu Chinese medicine compound and intervertebral pore lens.Data were extracted and Cochrane system was used to evaluate the quality of the study.Cochrane system in ReMan 5.1 was used to evaluate the publication bias and Stata 12.0 was used for meta analysis.Results:A total of 1039 patients were included in 16 articles,including 519 patients in the treatment group and 520 patients in the control group.The results showed that the total effective rate of the treatment group was higher than that of the control group(RR=1.20,95%CI(1.11,1.30),P<0.05);The excellent rate of the treatment group was higher than that of the control group(RR=1.20,95%CI(1.08,1.32),P<0.05);The JOA score of the treatment group was higher than that of the control group(MD=3.39,95%CI(1.90,4.87),P<0.00001);the VAS score of the treatment group was lower than that of the control group(MD=-1.13,95%CI(-1.84,-0.42),P=0.002);The ODI score of the treatment group was lower than that of the control group[MD=-3.34,95%CI(-4.49,-2.19),P<0.00001].Conclusion:Huoxue huayu Chinese medicine compound and intervertebral pore lens can improve the clinical effect and is worth popularizing.However,due to the poor quality of the literature,more high-quality double-blind randomized controlled trials with large samples are needed.

Early efficacy of endoscopic translaminar and intervertebral foraminal approaches in the treatment of lumbar disc herniation

Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.

Immunopathological observation of lumbar disc herniation and discogenic pain

Objective To evaluate and compare the immunopathological changes of lumbar disc herniation and discogenic pain.Methods Seventy-one lumbar disc nucleuses were collected intra-operation,and they were divided into four groups.Group A:30 cases

Apparent diffusion coefficient in normal and abnormal pattern of intervertebral lumbar discs: initial experience

The aim of the present study was to compare the relationship of morphologically defined non-bulging/herni-ated, bulging and herniated intervertebral lumbar discs with quantitative apparent diffusion coefficient （ADC）. Thirty-two healthy volunteers and 28 patients with back pain or sciatica were examined by MRI. All intervertebral lumbar discs from L1 to S1 were classified according to morphological abnormality and degenerated grades. The ADC values of nucleus pulposus （NP） were measured and recorded. The significant differences about mean ADC values of NP were found between non-bulging/herniated discs and bulging discs as well as herniated discs （P 0.05）, whereas there were no significant differences in ADC values between bulging and herniated discs （P 0.05）. Moreover, statistically significant relationship was found in the mean ADC values of NP between ＂non-bulging/herniated and non-degenerated discs＂ and ＂non-bulging/herniated degenerated discs＂ as well as herniated discs （P 0.05）. Linear regression analysis between ADC value and disc level revealed an inverse correlation （r = -0.18）. The ADC map of the NP is a potentially useful tool for the quantitative assessment of componential and molecular alterations accompanied with lumbar disc abnormalities.

Retraction of lumbar disc herniation achieved by noninvasive techniques: A case report

BACKGROUND Lumbar disc herniation(LDH)has emerged as one of the most common causes of low back pain.The routine treatment approach involves chemonucleolysis therapy,discectomy by percutaneous endoscopy,and percutaneous laser disc decompression.Unfortunately,all of these methods carry inherent risk of causing harm to the patient and,as such,there is an unmet but urgent need for an effective and safe noninvasive treatment for LDH.The purpose of this report is to describe a non-invasive method for re-absorption of LDH.CASE SUMMARY A 34-year-old woman was admitted with a complaint of waist pain that she reported as having become acutely aggravated over the past 3 d and accompanied by discomfort in the right lower limb.Her self-reported medical history included persistent postpartum low back pain from 7 years prior.Physical exam showed positivity for neck flexion test(Lindner sign)and supine abdomen test;the straight leg-raising test showed right 60(+)and left 80(-).Findings from standard imaging(magnetic resonance)and collective physical examinations indicated a L5/S1 herniated lumbar disc.Treatment consisted of three-dimensional(balanced regulating)spinal manipulation and acupuncture,upon which the LDH resolved by retraction.CONCLUSION Following L5/S1 herniated lumbar disc diagnosis,three-dimensional(balanced regulating)spinal manipulation combined with acupuncture therapy is an effective treatment.

Research the mechanism of Cinnamoni cortex-Aconm lateralis radixpraeparaia-Achtranthis bidentatae radix combination in treatment oflumbar disc herniation based on datamining and networkpharmacology

Background:This study gets a classic prescription of Song Dynasty medicine for the treatment of waist and leg pain through analyzing the inheritance of traditional Chinese medicine auxiliary platform.Further,the potential mechanism of the classic prescription was analyzed based on molecular docking and network pharmacology.Methods:Based on the frequency statistics,association rules and cluster analysis,the core herbal combination and the classic prescription was digged out.Use of network pharmacology methods and molecular docking to explore the pharmacological mechanism of classic prescriptions for treatment of lumbar disc herniation.Then gene ontology biological function annotation and Kyoto Encyclopedia of Genes and Genomes enrichment of pathways were performed.Finally,the compounds of herbs were docked with the important targets of MMP1 and CRP.Results:The high-frequency Chinese medicines for treating waist and leg pain were found and we further unearthed the“Rougui-Fuzi-Niuxi(Cinnamoni cortex-Aconm lateralis radix praeparaia-Achyranthis bidentatae radix”as the core herbal combination,and matched the classic ancient prescription of Chinese medicine Jiawei Shenzhuo decoction(CAPCMJWSZD).The targets of CAPCMJWSZD were mapped to the targets of lumbar disc herniation and 48 potential targets were obtained.The core potential targets were obtained in the protein-protein interaction network,such as CRP,IL2,FOS,MMP1,CASP3.Through the DAVID database,a total of 129 gene ontology function annotation terms(P<0.01)and 91 Kyoto Encyclopedia of Genes and Genomes pathways(P<0.01)were obtained.Molecular docking results showed that quercetin has the lowest binding energy for docking with MMP1and CRP,and these two methods of molecular docking are most likely to occur.Conclusion:The most important bioactive components in CAPCMJWSZD can eliminate inflammation and slow disc degeneration through some potential targets,such as CRP,IL-2,MMP1,and these targets can rich in the following pathways,such as metalloendopeptidase activity,MAP kinase activity,osteoclast differentiation,et al.

Applied anatomy of intrusive operations of lumbar intervertebral foramen

Objective:To provide anatomical datum for intrusive operations of lumbar intervertebral foramen,especially that using acupuncture-knife as intrusive tool.Methods:To dissect 10 antisepsis cadavers and observe the exposed blood vessels,ligaments,nerves and their adjacent relations in L1/2~L5/S1intervertebral foramen.Results:Lumbar intervertebral foramen exit zones were almost sealed by nerves and blood vessels.There were two zones with relatively no blood vessel and nerve(triangular working zones)located in the midpoint of the distance between two adjacent roots of transverse processus,and clung to lamina of vertebral arch,and they were also found upon the margo superior of the root of transverse processus,but the ascending lumbar vein or(and)the rami anastomoticus between the remi inferior of intervertebral vein and lumbar veins were observed in 12%triangular working zones upon the margo superior of root of transverse processus.Conclusions:"Triangular working zone"was relatively avascular zone.Pay attention to the possibilty of presence of blood vessels on the entrance passage of intrusive operations on lumbar side rear.The needlepoint should be pierced at the midpoint of the distance between two adjacent roots of transverse processus and cling to the outer edge of lamina of vertebral arch when doing the foraminal lumbar puncture.As lumbar intervertebral foramina exit zone was almost sealed by nerves and blood vessels,blind incising and debonding with acupuncture-knife in this area was relatively much more dangerous.

Comparison of the pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy

Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital between January 2013 and January 2017 were selected and randomly divided into two groups: Percutaneous transforaminal endoscope discectomy (PTED) group and control group. Patients in PTED group received percutaneous transforaminal endoscope discectomy, while control group received open fenestration discectomy. Serum levels of pain substances SP, NPY, PGE2 and NGF, inflammatory mediators IFN-γ, TNF-α, IL-17 and MMP3 as well as stress response substances Cor, NE, OH-, O2- and MDA of two groups of patients were determined the same day after surgery and 3 days after surgery.Results: The same day after surgery and 3 d after surgery, serum SP, NPY, PGE2, NGF, IFN-γ, TNF-α, IL-17, MMP3, Cor, NE, OH-, O2- and MDA levels of PTED group were significantly lower than those of control group. Conclusion: Percutaneous transforaminal endoscope discectomy for lumbar intervertebral disc herniation causes less postoperative pain and inflammatory stress than open fenestration discectomy.

Study on sodium hyaluronate product as inhibitor of pain due to epidural cicatrization

Objective To evaluate the clinical effect of sodium hyaluronate product(SHP) used as inhibitor to preventing the formation of epidural scar.Method 160 patients suffering from lumbar intervertebral disc herniation were treated by operation,during which SHP was daubed around dura matter as obstruct to prevent epidural scar formation.Result No adverse reaction was observed.Pain was relieved and VAS was decreassed from 8.35 to 0.42 in mean.Using SHP got better curative effect than control group did.The cure and mend rate is 100%.No relapse occurs.Less scar formation was proved by CT in some cases.Conclusion SHP is ideal material used as inhibitor of epidural cicatrization.