A Flat Sagittal Spinal Alignment Is Common among Young Patients with Lumbar Disc Herniation

Background: Recent studies suggest a correlation between spinal sagittal alignment and different types of lumbar pathologies due to different load patterns on the lumbar spine. The main objective of this study was to investigate the preoperative spinal sagittal alignment in young patients (Methods: Information regarding preoperative clinical examinations was collected from the patient medical charts. Preoperative MRI examinations were used to classify lumbar types according to four sagittal spinal alignment groups (1: a long thoracic kyphosis, 2: a flat back, 3: a normal spine and 4: an increased thoracic kyphosis). Other MRI findings were also noted. Classification of lumbar types was performed independently by three spine surgeons. To compare two sample proportions the 2-sample z-test was performed. Results: The distribution of lumbar curve types was: Type 1, 17% (9 patients);Type 2, 62% (33 patients);Type 3, 17% (9 patients) and Type 4, 4% (2 patients). The distribution of operated levels was: L3 - L4, 2% (1 patient);L4 - L5, 47% (25 patients);L5 - S1, 42% (22 patients) and L4 - L5 + L5 - S1, 9% (5 patients). Conclusions: A majority of the young patients (62%) that underwent surgery due to herniated disc in the lumbar spine were classified as Type 2 indicating a flat back. Future studies are needed to increase the knowledge about spinopelvic sagittal alignment and the correlation to spinal pathologies.

Clinical Study on Electroacupuncture for Cervical Intervertebral Disc Herniation

Objective:To compare the therapeutic efficacies between electroacupuncture(EA)and medication for cervical intervertebral disc herniation(CIDH).Methods:Totally 420 patients with CIDH were randomized into two groups by random number table.210 patients in the EA group were intervened by EA at Dazhui(GV 14),Dazhu(BL 11),and Houxi(SI 3);210patients in the medication group were treated by oral administration of Meloxicam tablets.Results:The average ranks of both short and long term efficacies in the EA group were significantly lower than that in the medication group(both P<0.01);there were significant differences in comparing the total effective rates of both short and long terms between the two groups(both P<0.01).It shows that EA group has better therapeutic efficacy than the medication group.Conclusion:EA is better than medication in comparing both short-term and long-term therapeutic efficacies in treating CIDH.

Hyperpolarization-activated cyclic nucleotide-gated 2 contributes to electroacupuncture analgesia on lumbar disc herniation-induced radicular pain through activation of microglia in spinal dorsal horn

OBJECTIVE:To explore the mechanisms of dorsal root ganglia and spinal microglia cascade cross in electroacupuncture(EA)analgesia in the treatment of lumbar disc herniation.METHODS:A rat model of lumbar disc herniation(LDH)was established,EA was administered at Huantiao(GB30)acupoint 30 min once a day,for 3 d.Before and after modeling,and after EA,mechanical allodynia thresholds were detected.Hyperpolarization-activated cyclic nucleotide-gated 2(HCN2)in dorsal root ganglia was detected by quantitative polymerase chain reaction(qPCR)and Western blot.C-X3-C motif chemokine ligand 1(CX3CL1)and activity of microglia in spinal cord was observed separately via qPCR and immunofluorescence staining.RESULTS:The mechanical allodynia threshold of the right planta of model rats was significantly reduced(P<0.01),EA increased the mechanical pain threshold of rats(P<0.01),and decreased HCN2 mRNA,and protein expression,reduced the expression of CX3CL1 and the activation of microglia.ZD7288(a blocker of HCN channel)reduced the analgesic effect of EA from 1.83±0.84 to 0.74±0.20(P<0.05),and the expression of CX3CL1 in the spinal cord decreased from 0.52±0.11 to 0.15±0.05(P<0.01).CONCLUSION:EA analgesia on the radicular pain of LDH is definite.EA reduced the expression of HCN2 channel in the dorsal root ganglion,thereby decreasing the noxious stimulation entered to microglia in spinal dorsal horn.Our work supports EA is an effective treatment for radicular pain of LDH.

Current status of full-endoscopic techniques in the surgical treatment of disk herniations and Spinal Canal stenosis

Degenerative constrictions of the spinal canal with compression of neural elements arise as a result of bony,disk,capsular or ligament structures.The most frequent causes are disk herniations and spinal stenoses.The lumbar and cervical spine is the most prominent cause.After conservative treatments have been exhausted,surgical intervention may be necessary.Today,microsurgical or microscopically-assisted decompression is regarded as the standard procedure for disk herniation and spinal stenosis in the lumbar region,while in the cervical spine,microsurgical or microscopically-assisted anterior decompression and fusion are standard.Both procedures demonstrate good clinical results but present problems associated with the operation.Decompressions in the area of the spine must be carried out under continuous visualization and must entail the possibility of adequate bone resection.Taking this into account,completely new endoscopes and instrument sets has been developed for full-endoscopic operations in tandem with the development of the lateral transforaminal and interlaminar approaches for the lumbar spine and the posterior,contralateral and anterior approaches for the cervical spine.The possibilities and results of comparable and established standard procedures have been used as a benchmark in the course of clinical validation.The development of surgically created approaches and the new rod lens endoscopes combined with appropriate instrument sets have laid the technical foundations for full-endoscopic operation in the lumbar spine on all primary and recurrent disk herniations inside and outside the spinal canal and on spinal stenoses.This development has also permitted resection of soft disk herniations in the cervical spine.The use of the relevant approaches depends on anatomical and pathological inclusion and exclusion criteria.The clinical results of standard procedures are achieved,which must be regarded as a minimum criterion for the introduction of new technologies.On the basis of evidence-based medicine(EBM) criteria,it can be established that using the full-endoscopic techniques developed,adequate decompression is achieved in the defined indications with reduced traumatization,improved visibility conditions and positive cost benefits.Today,fullendoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.