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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

经皮椎间孔镜脊柱系统术对老年LDH合并神经根管狭窄患者腰椎功能及手术效果研究

目的 探讨经皮椎间孔镜脊柱系统(TESSYS)术对老年腰椎间盘突出症(LDH)并神经根管狭窄患者腰椎功能的影响并分析手术效果。方法 前瞻性纳入2020年6月至2023年6月安庆市立医院收治的老年LDH并神经根管狭窄患者66例,按随机抽签法分成TESSYS组与对照组,各33例。对照组行椎板开窗减压加髓核摘除术,TESSYS组行TESSYS术。记录并比较两组手术时间、术中出血量、术后卧床时间、住院时间,术前、术后3 d的血清肿瘤坏死因子-α(TNF-α)、皮质醇、促肾上腺皮质激素(ACTH)水平。比较术前、术后3个月的腰椎曲度、腰骶角角度,运动、感觉神经传导速度,并进行疼痛视觉模拟法(VAS)评分、Oswestry功能障碍指数(ODI)评分,记录并比较术后总体疗效与并发症情况。结果 TESSYS组的手术时间、术中出血量、术后卧床时间、住院时间分别为(76.35±8.21) min、(72.36±6.28) mL、(27.35±2.17) h、(6.31±1.42) d,均短(少)于对照组[(112.49±12.10) min、(133.67±15.69) mL、(30.91±1.06) h、(8.03±1.97) d],差异均有统计学意义(P<0.05)。术后3 d,两组血清TNF-α、皮质醇、ACTH水平较术前增高,且TESSYS组血清TNF-α、皮质醇、ACTH水平分别为(3.15±0.65) ng/mL、(2.69±0.41)μmol/L、(14.21±2.36) pmol/L,均低于对照组[(3.59±0.47) ng/mL、(3.06±0.87)μmol/L、(16.98±3.18) pmol/L],差异均有统计学意义(P<0.05)。术后3个月,两组的腰椎曲度均术前升高,腰骶角角度均较术前降低,且TESSYS组的腰椎曲度为(22.87±4.36) mm,高于对照组[(20.93±3.04) mm],腰骶角角度为(25.39±4.15)°,低于对照组[(27.91±2.90)°],差异均有统计学意义(P<0.05)。术后3个月,两组神经传导速度均较术前升高,且TESSYS组的神经传导速度均高于对照组,差异均有统计学意义(P<0.05)。术后3个月,两组的VAS、ODI评分均较术前降低,且TESSYS组的VAS、ODI评分分别为(2.14±0.51)、(17.50±2.11)分,均低于对照组[(3.10±0.92)、(20.39±3.63)分],差异均有统计学意义(P<0.05)。TESSYS组手术优良率为96.97%,高于对照组(75.76%),差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论 TESSYS术能进一步促进老年LDH并神经根管狭窄患者围术期机体功能恢复,减轻炎症与应激反应,改善神经传导速度与腰椎功能,缓解疼痛,提升手术效果。

Treatment of large lumbar disc herniation with percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint

AIM:To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS:Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography.Second injections were performed 5 d after the initial injection.All patients were followed up for 6-18 mo.A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS:Successful puncture was obtained in all patients.The overall efficacy was 91.4;the outcome was the excellent in 37 cases(63.8),good in 16 cases(27.6) and fair/poor in 5 cases(8.6) according to the Macnab criteria.No severe complications were found throughout this study.CONCLUSION:Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large 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.

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.

Technique of Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.

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.