Explore the vast range of titles available.

Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain. Currently, inflammation is associated with adverse symptoms related to the stimulation of nerve fibers that may lead to pain. However, inflammation has also been indicated as the main factor responsible for LDH regression. This apparent controversy places inflammation as a good prognostic indicator of spontaneous regression of LDH. This review addresses the molecular and cellular mechanisms involved in LDH regression, including matrix remodeling and neovascularization, in the scope of the clinical decision on conservative versus surgical intervention. Based on the evidence, a special focus on the inflammatory response in the LDH context is given, particularly in the monocyte/macrophage role. The phenomenon of spontaneous regression of LDH, extensively reported in the literature, is therefore analyzed here under the perspective of the modulatory role of inflammation.

Background Although previous studies have illustrated improvements in surgical cohorts for patients with intervertebral disc herniation, there are limited data on predictors of long-term outcomes comparing surgical and nonsurgical outcomes. Questions/purposes We assessed outcomes of operative and nonoperative treatment for patients with intervertebral disc herniation and symptomatic radiculopathy at 8 years from the Spine Patient Outcomes Research Trial. We specifically examined subgroups to determine whether certain populations had a better long-term outcome with surgery or nonoperative treatment. Methods Patients with symptomatic lumbar radiculopathy for at least 6 weeks associated with nerve root irritation or neurologic deficit on examination and a confirmed disc herniation on cross-sectional imaging were enrolled at 13 different clinical sites. Patients consenting to participate in the randomized cohort were assigned to surgical or nonoperative treatment using variable permuted block randomization stratified by site. Those who declined randomization entered the observational cohort group based on treatment preference but were otherwise treated and followed identically to the randomized cohort. Of those in the randomized cohort, 309 of 501 (62%) provided 8-year data and in the observational group 469 of 743 (63%). Patients were treated with either surgical discectomy or usual nonoperative care. By 8 years, only 148 of 245 (60%) of those randomized to surgery had undergone surgery, whereas 122 of 256 (48%) of those randomized to nonoperative treatment had undergone surgery. The primary outcome measures were SF-36 bodily pain, SF-36 physical function, and Oswestry Disability Index collected at 6 weeks, 3 months, 6 months, 12 months, and then annually. Further analysis studied the following factors to determine if any were predictive of long-term outcomes: sex, herniation location, depression, smoking, work status, other joint problems, herniation level, herniation type, and duration of symptoms. Results The intent-to-treat analysis of the randomized cohort at 8 years showed no difference between surgical and nonoperative treatment for the primary outcome measures. Secondary outcome measures of sciatica bothersomeness, leg pain, satisfaction with symptoms, and self-rated improvement showed greater improvement in the group randomized to surgery despite high levels of crossover. The as-treated analysis of the combined randomized and observational cohorts, adjusted for potential confounders, showed advantages for surgery for all primary outcome measures; however, this has the potential for confounding from other unrecognized variables. Smokers and patients with depression or comorbid joint problems had worse functional outcomes overall (with surgery and nonoperative care) but similar surgical treatment effects. Patients with sequestered fragments, symptom duration greater than 6 months, those with higher levels of low back pain, or who were neither working nor disabled at baseline showed greater surgical treatment effects. Conclusions The intent-to-treat analysis, which is complicated by high rates of crossover, showed no difference over 8 years for primary outcomes of overall pain, physical function, and back-related disability but did show small advantages for secondary outcomes of sciatica bothersomeness, satisfaction with symptoms, and self-rated improvement. Subgroup analyses identified those groups with sequestered fragments on MRI, higher levels of baseline back pain accompanying radiculopathy, a longer duration of symptoms, and those who were neither working nor disabled at baseline with a greater relative advantage from surgery at 8 years. Level of Evidence Level II, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Background Lumbar disc herniation is a prevalent condition that leads to pain, disability, and a reduction in quality of life. While conventional treatments are widely utilized, virtual reality-based exercise programs present a promising alternative. However, the effectiveness of these exercises in the rehabilitation of lumbar disc herniation remains unclear. The aim of this study was to evaluate the effects of virtual reality-based exercises on pain, daily activities, quality of life, and fall risk in individuals with lumbar disc herniation. Materials and methods This randomized controlled trial included 68 patients meeting the study criteria. Inclusion criteria: No other physical disabilities, no surgery in the last 6 months, no uncontrolled diseases, no vertigo, knee or joint issues, moderate/low balance impairment, and body mass ındex below 40. Exclusion criteria: Uncontrolled diseases, vertigo, knee/joint issues, cognitive impairments, pregnancy, inability to complete fall risk measurement, or attend follow-ups . Participants were divided into a virtual reality group ( n  = 34, Mean age ± Standard Deviation = 51.05 ± 13.39, 41.2% male, 58.8% female) and a control group ( n  = 34, Mean age ± Standard Deviation = 53.55 ± 12.25, 29.4% male, 70.6% female). The virtual reality group performed 28 sessions of virtual reality -based exercises, while the control group received routine hospital treatment. The study was conducted in a single hospital due to equipment limitations in the region. Data were collected using the Patient Information Form, Visual Analog Scale, Oswestry Disability Index, Short Form-36 Quality of Life Scale, and Fall Risk Device. Statistical analyses were performed using Statistical Package for the Social Sciences 20, including t-tests, chi-square tests, effect size analysis, and skewness/kurtosis assessments for homogeneity. Results The virtual reality group showed a significant reduction in pain (Visual Analog Scale: 3.38 ± 1.48, Cl: -2.49, -0.86, p  < 0.05) and disability (Oswestry Disability Index: 21.59 ± 6.00, Cl: -19.92, -7.38, p  < 0.05), along with significant improvements in all Short Form-36 Quality Of Life sub-dimensions ( p  < 0.05).Fall risk scores also decreased significantly in the virtual reality group (Cl: -26.57, -7.26, p  < 0.05). There were no significant baseline differences between the groups, confirming their comparability before the intervention. Conclusion Virtual reality -based exercises effectively reduced pain, improved daily activities and quality of life, and decreased fall risk in lumbar disc herniation patients, suggesting their potential as a complementary rehabilitation approach. Blinding was not applied due to the nature of the interventions, which may introduce a potential risk of bias. Trial registration This study was registered at ClinicalTrials.gov (Clinical trial number: NCT05463588; Registration date: 08/07/2022). The study was retrospectively registered.

In a single-center, randomized trial involving 128 patients with sciatica lasting 4 to 12 months and lumbar disk herniation, diskectomy was superior to conservative care in reducing leg-pain intensity at 6 months after enrollment. Among the patients assigned to conservative care, 34% crossed over to undergo surgery.

Purpose. To predict the early recurrence after full endoscopic lumbar discectomy, we analyzed factors related to demographic factor anatomical factors, operative method, and postoperative management, and predicted the possibility of recurrence according to the scoring system. Materials and Methods. In this prospective study, we enrolled 300 patients who underwent 1 out of 3 surgical procedures. The patients were randomized into one of the following groups: group A (n=100), transforaminal inside-out approach; group B (n=100), transforaminal outside-in approach; and group C (n=100), interlaminar approach. The clinical results were evaluated by a visual analogue scale (VAS). Related factors evaluated with points of (A) demographic factors: (1) age, (2) gender, (3) BMI, (B) anatomical factors: (4) disc degeneration scale, (5) modic change, (6) number of involved disc herniation, (7) history of discectomy (first, recurred), (8) herniated disc level, (9) disc height, (10) segmental dynamic motion, (11) disc location, (C) operation factors: (12) annulus preservation along the disc protrusion, (13) approach method (transforaminal inside-out, transforaminal outside-in, interlaminar); (D) postoperative care factors: (14) early ambulation, (15) spinal orthosis (corset) application. Among these, we analyzed statistically significant recurrence risk factors after PELD in all patients and early recurrence predicting score ratio was obtained. Results. The overall recurrence rate was 9.33%. The recurrence rate was 11%, 10%, and 7% for groups A, B, and C, respectively. Average early recurrence time was 3.26 months. The change in preoperative and postoperative VAS score was from 8.07 to 1.39, 8.34 to 1.34, and 8.14 to 1.86 in groups A, B, and C, respectively. The recurrence rate based on the (1) age was <40 years: 5.22% (6/115), 41–60 years: 16.1% (20/124), and >61 years: 3.07% (2/65); (2) gender was male: 13/139 (9.35%), female: 15/161 (9.32%); (3) BMI was obese: 17.57% (13/74), overweight: 11.6% (9/77), underweight: 6.35% (4/63), and normal weight: 2.33% (2/86); (4) degeneration scale was grades 1–2: 2% (1/50), grade 3: 7.4% (10/135), and grades 4–5: 14.8% (17/115); (5) modic change was type I: 25% (3/12), type II: 14.3% (1/7), type III: 33% (1/3), and no modic change: 8.27% (23/278); (6) number of involved disc herniation was 1 level: 3.9% (5/128), 2 level: 10.4% (13/125), 3 levels: 18.9% (7/37), and 4 levels: 30% (3/10); (7) history of discectomy was first: 8.83% (25/283) and repeated: 17.65% (3/17); (8) herniated disc level was L1–L2/L2–L3/L3–L4: 3.95% (3/76) and L4–L5: 14.6% (18/123); (9) disc height was <80%: 17.14% (6/35), 81%–100%: 8.16% (12/147), and >101%: 8.5% (10/118); (10) segmental dynamic motion was 1–10°: 8.58% (20/233) and 11–20° : 11.9% (8/67); (11) disc location was central: 7.41% (2/27), foraminal: 3.03% (2/66), and inferior/superior/paracentral: 11.59% (24/207); (12) radical annulotomy was 8.05% (7/87) vs. 9.86% (21/213); (13) approach method was transforaminal (inside-out): 11% (11/100), transforaminal (outside-in): 10% (10/100), and interlaminar: 7% (7/100); (14) early ambulation was 16.42% (23/140) vs. 3.13% (5/160); and (15) spinal orthosis application was 7.35% (10/136) vs. 10.98% (18/164). According to the above results, after summation of all scores, the early recurrence predicting score: recurrence rate ratio was 1–4: 0% (0/23), 5–8: 7.1% (13/183), 9–12: 8% (6/75) and 13–16 100% (10/10). Conclusions. Early recurrence after PELD is associated with several risk factors such as BMI, degeneration scale, combined HNP, and early ambulation. If we use the predicting score, we can postulate the occurrence of early recurrence after PELD. Knowing the predictive factors prior to surgical intervention will allow us to decrease the early recurrence rate after PELD.

Background Percutaneous endoscopic lumbar discectomy (PELD) is a relatively safe and effective minimally invasive surgery in the treatment of calcified lumbar disc herniation (CLDH). However, studies on percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) for CLDH have rarely been reported. This research aimed to compare the clinical efficacy of PEID and PETD for L5-S1 CLDH. Methods We retrospectively analyzed 54 consecutive patients with L5-S1 CLDH treated with PELD at our institution from August 2016 to August 2020. Patients were divided into PEID group ( n  = 28) and PETD ( n  = 26) group according to the surgical methods. The demographic characteristics and surgical results of the two groups were compared. Clinical outcomes were estimated by the visual analog scale (VAS) for leg pain, Oswestry disability index (ODI) and modified MacNab criteria. Results All patients were successfully operated on by PEID or PETD. No significant differences in the demographic characteristics, intraoperative blood loss, postoperative hospital stay and complication rate were noted between the PEID and PETD groups. The excellent and good rates in the PEID group were similar to those in the PETD group (89.29% vs 88.46%, P  = 1.000), whereas the PEID group exhibited superior results for operative time (min) (64.61 ± 5.60 vs 85.58 ± 8.52, P  < 0.001) and fluoroscopy times (n) (2.93 ± 0.90 vs 13.35 ± 2.30, P  < 0.001) compared with the PETD group. Conclusions PEID has achieved good clinical efficacy as PETD for L5-S1 CLDH. Compared with PETD, PEID has the advantages of shorter operative time and a reduced number of fluoroscopy times in the treatment of CLDH.

Background The unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. A new endoscopic technique that uses a UBE approach has been applied to conventional arthroscopic systems for the treatment of spinal disease. In this study, we aimed to compare and evaluate the perioperative parameters and clinical outcomes, including recovery from surgery, pain and life quality modification, patient’s satisfaction, and complications, between UBE and open lumbar microdiscectomy (OLM) for single-level discectomy procedures. Methods This study included 141 patients with degenerative disc disease requiring discectomy at a single level from L2–L3 to L5–S1. A total of 60 and 81 patients underwent UBE and OLM, respectively. Analysis was based on comparison of perioperative metrics, operation time (OT); estimated blood loss (EBL); length of hospital stay (HS); clinical outcomes, including assessment using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI); patient satisfaction (the MacNab score); and the incidence of reoperation and complications. Results The study cohort was 56.7% women, and the mean patient age was 50.98 ± 18.23 years. The mean VAS (the back and leg), MacNab score, and ODI improved significantly from the preoperative period to the last follow-up (12.92 ± 3.92) in both groups ( p  < 0.001). One week after operation, the back VAS score in the UBE group showed significantly more improvement than that in the OLM group. However, the 1-week, 3-month, and 12-month VAS (the back and leg), ODI improvement, modified MacNab score, and OT were not significantly different between the two groups. In the UBE group, EBL (34.67 ± 16.92) was smaller and HS (2.77 ± 1.2) was shorter than that of the OLM group (140.05 ± 57.8, 6.37 ± 1.39). However, OT (70.15 ± 22.0) was longer in the UBE group than in the OLM group (60.38 ± 15.5), and the difference was statistically significant. Meanwhile, the differences in the rate of surgical conversion and complications between the two groups were not statistically significant. Conclusions The UBE for single-level discectomy yielded similar clinical outcomes to OLM, including pain control, functional disability, and patient satisfaction, but incurred minimal EBL, HS, and postoperative back pain. Trial registration Not applicable.

Purpose This study evaluated and compared the clinical support capabilities of ChatGPT 4o and ChatGPT 4o mini in diagnosing and treating lumbar disc herniation (LDH) with radiculopathy. Methods Twenty-one questions (across 5 categories) from NASS Clinical Guidelines were input into ChatGPT 4o and ChatGPT 4o mini. Five orthopedic surgeons assessed their responses using a 5-point Likert scale for accuracy and completeness, and a 7-point scale for reliability. Flesch Reading Ease scores were calculated to assess readability. Additionally, ChatGPT 4o analyzed lumbar images from 53 patients, comparing its recognizable agreement with orthopedic surgeons using Kappa values. Results Both models demonstrated strong clinical support capabilities with no significant differences in accuracy or reliability. However, ChatGPT 4o provided more comprehensive and consistent responses. The Flesch Reading Ease scores for both models indicated that their generated content was “very difficult to read,” potentially limiting patient accessibility. In evaluating lumbar disc herniation images, ChatGPT 4o achieved an overall accuracy of 0.81, with LDH recognition precision, recall, and F1 scores exceeding 0.80. The AUC was 0.80, and the Kappa value was 0.61, indicating moderate agreement between the model’s predictions and actual diagnoses, though with room for improvement. Conclusion While both models are effective, ChatGPT 4o offers more comprehensive clinical responses, making it more suitable for high-integrity medical tasks. However, the difficulty in reading AI-generated content and occasional use of misleading terms, such as “tumor,” indicate a need for further improvements to reduce patient anxiety.

Background Intervertebral disc degeneration is a common condition with few inexpensive and effective modes of treatment, but current investigations seek to clarify the underlying process and offer new treatment options. It will be important for physicians to understand the molecular basis for the pathology and how it translates to developing clinical treatments for disc degeneration. In this review, we sought to summarize for clinicians what is known about the molecular processes that causes disc degeneration. Results A healthy disc requires maintenance of a homeostatic environment, and when disrupted, a catabolic cascade of events occurs on a molecular level resulting in upregulation of proinflammatory cytokines, increased degradative enzymes, and a loss of matrix proteins. This promotes degenerative changes and occasional neurovascular ingrowth potentially contributing to the development of pain. Research demonstrates the molecular changes underlying the harmful effects of aging, smoking, and obesity seen clinically while demonstrating the variable influence of exercise. Finally, oral medications, supplements, biologic treatments, gene therapy, and stem cells hold great promise but require cautious application until their safety profiles are better outlined. Conclusions Intervertebral disc degeneration occurs where there is a loss of homeostatic balance with a predominantly catabolic metabolic profile. A basic understanding of the molecular changes occurring in the degenerating disc is important for practicing clinicians because it may help them to inform patients to alter lifestyle choices, identify beneficial or harmful supplements, or offer new biologic, genetic, or stem cell therapies.

In patients with symptomatic lumbar disk herniation treated with surgery or conservative care, there was no significant association between findings on MRI and clinical outcome at 1 year. Disk herniation persisted in 35% with a favorable outcome and 33% with an unfavorable outcome. Sciatica is a relatively common condition, with a lifetime incidence of 13 to 40%. 1 The most common cause of sciatica is a herniated disk. The natural history of sciatica is favorable, with spontaneous resolution of leg pain within 8 weeks in the majority of patients. 2 Surgery should be offered only if symptoms persist after a period of conservative treatment. However, contrary to what one might expect, given the advancements in diagnostic imaging and surgical techniques, the results after lumbar-disk surgery do not seem to have improved during recent decades. Both classic studies and randomized, controlled trials have shown that during . . .