Prevalence of Lumbar Disc Herniation in Adolescent Males in Seoul, Korea: Prevalence of Adolescent LDH in Seoul, Korea

Genetics- and age-driven neuroimmune and disc changes underscore herniation susceptibility and pain-associated behaviors in SM/J mice

There are no appropriate mouse models to study the pathophysiology of spontaneous disc herniations in a wild-type setting. SM/J mice, a poor healer inbred strain, presented a high incidence of age-associated lumbar disc herniations with neurovascular innervations. Transcriptomic comparisons of the SM/J annulus fibrosus with human tissues showed shared pathways related to immune cell activation and inflammation. Notably, aged SM/J mice showed increased pain sensitization and neuroinflammation with altered extracellular matrix regulation in the dorsal root ganglia and spinal cord. There were increased T cells in the vertebral marrow, and cytometry by time-of-flight analysis showed increased splenic CD8+ T cells, nonspecific activation of CD8+ memory T cells, and enhanced interferon-γ production in the myeloid compartment. Single-cell RNA sequencing of peripheral blood mononuclear cells showed more B cells, with lower proportions of T cells, monocytes, and granulocytes. This study highlights the contribution of genetic background and aging to increased susceptibility of spontaneous intervertebral disc herniations in a clinically relevant murine model.

Efficacy of acupuncture for lumbar disc herniation: changes in paravertebral muscle and fat infiltration - a multicenter retrospective cohort study

Objective

This study seeks to elucidate the dynamic alterations in the multifidus, erector spinae, and psoas major muscles, along with their fatty infiltration, in patients diagnosed with lumbar disc herniation treated through acupuncture. Concurrently, the Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores are employed to evaluate modifications in lumbar and leg pain and the enhancement in lumbar functionality.

Methods

A retrospective multi-center cohort study enrolled 332 adult LDH patients. Participants were divided into acupuncture and rehabilitation therapy groups. The acupuncture cohort received targeted treatments at specific acupuncture points, while the rehabilitation group received traditional rehabilitative therapy. Magnetic Resonance Imaging (MRI) gauged muscle cross-sectional areas (Sm, Se, Sp) and their ratios to vertebral area (Sm/Sv, Se/Sv, Sp/Sv), and fatty infiltration areas (Sfm, Sfe, Sfp) and their ratios (Sfm/Sv, Sfe/Sv, Sfp/Sv). Pain and function were assessed using Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores pre-treatment, 2-weeks, and 3-months post-intervention.

Results

A total of 332 patients were enrolled for analysis. Post-treatment, the acupuncture group exhibited increased Sm, Se, Sp and their ratios and reduced fatty infiltration areas and their ratios (P<0.05) compared to rehabilitation. Both treatments decreased VAS scores and enhanced JOA scores at both intervals (P<0.05). Intriguingly, no significant disparities were observed between the acupuncture and rehabilitation groups concerning pain and JOA scores at the 2-week follow-up (p>0.05); however, 3 months post-treatment, the acupuncture group significantly outperformed the rehabilitation group in both pain and JOA scores (p<0.05).

Conclusion

This study demonstrates that acupuncture treatment is significantly more effective than traditional rehabilitation therapy in improving paraspinal muscle function, reducing muscle fat infiltration, and alleviating lumbar and leg pain in patients with lumbar disc herniation (LDH). Specifically, acupuncture significantly increases the cross-sectional areas (Sm, Se, Sp) of the paraspinal muscles and reduces muscle fat infiltration, showing superior long-term results in pain relief and functional improvement. Future research should further explore the long-term effects of acupuncture on the function and structure of paraspinal muscles, assess its potential in preventing the recurrence of LDH, and delve deeper into how acupuncture affects paraspinal muscles at the molecular level, to better understand its therapeutic mechanisms and enhance its clinical application.

Prevalence of lumbar disc herniation in populations with different symptoms based on magnetic resonance imaging study

BACKGROUND

Lumbar disc herniation (LDH) is common in aged human beings. This study is to investigate the prevalence of lumbar disc herniation (LDH) in different symptomatic populations attending outpatient clinics based on magnetic resonance imaging (MRI) studies, and to analyze the characteristics, distribution, and treatment strategies thereof.

METHODS

Patients who visited our outpatient clinics between January 1, 2022, and December 31, 2022, with complaints of low back pain, either accompanied or unaccompanied by lower limb symptoms (radiating pain, numbness or muscle weakness), were included. All patients underwent comprehensive lumbar spine MRI examinations. The prevalence of LDH in different symptomatic populations, as well as the characteristics, distribution, and treatment strategies of disc herniation were analyzed.

RESULTS

Among 8,161 individuals (3,411 males and 4,750 females), 4,496 were diagnosed with LDH, resulting in a prevalence of 55.1 %. Of these, 683 (15.2 %) individuals underwent surgical treatment. Among all patients, 3,529 exhibited only low back pain symptoms, 1,820 (51.6 %) were diagnosed with LDH, and 201 (11.0 %) received surgical treatment. Additionally, 2,673 patients with low back pain accompanied by lower limb symptoms were identified, with 1,608 individuals (82.1 %) diagnosed with LDH; 319 (19.8 %) underwent surgical treatment. Furthermore, 1,959 patients presented with lower limb symptoms only, 1,068 (54.5 %) were diagnosed with LDH, and 163 received surgical treatment (P < 0.001). The prevalence rate for males was 58.8 %, compared to females with 52.4 % (P < 0.01). The prevalence of LDH exhibited an initially increasing trend, later decreasing with advancing age. L4/5 and L5/S1 were the most commonly affected segments.

CONCLUSION

LDH prevalence varies among patients with different symptoms, with a higher rate in those presenting with low back pain accompanied by lower limb symptoms. These symptomatic patients also exhibit a higher rate of surgical intervention.

Immediate postoperative lumbar spine magnetic resonance imaging: Correlation with postoperative pain in lumbar microdiscectomy

Magnetic resonance imaging (MRI) has been extensively used in the management of patients with a herniated lumbar disc. Nevertheless, immediate postoperative MRI has not become a standard procedure, with limited research suggesting that the findings are often similar to preoperative MRI in both symptomatic and asymptomatic patients. This study aimed to determine the benefits of immediate postoperative MRI in patients with or without postoperative symptoms and its correlation with these symptoms. A total of 172 patients who underwent lumbar spine microdiscectomy at our institution between 2014 and 2021 were included. Patients who had previous spinal surgery and lumbar fusion were excluded. Patient data were collected from medical records. MRI was performed 3 days after surgery and assessed by 2 neurosurgeons to minimize bias. Immediate postoperative MRI results showed dural sac compression or foraminal stenosis in 29 patients (16.86%), of which 10 had postoperative pain and 19 were pain free. Among the 143 patients (83.14%) without these findings on MR imaging, 38 had postoperative pain. Immediate postoperative MRI did not correlate with postoperative pain (P = .421/.357). Intraoperative bleeding and the Charlson comorbidity index (CCI) showed significant correlations with postoperative pain (P = .018 and .002, respectively). In a multivariate analysis, intraoperative blood loss and CCI independently correlated with postoperative pain (P = .001 and .001, respectively). Based on our findings, intraoperative blood loss and CCI appear to be the factors that may predict the persistence of postoperative pain, despite normal findings on MRI.

Early outcomes of transforaminal percutaneous endoscopic lumbar discectomy for high school athletes with herniated nucleus pulposus of the lumbar spine

There are no reports in the literature on the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for high school athletes suffering from herniated nucleus pulposus (HNP) of the lumbar spine. PELD is a minimally invasive surgical procedure that can be performed under local anesthesia via an 8-mm skin incision. This study examined the outcomes of transforaminal PELD in high school athletes suffering from HNP. Subjects were 18 patients [14 males and four females; mean age 17 (15-18) years] who underwent PELD at our institutions. The events in which the patients competed were baseball (n = 6), softball (n = 2), rugby (n = 2), basketball (n = 2), table tennis (n = 2), American football (n = 1), wrestling (n = 1), track and field (n = 1), and dance (n = 1). All patients underwent PELD under local anesthesia. Back pain was assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and a visual analog scale (VAS) before and after surgery. Time to return to competitive sport, complications, and rate of recurrence of herniation were examined. All factors assessed by the JOABPEQ were significantly improved after surgery. VAS score was also improved after surgery. Time to return to competitive sport was 7 weeks on average. The rate of return to play was 94.4%. There were no complications, such as dural tear, exiting nerve root injury, or hematoma. One patient had recurrence of HNP. PELD is a promising minimally invasive and effective procedure for high school athletes with HNP.

Evaluating the clinical application of a leaflet for clinical practice guideline in patients with lumbar herniated intervertebral discs: Randomized controlled trial

BACKGROUND

This study aims to demonstrate the effectiveness of using clinical practice guideline (CPG) leaflets as a communication tool between doctors and patients. We evaluated the leaflets as a communication tool in the treatment of lumbar herniated intervertebral discs (HIVDs) in terms of patient and physician satisfaction and ease of treatment.

METHODS

This study is a 2-parallel-arm, assessor-blinded, randomized controlled trial at Jaseng Hospital, Seoul, South Korea. We evaluated efficacy through a comparison of satisfaction and clinical outcomes in randomly allocated groups of HIVD lumbar patients visiting Jaseng Hospital of Korean Medicine. We used leaflets on the basis of Korean medicine CPG recommendations as an intervention. The intervention group received treatment and diagnosis using the leaflet, and the control group received the typical intervention, which was provided without the leaflet.

RESULTS

The levels of patient satisfaction with and understanding of the doctors' explanation was 92% in the leaflet group and 64% in the nonleaflet group, which showed that, compared with patient satisfaction in the nonleaflet group, patient satisfaction was considerably higher by 28% in the leaflet group. In addition, the level of the reliability with treatment was 92% in the leaflet group and 64% in the control group. However, there were no significant differences in statistical analyses. The level of doctors' satisfaction with communicating with patients using the leaflet was 100% in the leaflet group. Given this satisfaction, the ease of persuasion of treatment was highest (84%) and followed the improvement in the patient's understanding of the treatment (16%) in the leaflet group. In addition, in the nonleaflet user group, almost all doctors thought that having a leaflet would be a more effective treatment.

CONCLUSION

Although this study failed to show significant differences between the intervention and control groups, the leaflet, which included CPG information in the treatment of HIVD patients, was an effective communication tool between patients and doctors. However, further studies with larger samples should be conducted to investigate the effectiveness of the communication tool based on the CPG.

TRIAL REGISTRATION NUMBER

Clinical Research Information Service: KCT0001762.

Clinical efficacy of lumbar interbody fusion using a channel system combined with ozone therapy for the treatment of central-type L3-L4 lumbar disc herniation

The clinical efficacy of minimally invasive lumbar interbody fusion via the intervertebral foramen combined with ozone (O₃) therapy for the treatment of L3-L4 central-type lumbar disc herniation was explored. We recruited patients with sciatica who attended our hospital between July 2013 and October 2015 and underwent lumbar X-ray (anteroposterior and lateral view), lumbar flexion-extension radiographs, computed tomography, and magnetic resonance imaging after admission. Seventy-four patients with central-type lumbar disc herniation but no other complications were randomly selected and divided into the observation and control groups. The observation group comprised 37 patients treated with lumbar fusion using a channel system combined with O₃ therapy, whereas the control group comprised 37 patients treated with lumbar fusion alone. The effects of the two therapies were evaluated using visual analog scale, Japanese Orthopaedic Association, and MacNab scores. There was no significant difference in scores between the two groups before surgery (P>0.05). The scores of the observation group after treatment were significantly lower than those before surgery and those of the control group (P<0.05). One patient in the observation group experienced no obvious improvement in symptoms after surgery, and two patients in the control group experienced postoperative recurrence; these three patients subsequently underwent laminectomy combined with planted bone fusion and internal fixation. There was no significant difference in total efficacy rates between the two groups (P>0.05). Lumbar fusion using a channel system combined with O₃ therapy for the treatment of L3-L4 central-type lumbar disc herniation is safe and effective. It has the advantages of reduced trauma, fewer complications, and rapid pain relief, and it promotes the recovery of lumbar function. Strict mastery of the surgical indications is key to the success of the procedure; however, it is worth expanding its use in the clinical setting.

Lumbar Disc Herniation Combined with Posterior Apophyseal Ring Separation in a Young Child: A Case Report

Lumbar disc herniation in children aged 10 years or less is extremely uncommon and posterior apophyseal ring separation is not a common injury that usually occurs in adolescents or young adults after a sports-related microtraumatism. The authors report an unique case of 10-year-old boy who presented with low back pain and radiating pain on both legs. The boy received conservative treatment, which included anti-inflammatory medication, muscle relaxants, and physical therapy, but symptoms were not improved. Computed tomography and magnetic resonance imaging revealed a huge central disc herniation combined with posterior apophyseal ring separation. Microscopic lumbar discectomy with the removal of apophyseal ring separation was performed due to the intractable pain. At six months after surgery, the child was symptom free.

Psychopathological influence of lumbar disc herniation in male adolescent

PURPOSE

There is no report about psychopathological effect causing by disc herniation. The disease could impose psychopathological influence on the social life, the treatment period, and response to the treatment. This study was to evaluate retrospectively the psychopathological influence of lumbar disc herniation (LDH) among Korean 19-year-old males.

MATERIALS AND METHODS

We compared the Korean military multiphasic personality inventory (KMPI) profiles of 74 LDH cases with the KMPI profiles of 150 controls. The LDH groups were categorized to 2 groups according to the presence of thecal sac compression by disc materials, and evaluated the relation between the KMPI and LDH.

RESULTS

The decrease of the faking-good response scale and increase of the faking-bad response scale were observed more in the LDH group than in the normal volunteer group (p<0.05). The neurosis set such as anxiety, depression and somatization was markedly increased in the LDH group compared to the normal volunteers group (p<0.05). The scale of personality disorder was also increased more in the LDH group (p=0.002). The differences of KMPI scales were not correlated with the severe pathology of LDH.

CONCLUSION

Young male with LDH may tend to have more abnormal results of multiphasic personality inventory test compared to the normal volunteers, suggesting that LDH may be related to the psychopathology in young males in Korea. Therefore, clinicians are recommended to evaluate and treat the psychopathological aspects in patients with LDH.

Clinical outcomes of spinal epidural abscess

Objective

The aim of this study is to elucidate the clinical characteristics of patients with spinal epidural abscess (SEA) and demonstrate the risk factors, treatments and neurologic outcomes.

Methods

We retrospectively reviewed the medical records and radiologic images of 35 patients admitted to our department with SEA between March 1987 and April 2011. While we performed decompressive laminectomy and abscess drainage on 19 patients (54.3%), and 16 patients (45.7%) initially received conservative therapy with antibiotics alone. Medical Research Council (MRC) scale was applied to estimate results objectively.

Results

The neurological outcome data showed improved MRC scale from 14 (40%) patients. 13 (37.1%) patients showed unchanged MRC scale and 8 (22.9%) patients revealed worsened MRC scale at the time of discharge. The patients with surgical treatment showed more improved MRC scale than the patients with conservative treatment and this was statistically significant (p=0.001) on univariate analysis. Initially, patients with decreased MRC scale and rapidly progressing neurological deficit underwent emergency surgery within 24 hours. Patients with intact MRC scale and minor neurological deficit received delayed surgery or conservative management with antibiotics. Among 19 patients those who experienced emergent operations within 24 hours showed better prognosis than those who underwent delayed operations after 24 hours.

Conclusion

Surgical treatment is the modality of choice in patients with SEA and urgent surgery especially is indicated in patients with neurological deficits. And early surgery is more effective in neurological improvements than delayed surgery and conservative management.