Search Results (218)

Background and Clinical Significance: Posteriorly migrated lumbar disc herniation [PMLDH] is a rare entity that may present with atypical clinical and radiological features, often mimicking other spinal pathologies. Migration of sequestered fragments through the interlaminar space is exceptionally uncommon, and diagnostic challenges are further amplified in the presence of spinal instability. While MRI and CT are generally sufficient for diagnosis, undetected lesions on preoperative imaging may complicate clinical management. Case Presentation: A 59-year-old male presented with acute low back pain and left-sided radiculopathy. Examination revealed mild motor weakness in ankle dorsiflexion. MRI showed L4–L5 segmental instability with central canal stenosis but no migrated disc fragment. Owing to neurological deficit, decompressive laminectomy with posterior instrumentation was performed. Intraoperatively, a posteriorly migrated sequestered fragment compressing the thecal sac was excised and confirmed as degenerative disc material. Postoperatively, the patient’s neurological deficit and radicular pain resolved, with no new complaints at 3-month follow-up. Conclusions: This case highlights an unusual presentation of PMLDH in a patient with lumbar stenosis and spinal instability, undetected on preoperative imaging. Recognition of the biomechanical predisposition at the L3–4 and L4–5 levels is important in understanding such rare migrations. Although literature emphasizes early surgical intervention for PMLDH, our patient required urgent surgery due to neurological deficits rather than a definitive preoperative diagnosis. Further studies are warranted to clarify the relationship between instability and posterior migration. Full article

Aim of the study: This paper focuses on the correlation of nicotine use with chronic lumbar back pain (CLBP). Methods: This is a cross-sectional observational study involving smoker and non-smoker patients with a diagnosis of chronic low back pain (CLBP), recruited during their initial neurosurgical consultation at the Neurosurgery Clinic over a period of 6 months. All patients were followed for a minimum of 3 months after the start of conservative therapy. Age, sex, smoking habits, and the presence of any comorbidities were noted. Pain severity and discomfort were evaluated using the Numeric Rating Scale (NRS), the DN4 questionnaire, and the Oswestry Disability Index (ODI). Based on imaging (MRI of the lumbosacral spine), diagnoses of disc herniation or vertebral lumbar stenosis were documented. Statistical analysis was performed using IBM SPSS Statistics software (Version 30). A p-value of less than 0.05 was considered statistically significant. Results: Improvement on the CLBP, NRS, and DN4 scales after the same conservative therapy was better in Patients with non-smoking habits improved more on the CLBP, NRS and DN4 scales when compared to smokers (NRS scale 0.001 and DN4 scale 0.027). Conclusions: Patients with smoking habitudes affected by lumbar disk her-niation and stenosis and undergoing conservative therapy had worse pain scores Full article

Lumbar disc herniation is one of the primary causes of lower back pain, and its incidence has significantly increased with the development of industrialization. To assist in rehabilitation therapy, this paper proposes a flexible exoskeleton for active lumbar rehabilitation based on a 4-SPU/SP biomimetic parallel mechanism. By analyzing the anatomical structure and movement mechanisms of the lumbar spine, a four degree of freedom parallel mechanism was designed to mimic the three-axis rotation of the lumbar spine around the coronal, sagittal, and vertical axes, as well as movement along the z-axis. Using a 3D motion capture system, data on the range of motion of the lumbar spine was obtained to guide the structural design of the exoskeleton. Using the vector chain method, the display equations for the drive joints of the mechanism were derived, and forward and inverse kinematic models were established and simulated to verify their accuracy. The dynamic characteristics of the biomimetic parallel mechanism were analyzed and simulated to provide a theoretical basis for the design of the exoskeleton control system. A prototype was fabricated and tested to evaluate its maximum range of motion and workspace. Experimental results showed that after wearing the exoskeleton, the lumbar spine’s range of motion could still reach over 83.5% of the state without the exoskeleton, and its workspace could meet the lumbar spine movement requirements for daily life, verifying the rationality and feasibility of the proposed 4-SPU/SP biomimetic parallel mechanism design. Full article

Degenerative disc disease (DDD) is a major cause of chronic low back pain (LBP), yet the molecular mechanisms driving disc degeneration and pain remain poorly understood. This study analyzed intervertebral disc (IVD) tissue from 36 young patients (median age = 36.00 [31.00, 42.50] years) with herniated discs and LBP, alongside healthy controls, to investigate changes in the extracellular matrix (ECM) and neurochemical alterations. Disc degeneration was assessed using MRI (Pfirrmann grading) and histology (Sive’s criteria). Histochemical and immunohistochemical methods were used to evaluate aggrecan content, calcification, and the expression of nerve growth factor (NGF), substance P (SP), and S-100 protein. MRI findings included Pfirrmann grades V (30.55%), IV (61.11%), III (5.56%), and II (2.78%). Severe histological degeneration (10–12 points) was observed in three patients. Aggrecan depletion correlated with longer pain duration (r = 0.449, p = 0.031). NGF expression was significantly elevated in degenerated discs (p = 0.0287) and strongly correlated with SP (r = 0.785, p = 5.268 × 10⁻⁹). Free nerve endings were identified in 5 cases. ECM calcification, present in 36.1% of patients, was significantly associated with radiculopathy (r = 0.664, p = 0.005). The observed co-localization of NGF and SP suggests a synergistic role in pain development. These results indicate that in young individuals, aggrecan loss, neurochemical imbalance, and ECM calcification are key contributors to DDD and chronic LBP. Full article

In this narrative review, we explore the role of artificial intelligence (AI) in managing lumbar degenerative conditions, a topic that has recently garnered significant interest. The use of AI-based solutions in spine surgery is particularly appealing due to its potential applications in preoperative planning and outcome prediction. This study aims to clarify the impact of artificial intelligence models on the diagnosis and prognosis of common types of degenerative conditions: lumbar disc herniation, spinal stenosis, and eventually spinal fusion. Additionally, the study seeks to identify predictive factors for lumbar fusion surgery based on a review of the literature from the past 10 years. From the literature search, 96 articles were examined. The literature on this topic appears to be consistent, describing various models that show promising results, particularly in predicting outcomes. However, most studies adopt a retrospective approach and often lack detailed information about imaging features, intraoperative findings, and postoperative functional metrics. Additionally, the predictive performance of these models varies significantly, and few studies include external validation. The application of artificial intelligence in treating degenerative spine conditions, while valid and promising, is still in a developmental phase. However, over the last decade, there has been an exponential growth in studies related to this subject, which is beginning to pave the way for its systematic use in clinical practice. Full article

Background/Objectives: Radicular pain is a frequent pathology, and disc herniation is the commonest aetiology. A meta-analysis summarising international guidelines for radicular pain, published in 2021, showed that lumbar traction’s place is still a topic of debate. In this study, our aim was to evaluate the effectiveness of lumbar tractions in treating radicular pain of discal origin in association with medical treatment versus medical treatment alone. We performed a randomised, controlled, interventional, prospective, superiority trial in Reims Hospital Rheumatology Unit. Methods: We included participants with radicular pain and concordant disc herniation with ambulatory treatment failure. Participants were randomised into two groups: medical group (analgesics, anti-inflammatories treatments, at least two epidural injections); tractions group with this medical treatment associated with lumbar tractions. The primary outcome was the difference in the proportion of participants experiencing a minimum of 25% improvement in radicular pain at one month follow-up between the two groups. Results: We included 424 participants: 211 in the tractions group and 213 in the medical group. We analysed 388 participants (194 in each group). We collected demographic and clinical data, lumbar and radicular Numeric Pain Scale at baseline, one and three months. A statistical difference was found for the primary outcome: 120/194 participants (62%) in tractions group and 98/194 participants (51%) in medical group (p = 0.024). Conclusions: To our knowledge, this is the first randomised and controlled study on this topic with these results. We can assert the superiority of lumbar tractions in association with medical treatment over medical treatment alone for radicular pain with concordant disc herniation. Full article

Background/Objectives: Lateral lumbar interbody fusion (LLIF) has gained popularity as an effective technique for indirect decompression through ligamentotaxis. Despite the perceived importance of using appropriately sized cages for achieving optimal decompression, comprehensive reports on cage size and its impact on indirect decompression are limited. This study aimed to assess the ligamentotaxis effect by measuring the “backward bulging” length in pre- and postoperative MRIs and examining its correlation with cage size and subsidence. Methods: T2 images of 270 patients with lumbar herniated disc and/or lumbar spondylolisthesis (June 2022 to March 2025) were analyzed for 530 intervertebral spaces. Data on gender, age, length of hospital stay, preoperative and postoperative lumbar JOA scores, and the level of the disease were collected. Measurements included backward bulging length, intervertebral height, and cage subsidence. Statistical analysis was performed using StatMate. Surgical procedures involved oblique lateral interbody fusion (OLIF) to minimize impact on the iliopsoas and lumbar plexus. Trial cages starting from 8 mm were sequentially inserted, with confirmation through lateral fluoroscopy. Posterior fixation was performed using percutaneous pedicle screws. Results: Analysis of 530 intervertebral spaces revealed that 70% could accommodate a cage 3 mm or larger than the preoperative intervertebral height. Significant backward bulging shortening (3 mm or more) occurred in 339 spaces, predominantly with larger cages. Only 8.8% of cases (14/159) with a large backward bulging shortening had an intervertebral height extension of 3 mm or less. On the other hand, a large reduction in backward bulging was observed in 91.3% of cases (339/371) with an intervertebral height extension of 3 mm or more. Postoperative cage subsidence was observed in 9.2% (49/530) of all intervertebral spaces and 8.6% (32/371) in spaces where a cage larger than 3 mm was used. There was no statistically significant difference between these two groups. Conclusions: To achieve a sufficient ligamentotaxis effect, it is necessary to select a cage size that allows for an intervertebral height increase of at least 3 mm compared to the preoperative measurement. Full article

Background: Lumbar disc herniation (LDH) recurrence remains a pressing clinical challenge, with limited predictive tools available to support early identification and personalized intervention. Predicting recurrence after lumbar disc herniation (LDH) remains clinically important but algorithmically difficult due to extreme class imbalance and low signal-to-noise ratio. Objective: This study proposes a hybrid machine learning framework that integrates supervised classifiers, unsupervised anomaly detection, and decision threshold tuning to predict LDH recurrence using routine clinical data. Methods: A dataset of 977 patients from a Romanian neurosurgical center was used. We trained a deep neural network, random forest, and an autoencoder (trained only on non-recurrence cases) to model baseline and anomalous patterns. Their outputs were stacked into a meta-classifier and optimized via sensitivity-focused threshold tuning. Evaluation was performed via stratified cross-validation and external holdout testing. Results: Baseline models achieved high accuracy but failed to recall recurrence cases (0% sensitivity). The proposed ensemble reached 100% recall internally with a threshold of 0.05. Key predictors included hospital stay duration, L4–L5 herniation, obesity, and hypertension. However, external holdout performance dropped to 0% recall, revealing poor generalization. Conclusions: The ensemble approach enhances detection of rare recurrence cases under internal validation but exhibits poor external performance, emphasizing the challenge of rare-event modeling in clinical datasets. Future work should prioritize external validation, longitudinal modeling, and interpretability to ensure clinical adoption. Full article

Background/Objectives: Surgery is the treatment of choice for symptomatic disc herniation after unsuccessful conservative management. This prospective study compared the impact on clinical and hospital outcomes of intradiscal ozone treatment vs. surgery (microdiscectomy/discectomy) in our clinical practice. Methods: Intradiscal ozone treatment was offered to 70 patients with scheduled surgery because of lumbar disc herniation. Initial treatment was surgery in 38 patients and ozone infiltration in 32 patients: lumbar and sciatic pain (Visual Analog Scale), Roland-Morris Disability Questionnaire score, days of hospital admission, and direct hospital costs were recorded during 24 months of follow-up. Results: At 12 and 24 months, lumbar pain, sciatic pain, and Roland-Morris score decreased significantly within both groups (p < 0.001). At 24 months, compared to the initial surgery, the initial intradiscal ozone treatment showed similar clinical outcomes with significantly lower requirements of surgery (100% versus 47%, p < 0.001) and lower hospital stay [median 2.5 (2–3) versus 0.5 (0–2) days, p < 0.001]. Direct hospital costs were significantly lower with initial ozone treatment at 12 months (p = 0.040). Conclusions: In our real-world prospective study, after 24 months of follow-up, initial intradiscal ozone treatment avoided surgery in more than half of patients and provided similar clinical outcomes with lower hospitalization requirements. In patients with lumbar disc herniation requiring surgery (microdiscectomy/discectomy), initial intradiscal ozone treatment could offer benefits for patients and healthcare service providers (NCT00566007). Full article

Background: Transcutaneous Randomized Pulsed Radiofrequency (TCPRF-STP) is a non-invasive therapeutic approach increasingly explored for managing spine-related pain, particularly in cases involving disc herniations and degenerative spine conditions. Objectives: To evaluate the use of transcutaneous PRF-STP in the treatment of spine pathologies and its evolution in short-term follow-up. Methods: This case series examines the outcomes of three patients treated with TCPRF-STP for varying spine pathologies, including lumbar and cervical disc herniations, lumbar stenosis, and radiculopathy. All patients had previously undergone conventional conservative therapies without a satisfactory improvement and were unwilling or unable to undergo invasive procedures. The treatment involved the application of electromagnetic fields through adhesive skin patches at targeted sites. Patients underwent three sessions of TCPRF-STP, with follow-up assessments evaluating pain and MRI. Results: Transcutaneous PRF-STP showed notable reductions in pain (VAS 0 in most cases), improvements in movement, and the restoration of normal daily activities. Follow-up MRI scans demonstrated positive structural changes in the treated discs. Although long-term recurrence occurred in one case, the patient remained active without functional limitations. Conclusions: Transcutaneous PRF-STP offers a promising, minimally invasive alternative for patients seeking to avoid surgery, though further studies with larger cohorts and longer follow-up periods are necessary to establish more robust evidence of its efficacy. This technique could become an important adjunct in managing chronic spinal pain conditions, offering patients an option with minimal risk and hospital demands. Full article

Background/Objectives: Lumbar disc herniation (LDH) is the most common condition associated with low back pain, and it adversely impacts individuals’ health. The interplay between energy metabolism and apoptosis is critical, as the loss of viable cells in the intervertebral disc (IVD) can lead to a cascade of degenerative changes. Efferocytosis is a key biological process that maintains homeostasis by removing apoptotic cells, resolving inflammation, and promoting tissue repair. Therefore, enhancing mitochondrial energy metabolism and efferocytosis function in IVD cells holds great promise as a potential therapeutic approach for LDH. Methods: In this study, energy metabolism and efferocytosis-related differentially expressed genes (EMERDEGs) were identified from the transcriptomic datasets of LDH. Machine learning approaches were used to identify key genes. Functional enrichment analyses were performed to elucidate the biological roles of these genes. The functions of the hub genes were validated by RT-qPCR. The CIBERSORT algorithm was used to compare immune infiltration between LDH and Control groups. Additionally, we used single-cell RNA sequencing dataset to analyze cell-specific expression of the hub genes. Results: By using bioinformatics methods, we identified six EMERDEGs hub genes (IL6R, TNF, MAPK13, ELANE, PLAUR, ABCA1) and verified them using RT-qPCR. Functional enrichment analysis revealed that these genes were primarily associated with inflammatory response, chemokine production, and cellular energy metabolism. Further, we identified candidate drugs as potential treatments for LDH. Additionally, in immune infiltration analysis, the abundance of activated dendritic cells, neutrophils, and gamma delta T cells varied significantly between the LDH group and Control group. The scRNA-seq analysis showed that these hub genes were mainly expressed in chondrocyte-like cells. Conclusions: The identified EMERDEG hub genes and pathways offer novel insights into the molecular mechanisms underlying LDH and suggest potential therapeutic targets. Full article

Background/Objectives: There exists a need to capture the current landscape of the literature for lumbar decompression on muscle strength, as measured by manual muscle testing (MMT), in cohorts with foot drop secondary to lumbar degenerative disease (LDD). Methods: A literature search of PubMed, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from each database’s inception to 21 March 2025. Eligible studies reported patients with LDD-related foot drop treated surgically. This review was registered in PROSPERO (ID: CRD42024550980). Results: A total of 20 studies comprising 918 patients met the eligibility criteria, with most cases attributable to lumbar disc herniation (79% of patients, 95% CI: 0.72–0.85, I² = 96%) or spinal stenosis (22% of patients, 95% CI: 0.15–0.30, I² = 96%). Following surgery, 60% of patients (95% CI: 0.44–0.75, I² = 97%) achieved an MMT score of 4–5, indicating recovery, while 82% (95% CI: 0.76–0.88, I² = 89%) demonstrated an improvement of at least one MMT grade. No improvement was seen in 18% of patients (95% CI: 0.12–0.24, I² = 89%). For pain, the preoperative VAS mean was 5.91 (95% CI: 4.21–7.60, I² = 99%), while the postoperative mean was 1.00 (95% CI: −0.05–2.06, I² = 99%). Overall complications were reported at 1% (95% CI: −0.00–0.02, I² = 0%). Conclusions: Lumbar decompression achieves clinically meaningful recovery of LDD-induced foot drop. However, this meta-analysis highlights the overlooked portion of patients who will not respond, providing a sequential approach for future investigation of these cohorts through foundational evidence of the present literature base. Full article

Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. Full article

Background/Objectives: Canine intervertebral disc herniation (IVDH) is an important musculoskeletal pathology. Unlike in humans, IVDH mechanisms in dogs are underinvestigated from a system-level integrative omics point of view. The aim of this study was to identify key serum molecular players in canine IVDH. Methods: An integrative multi-omics approach combining high-resolution LC-MS-based untargeted metabolomics and tandem mass tag (TMT)-based proteomics was applied. Additionally, serum zinc concentration was determined by spectrophotometry. Results: Nineteen serum metabolites were differentially abundant in IVDH dogs. Metabolite analysis highlighted dysregulation in lipoic acid and branched-chain amino acid (BCAA) metabolism, with elevated levels of valine, leucine, and isoleucine in IVDH. These findings suggest disrupted energy, nitrogen, and neurotransmitter metabolism, potentially contributing to the IVDH pathophysiology. Additionally, lower serum uridine, possibly influenced by BCAA accumulation, was observed, indicating altered neuroinflammatory responses. ELISA validation confirmed elevated serum levels of zinc-α2-glycoprotein (ZAG), alpha-1-microglobulin/bikunin precursor (AMBP), and vitronectin (VTN) in IVDH, supporting immune modulation and neuroprotective mechanisms. Serum prekallikrein (KLKB1) and Protein C inhibitor (SERPINA5), involved in fibrin cloth formation, were found to be lowered in IVDH patients. Pathway enrichment revealed disturbances in aromatic amino acid biosynthesis, with elevated phenylalanine, tyrosine, and tryptophan influencing neurotransmission and inflammation. In addition, elevated serum Zn concentration emphasized its antioxidant importance in immune response, wound healing, and neuropathic pain signaling. Conclusions: Integration with our prior CSF multi-omics data reinforced the relevance of identified molecules in IVDH-associated neurodegeneration, inflammation, and repair processes. This study offers insight into potential diagnostic biomarkers and therapeutic targets for canine IVDH through serum-based molecular profiling. Full article

Endoscopic spine surgery (ESS) has traditionally been employed for lumbar disc herniation (LDH). Recent innovations in surgical methods and technologies have expanded its range to address other spinal pathologies, providing minimally invasive solutions with potential clinical benefits. Our review aims to summarize the applications, clinical outcomes, and limitations of ESS beyond LDH, focusing on its role in complex spinal conditions such as stenosis, thoracic disc herniation, spinal tumors, synovial cysts, and failed back surgery syndrome. A thorough review of the literature was conducted to assess and summarize the current evidence regarding ESS applications for spinal conditions beyond LDH surgery. Areas of focus included innovations in technology and technique, as well as comparisons with conventional open surgical methods. ESS shows notable potential across different spinal conditions by providing minimally invasive alternatives to traditional open surgery. Its use could be associated with reduced surgical morbidity, shorter recovery times, and improved patient outcomes. In particular, ESS is versatile in addressing both degenerative and neoplastic conditions of the spine. Despite this, challenges such as technical complexity, steep learning curves, and limited indications for certain pathologies remain as barriers to wider adoption. ESS is evolving in spine surgery, extending its utility beyond LDH surgery. While the current evidence largely supports its clinical efficacy, further studies are needed to address the present limitations and optimize its application. Future developments in surgical training and technology will likely enhance its adoption and broaden its clinical indications. Full article